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Cough
Original research
Risk and impact of chronic cough in obese individuals from the general population
  1. Eskild Morten Landt1,
  2. Yunus Çolak2,3,
  3. Børge G Nordestgaard2,3,4,
  4. Peter Lange5,
  5. Morten Dahl1,4
  1. 1 Department of Clinical Biochemistry, Zealand University Hospital Køge, Køge, Denmark
  2. 2 Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  3. 3 The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
  4. 4 Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  5. 5 Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
  1. Correspondence to Professor Morten Dahl, Department of Clinical Biochemistry, Zealand University Hospital Koge, Koge DK-4600, Denmark; dahlos2003{at}yahoo.dk

Abstract

Background Obese individuals may be at higher risk of chronic cough. We investigated the risk and impact of chronic cough in obese individuals from the general population.

Methods We recorded chronic cough, body mass index (BMI) and other related clinical conditions in 44 554 adults from the Copenhagen General Population Study. Individuals with asthma and/or chronic obstructive pulmonary disease were excluded (n=10 977). BMI was divided into: underweight (BMI <18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obese (30.0–34.9 kg/m2) and severely obese (≥35.0 kg/m2).

Results Among 33 577 adults from the general population, 27 829 (83%) were non-obese and 5748 (17%) were obese. Compared with individuals with normal weight, multivariable adjusted ORs for chronic cough risk were 1.4 (95% CI 1.2 to 1.6) in overweight, 1.9 (95% CI 1.7 to 2.2) in obese and 2.6 (95% CI 2.1 to 3.2) in severely obese individuals. Mediation analyses showed that chronic cough due to obesity was up to 23% mediated by gastro-oesophageal reflux disease (GERD). Other mediators included low vegetable intake with 10% and occupational exposure with 8%. Among obese individuals, those with versus without chronic cough had worse accompanying respiratory symptoms, more often comorbidities including GERD and diabetes, greater healthcare utilisations, lower lung function and higher blood inflammation (all p<0.05).

Conclusion There is dose–response relationship between BMI and chronic cough, and chronic cough risk is twofold to threefold higher in obese individuals from the general population. This increased risk was partly mediated by GERD, low vegetable intake and occupational exposure, supporting that there may be benefit to gain by ameliorating some of these factors in obese individuals with chronic cough.

  • cough/mechanisms/pharmacology
  • clinical epidemiology

Data availability statement

Data are available upon reasonable request. Summarised data and scripts for analyses are available according Danish law.

https://doi.org/10.1136/thoraxjnl-2020-216351

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    Data availability statement

    Data are available upon reasonable request. Summarised data and scripts for analyses are available according Danish law.

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    Footnotes

    • Correction notice This article has been corrected since it was published Online First. Changes have been made to table 1 footnote, figure 4 legend and a minor change has been made to an in-text citation.

    • Contributors EML, YÇ, BGN, PL and MD contributed to the study concept and design. EML, YÇ, BGN, PL and MD collected, analysed or interpreted the data. EML wrote the draft manuscript and did the statistical analyses. EML, YÇ, BGN, PL and MD revised the manuscript for important intellectual content.

    • Funding The Lundbeck Foundation, Danish Lung Association, Danish Cancer Society, Departments of Clinical Biochemistry and Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, and Department of Public Health, University of Copenhagen.

    • Disclaimer The funders had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

    • Competing interests YÇ reports personal fees from AstraZeneca, Boehringer Ingelheim and Sanofi Genzyme outside the submitted work. PL reports grants from AstraZeneca and GlaxoSmithKline and personal fees from Boehringer Ingelheim, Astra Zeneca, Novartis, and GlaxoSmithKline outside the submitted work. EML, BGN and MD have nothing to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.