Persistent cough and sputum: prevalence and clinical characteristics in south east England

doi:10.1016/S0954-6111(06)80231-3

Respiratory Medicine

Volume 86, Issue 2, March 1992, Pages 143-149

https://doi.org/10.1016/S0954-6111(06)80231-3 Get rights and content

In order to measure the prevalence of chronic respiratory symptoms in the population and to identify subjects fora case-referent study of aetiologic factors, 10 000 persons registered with general practices in south east England were surveyed. Responses to an initial postal questionnaire were validated by telephone interview; clinical interviews and simple spirometry were subsequently carried out on a sample of persons aged 5-54 years, reporting persistent sputum production. Results indicated that the postal questionnaire was an effective and sensitive method of surveying respiratory symptoms in the population. Comparison with earlier surveys suggests that the prevalence of chronic cough and sputum in Great Britain has fallen in males but not in females. Of those adults reporting persistent sputum production, high proportions reported associated symptoms of wheezing (54%), breathlessness (45%) or upper respiratory tract symptoms (54%). Thirty percent recalled a serious respiratory infection in childhood and 52% were current cigarette smokers although 34% reported that they had never been regular smokers. Overall there was little evidence of serious airflow obstruction in this group.

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A cough that persists for more than 8 weeks is defined as a chronic cough. In routine practice, asthma, gastroesophageal reflux disease, and postnasal drip are the most common causes of chronic cough. A 58-year-old non-smoking male patient with no known comorbidities presented with a 3-month history of non-productive cough. Clinically, the respiratory system examination was normal, and radiological evaluation showed tracheal nodularity on computed tomography scan. He was then subjected to bronchoscopy, which showed multiple white-colored nodules involving the anterolateral wall of the tracheobronchial tree with the sparing of the posterior membranous wall. The bronchoscopic picture was the characteristic of Tracheobronchopathia osteochondroplastica (TBOP) and was later confirmed on histopathological examination of the nodules. TBOP presenting as chronic cough is very rare. It is a rare benign disease of the tracheobronchial tree and does not warrant any active intervention in the majority of patients.
A new method for objectively evaluating nocturnal cough in adults
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For the management of cough diseases in adults, an objective method of evaluating nocturnal cough is required.
In Study 1, a cough monitoring system was evaluated using 25 adult volunteers. In Study 2, the cough monitoring system was validated using 20 samples from 10 adult patients with cough diseases obtained overnight. In hospitalized patients, our original cough monitoring system with a microphone and accelerometer was used. At the same time, coughs were recorded using a video camera with digital sound recording. The number of coughs in each 8-h video-audio recording was counted manually by three trained observers. All cough data were printed out, and the basal number of cough events, using both the printed-out data and video-audio recordings, were then calculated by three observers.
In Study 1, the cough monitoring system demonstrated good agreement with the number of coughs counted by examiners (sensitivity 99.2%, specificity 98.9%). In Study 2, there was significant agreement in the counts of natural coughs between our system and the video-audio method (p < 0.0001) and between our system and the basal cough events (p < 0.0001).
Our method demonstrated excellent agreement with the video-audio recording method in adults and is considered extremely useful for the objective monitoring of overnight cough in adult patients with cough diseases.
Utility of Salivary Pepsin in Patients With Reflux Related Chronic Cough
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La tos crónica (TC) asociada a reflujo es muy frecuente en la práctica clínica, pero su diagnóstico no siempre es sencillo. La determinación de pepsina en saliva es un método novedoso, sencillo y no invasivo para el estudio de reflujo.
Analizar rentabilidad diagnóstica de la determinación de pepsina en saliva en paciente con TC.
Estudio prospectivo sobre una cohorte consecutiva de pacientes con TC. Los pacientes se diagnostican de tos asociada a reflujo según 3 criterios: 1) presencia de síntomas típicos de reflujo gastroesofágico; 2) Reflux Symptom Index > 13, Reflux Findings Score ≥ 5, y 3) tránsito gastroesofágico, endoscopia digestiva o pHmetría-impedanciometría positiva. A todos los pacientes se les realizaron 2 determinaciones de pepsina en saliva, mediante la aplicación del Peptest®.
Se incluyó a 99 pacientes, de los cuales 64 (64,6%) fueron diagnosticados de TC asociada a reflujo, 9 (14,1%) como única causa y 55 (85,9%) asociada a otros diagnósticos. Cincuenta y seis tenían un Peptest® positivo, con una sensibilidad de la prueba del 87,5%, una especificidad del 65,7% y los valores predictivo positivo (VPP) y negativo (VPN) del 82 y el 74%, respectivamente. En pacientes sin síntomas digestivos, el VPP de la pepsina fue del 64% y el VPN del 88%.
El reflujo es una causa importante de TC y generalmente forma parte de una etiología multifactorial. La determinación de pepsina en saliva tiene una alta sensibilidad para reflujo, aunque con baja especificidad que a día de hoy limita su uso sistemático.
Chronic cough (CC) associated with reflux is very common in clinical practice, but it is not always easy to diagnose. The determination of pepsin in saliva is a novel, simple and non-invasive method for the study of reflux.
To analyze the diagnostic yield of the determination of pepsin in saliva in a patient with CC.
This was a prospective study conducted in a consecutive cohort of patients with CC. Patients were diagnosed with cough associated with reflux according to 3 criteria: 1) Presence of typical symptoms of gastroesophageal reflux disease (GERD), 2) Reflux Symptom Index > 13, Reflux Findings Score ≥ 5 and 3) gastroesophageal transit, gastrointestinal endoscopy, and/or positive impedance pH monitoring. All patients underwent 2 determinations of pepsin in saliva, using the Peptest®.
We included 99 patients, of which 64 (64.6%) were diagnosed with CC associated with reflux, 9 (14.1%) as the sole cause and 85.9% (55) associated with other diagnoses. Fifty-six had a positive Peptest®, with a sensitivity of 87.5%, specificity of 65.7%, and positive (PPV) and negative (NPV) predictive values of 82% and 74%, respectively. In patients without digestive symptoms, the PPV of pepsin was 64% and the NPV was 88%.
Reflux is an important cause of chronic cough and usually forms part of a multifactorial etiology. The determination of pepsin in saliva has a high sensitivity for reflux, but a low specificity that currently limits its routine use.
The double-sidedness of cough in the elderly
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Citation Excerpt :
Prevalence of chronic cough is estimated as 10% of general adult populations as overall, but it considerably varies with regions or age groups (Song et al., 2016, 2015). In the literature, there are only a few studies focused on the community prevalence of cough in the elderly, and available evidence indicates the prevalence range as 4.6–19.8% (Çolak et al., 2017; Cullinan, 1992; Enright et al., 1994; Kang et al., 2017; Lai et al., 1995; Mahesh et al., 2011; Song et al., 2013). Of note, the prevalence of chronic cough (or proportion of chronic cough per total cough) increases with aging in adults.
Cough is a physiological reflex to protect airways against aspiration, but also it is one of the most frequent problems that lead patients to seek medical care. Chronic cough is more prevalent in the elderly than younger subjects, and more challenging to manage due to frequent comorbidities and possible side effects from drug treatment. Meanwhile, cough reflex does not decrease with natural aging but is often impaired by pathologic conditions like stroke. The impairment in cough reflex may lead to fatal complication like aspiration pneumonia. In this paper, we reviewed epidemiology and clinical considerations for chronic cough in the elderly, and summarized aging-related changes in cough reflex and also possible ways to normalize cough reflex and prevent aspiration pneumonia.
The research of the possible mechanism and the treatment for capsaicin-induced cough
2018, Pulmonary Pharmacology and Therapeutics
Citation Excerpt :
Chronic cough is a common clinical problem in patients that is often encountered by most medical doctors. Epidemiologic studies indicated that chronic cough is very prevalent in the community (up to 20% of the population) [1–5]. Although some patients are treated successfully, the cough persists in the majority of outpatient referrals even after extensive investigation and/or treatment, which affects them on different levels including physically, psychologically, and socially [6].
Unexplained chronic cough (UCC) affects millions of patients worldwide. New therapeutic approaches to this condition are urgently needed, since current treatment options provide only symptomatic relief. Cough reflex hypersensitivity has been shown to play an important role in the pathogenesis of UCC. The transient receptor potential vanilloid type 1 (TRPV1) is present on peripheral terminals of airway sensory nerves and modulation of its activity represents a potential target for the pharmacological treatment of UCC. The aim of this study was to explore the efficacy and the possible mechanism of SB705498, a TRPV1 antagonist, for cough in a capsaicin-induced cough animal model (i.e. guinea pigs). Induction of cough by capsaicin was successfully implemented in the guinea pigs, and the animals that met the inclusion criteria were randomly divided into four treatment groups: (1) Saline inhalation group (NSInh group, N = 10, negative control group), (2) Codeine phosphate intraperitoneal injection group (CPInp group, N = 10, positive control group), (3) SB705498 inhalation group (SBInh group, N = 10), (4) SB705498 intragastric administration group (SBIng group, N = 10). After treatment with above compounds, the capsaicin-induced cough experiment was performed again. The cough numbers and the cough incubation periods were recorded to evaluate the antitussive effect of SB705498. Enzyme-linked immunosorbent assay (ELISA) testing and Immunohistochemistry (IHC) staining for substance P (SP), calcitonin gene related peptide (CGRP) and neurokinin A (NKA) expression in lung and brain tissues were performed as an indication of neurogenic inflammation. Hematoxylin-Eosin (H&E) staining was used to observe the pathology morphology of lung and brain tissues. When the CPInp, SBInh and SBIng groups were compared to the NSInh group, the cough numbers were significantly reduced (p < .001), while the cough incubation periods were significantly prolonged (P < .001). In addition, the expression of SP, CGRP and NKA in lung and brain tissue was reduced (P < .05). None of the animals in the four groups exhibited lung and brain parenchymal inflammation. The results from this study showed that SB705498 had a significant antitussive effect, could reduce the neurogenic inflammation by reducing the expression of SP, CGRP and NKA in a capsaicin-induced cough model of guinea pigs. The results further indicated that TRPV1 played an important role in UCC and SB705498 might be a promising therapeutic agent for UCC.
Therapeutic effects of naringin in a guinea pig model of ovalbumin-induced cough-variant asthma
2015, Pulmonary Pharmacology and Therapeutics
Citation Excerpt :
Chronic cough is a common and frustrating problem for patients and healthcare providers [1–3], which affects 9%–33% of the adult population [4].
Naringin, a well known component isolated from Exocarpium Citri Grandis, has significant antitussive effects. Recently, Naringin exhibited novel anti-inflammatory effect in chronic inflammatory diseases. In this work, we firstly evaluated the effects of naringin on enhanced cough, airway hyper-responsiveness (AHR), and airway inflammation in an ovalbumin-induced experimental cough-variant asthma (CVA) model in guinea pigs. We investigated the effect of naringin (18.4 mg/kg, per os, single dose or consecutively) on cough to inhaled capsaicin after challenge with an aerosolized antigen in actively sensitized guinea pigs. The effect of naringin on AHR to inhaled methacholine was evaluated 24 h after cough determination. Airway inflammation was assessed via bronchoalveolar lavage fluid (BALF) cytology and lung histopathology. Naringin, given consecutively, significantly reduced ovalbumin-induced enhanced cough and AHR, inhibited the increases in the leukocytes, interleukin-4 (IL-4), IL-5, and IL-13 in BALF compared with the model group. Moreover, the pathologic changes in lung tissues were clearly ameliorated by naringin treatment. These results suggest that naringin may be a beneficial agent for CVA treatment.

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Original ArticlePersistent cough and sputum: prevalence and clinical characteristics in south east England

The Lancet

Tubercle

A new look at the pathogenesis and management of persistent bronchial sepsis: a ‘vicious circle’ hypothesis and its logical therapeutic connotations

Questionnaire on respiratory symptoms

Med Res Council, London

Standardization of spirometry—1987 update

Am Rev Respir Dis

Standardized lung function testing

Bull Eur Physiopalhol Respir

Prevalence and diagnosis of chronic respiratory symptoms in adults

Br Med J

Response to a questionnaire on chronic bronchitis symptoms in East Anglia

Br J Prev Soc Med

Original Article
Persistent cough and sputum: prevalence and clinical characteristics in south east England