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Bottine A, Grandjean J, Standaert M, Abdellaoui A, Reychler G. A systematic review of the psychometric properties of the Leicester Cough Questionnaires based on the COSMIN Guidelines. Respir Med 2024; 231:107739. [PMID: 39029808 DOI: 10.1016/j.rmed.2024.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Chronic cough affects around 10% of the general adult population, impairing all aspects of quality of life. RESEARCH QUESTION What are the Leicester Cough Questionnaire's psychometric properties? STUDY DESIGN AND METHODS Electronic searches of PubMed, CINAHL, and ScienceDirect databases were conducted from inception until October 1rst 2022. All full-text articles, published in French or English, aimed at evaluating the LCQ's content validity or psychometric properties were included. The COSMIN Risk of Bias checklist was applied to assess their methodological quality and results. Results were qualitatively summarised and rated by a modified GRADE approach. RESULTS 40 studies were included accounting for 8,731 adults, subject to cough or a respiratory condition. Chronic cough (> 8 weeks) was the most represented. The LCQ's total score is relevant and comprehensible for the assessment of the impact of cough on QoL. The original 3-factor model showed a satisfactory model fit. Good convergent validity was found for the total and physical domain scores. These scores demonstrate good internal consistency and test retest reliability, with some variability noted and they are responsive to change. Recent estimates of MID thresholds were 1.7 and 0.4 for total and domain scores respectively. The quality of the studies is globally poor. INTERPRETATION The LCQ is a valid outcome to assess the intra-individual impact of cough on QoL and to detect large changes in quality of life mainly in a short-term clinical trial setting. CLINICAL TRIAL REGISTRATION The protocol was registered with PROSPERO (CRD42XXXXX).
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Affiliation(s)
- Anne Bottine
- Département de kinésithérapie, VINCI, 1200 Brussels, Belgium.
| | | | - Marie Standaert
- Département de kinésithérapie, VINCI, 1200 Brussels, Belgium.
| | - Aldjia Abdellaoui
- Institut Formation Masso-Kinésithérapie (IFMK), 1702 Rue de St-Priest, 34090 Montpellier, France.
| | - Gregory Reychler
- Département de kinésithérapie, VINCI, 1200 Brussels, Belgium; Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.
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Sorano A, Fumagalli C, Cinelli E, Birring SS, Fontana GA, Lavorini F. Development of an Italian version of the Leicester cough questionnaire and its relationship with other symptom-specific measures for patients with chronic cough. Respir Med 2024; 227:107642. [PMID: 38670318 DOI: 10.1016/j.rmed.2024.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To implement subjective methods for measuring the impact of chronic cough on patients' daily life, including an Italian version of the symptom-specific, health status measure for patients with chronic cough, i.e. the Leicester Cough Questionnaire (LCQ). METHODS Sixty-five chronic cough patients attended a tertiary cough clinic on two separate occasions 8 weeks apart. The visual analogue scale for cough severity (VAS), the LCQ and the cough disturbance score (CDS) were administered on both occasions. The LCQ was adapted for Italian conditions following a forward-backward translation procedure. Concurrent validation, internal consistency, repeatability and responsiveness were determined. RESULTS The CDS, VAS and LCQ were correlated (r coefficients ranging from 0.69 to 0.94, p < 0.01). The internal consistency for each LCQ domain was high (alpha coefficient range 0.87-0.93), as was the 8-week repeatability of the LCQ in the patients (n = 36, 60 %) who displayed no change in CDS and VAS (intra-class correlation coefficient = 0.86, p < 001) over the same period. Patients who reported an improvement in CDS and VAS after 8 weeks (n = 29) also demonstrated significant improvements in each LCQ domain. The mean difference in LCQ total score before and after improvements was 2.26 (95 % CI: 1.58-4.47). CONCLUSIONS The Italian version of the LCQ appears to be just as valid as the other language versions of the questionnaire. In addition, the CDS appears to be a clinically useful, symptom-specific measure of the overall disturbance provoked by cough.
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Affiliation(s)
- Alessandra Sorano
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Carlo Fumagalli
- Department of Advanced Medical and Surgical Sciences, 'Luigi Vanvitelli' University of Campania', Naples, Italy
| | - Elenia Cinelli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Giovanni A Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Italy.
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Dornelas R, Casmerides MCB, da Silva RC, Victória Dos Anjos Souza M, Pereira LT, Ribeiro VV, Behlau M. Clinical Parameters of the Speech-Language Pathology Assessment of the Chronic Cough: A Scoping Review. J Voice 2024; 38:703-710. [PMID: 35012819 DOI: 10.1016/j.jvoice.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to map the clinical parameters used in the speech-language pathology assessment of the chronic cough. METHODS a scoping review was performed to answer the clinical question: "What are the clinical parameters included in the speech-language pathology assessment of patients with chronic cough?" Evidence was searched by electronic and manual search. The electronic search included: MEDLINE, Cochrane Library, EMBASE, Web of Science, SCOPUS, and LILACS. Each database had a specific search strategy. The manual search included Journal of Voice, Chest, and Thorax, Brazilian Library of Theses and Dissertations, Open Grey, and Clinical Trials, in addition to scanning the references of the included studies. The extracted data considered information regarding the publication, sample, assessment, and measures used when assessing chronic cough. RESULTS the electronic search found 289 studies; the manual search found 1036 studies; 12 were selected for the present study. The most used assessments were: self-assessment (75%), aerodynamic analysis (66.67%), the perceptual auditory judgment of the voice quality (58.33%), acoustic analysis of the voice (41.67%), cough frequency, and cough threshold (41.67%) and electroglottography (25%). CONCLUSIONS the subjective instruments were used more frequently, while specific objective instruments, which are recent, were used less frequently. Complementary assessments such as vocal assessment, have been frequently used, also, with no other parameter. A lack of homogeneity was identified in the speech-language pathology assessment and measures of patients with chronic cough, thus, the comparison among studies and clinical analysis is difficult.
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Affiliation(s)
- Rodrigo Dornelas
- Speech-Language Pathology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Maria Christina Bussamara Casmerides
- Postgraduate Program in Medicine (Otorhinolaryngology), Universidade Federal de São Paulo, São Paulo, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Rebeca Cardoso da Silva
- Speech-Language Pathology Department, Universidade Federal de Sergipe, Lagarto, Sergipe, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Maria Victória Dos Anjos Souza
- Speech-Language Pathology Department, Universidade Federal de Sergipe - UFS. Lagarto, Sergipe, Brazil; Speech-Language Pathology Department, Universidade Federal de Sergipe, Lagarto, Sergipe, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Lucas Tito Pereira
- Speech-Language Pathology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil; Speech-Language Pathology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal da Paraíba, João Pessoa, Paraiba, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil.
| | - Mara Behlau
- Speech-Language Pathology Department, Universidade Federal de São Paulo, São Paulo, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
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Zhong S, Zhong M, Fang L, Zhi H, Ji X, Tang K, Zhan C, Shi X, Xian M, Wang W, Li J, Luo W, Lai K, Chen R. Potassium-Competitive Acid Blocker Versus Proton Pump Inhibitor: A Pilot Study on Comparable Efficacy in the Treatment of Gastroesophageal Reflux-Related Cough. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:191-201. [PMID: 38528386 DOI: 10.4168/aair.2024.16.2.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 03/27/2024]
Abstract
Acid inhibitors have been considered in treating gastroesophageal reflux-related cough (GERC). Compared to proton pump inhibitors (PPIs), potassium-competitive acid blockers (P-CABs) have more potent and durable effects on anti-acid secretion. However, whether vonoprazan and esomeprazole have different therapeutic effects on GERC remains unknown. Patients diagnosed with GERC were enrolled in our study and randomly treated with vonoprazan (20 mg, once daily, P-CAB) or esomeprazole (20 mg, twice daily, PPI) for two months. A prokinetic agent was also administered. Patients were followed up once a month. Cough severity visual analogue scale (VAS) was measured as the primary outcome, while cough symptom score (CSS) and scores for cough-related quality-of-life or reflux-related symptoms were the secondary endpoints. A total of 50 patients completed the study, with 25 patients in each group. P-CAB and PPI groups showed similar decreases in cough severity VAS and CSS scores after the 2-month treatment (all P < 0.001). For quality-of-life, the Leicester Cough Questionnaire (LCQ) score increased significantly from baseline in both groups, but the P-CAB group had greater improvement and a higher LCQ score in month 2 (all P ≤ 0.05). For reflux-related symptoms, the Hull Airway Reflux Questionnaire (HARQ) score declined substantially over time in the P-CAB group, while the reflux symptom index (RSI) score decreased in both groups. The P-CAB group tended to have a lower HARQ (P = 0.051) and RSI (P = 0.069) scores in month 2. In conclusion, vonoprazan may be comparable to esomeprazole in cough symptom relief in GERC during the 2-month treatment period, but possibly provides better gains on classic reflux symptoms and quality-of-life. The long-term efficacy of P-CABs on GERC may be worth further exploration. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2200067089.
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Affiliation(s)
- Shuxin Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyu Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liman Fang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haopeng Zhi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaolong Ji
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kailun Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chen Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xu Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mo Xian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wanjun Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wei Luo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Ruchong Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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Song WJ, Lee HY. Measuring Cough Severity: Time to Replace VAS With Patient Global Impression Scale? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3713-3714. [PMID: 38065639 DOI: 10.1016/j.jaip.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Hwa Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Rhatigan K, Hirons B, Kesavan H, Turner RD, Ebelthite C, Hull JH, Jolley CJ, Birring SS, Cho PSP. Patient Global Impression of Severity Scale in Chronic Cough: Validation and Formulation of Symptom Severity Categories. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3706-3712.e1. [PMID: 37678666 DOI: 10.1016/j.jaip.2023.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The Patient Global Impression of Severity (PGI-S) scale is a self-reported, single-item categorical scale that is increasingly used when assessing chronic cough (CC). OBJECTIVE This study aimed to establish validity, repeatability, and responsiveness of the PGI-S scale in CC and use the scale to define discrete categories of severity when measured with other commonly used patient-reported outcome (PRO) tools. METHODS Consecutive patients with CC completed the PGI-S scale, cough severity and urge to cough visual analog scales (VAS), and cough-specific health status Leicester Cough Questionnaire (LCQ) at a clinic visit. Validity, repeatability, and responsiveness were assessed, and threshold scores for PRO severity categories determined. RESULTS A total of 482 participants completed the assessments; the median (interquartile range [IQR]) age was 57 (46-67) years, 71% were female, and the median (IQR) duration of cough was 48 (24-120) months. They reported a median (IQR) PGI-S score of 3 (3-4; moderate severity), cough severity VAS of 57 (31-75) mm, urge to cough VAS of 62 (40-81) mm, and LCQ of 11.5 (8.7-14.4). There were strong associations between PGI-S scores and cough severity VAS (ρ = 0.81), urge to cough VAS (ρ = 0.73), and LCQ (ρ = -0.73) (all P < .001). Repeatability of the PGI-S scale was high (n = 77); the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.77-0.91) (P < .001). The PGI-S scale was responsive in participants with a treatment response (P < .001). The suggested PRO thresholds to define severe cough are ≥61 mm (cough severity VAS), ≥71 mm (urge to cough VAS), and ≤10 (LCQ). CONCLUSION The PGI-S scale is a simple and valid tool that characterizes cough severity and is repeatable and responsive in CC. The proposed categorical severity thresholds for VAS and LCQ can provide intuitive meaning for patients and clinicians.
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Affiliation(s)
- Katherine Rhatigan
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Barnaby Hirons
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Harini Kesavan
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard D Turner
- Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Candice Ebelthite
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - James H Hull
- Airway Disease Section, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Caroline J Jolley
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Peter S P Cho
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, London, United Kingdom.
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Rameau A, Andreadis K, German A, Lachs MS, Rosen TE, Pitzrick MS, Symes LB, Klinck H. Changes in Cough Airflow and Acoustics After Injection Laryngoplasty. Laryngoscope 2023; 133 Suppl 3:S1-S14. [PMID: 35723533 PMCID: PMC9763552 DOI: 10.1002/lary.30255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. STUDY TYPE/DESIGN Prospective interventional study. METHODS Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures. RESULTS Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: -0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2 , SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: -0.31, p = 0.04) and peak power density (coefficient: -0.35, p = 0.02). CONCLUSIONS Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. LEVEL OF EVIDENCE 3 Laryngoscope, 133:S1-S14, 2023.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Alexander German
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Michael S. Pitzrick
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Laurel Braden Symes
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Holger Klinck
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
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Weiner M, Weaver J, Gowan T, Baird SA, Huffman M, Dexter P, Bali V, Schelfhout J, Griffith A, Pell J, Doshi I, Talib T. Health-related experiences of adults with chronic cough: Empirical research mixed methods. Nurs Open 2023; 10:4055-4063. [PMID: 36815576 PMCID: PMC10170930 DOI: 10.1002/nop2.1665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023] Open
Abstract
AIM To describe adults' health-related experiences with chronic cough. DESIGN Survey and interviews. METHODS Participants completed questionnaires and interviews, to explore chronic cough's impact and management. DATA SOURCES Patients aged 18-85 years with at least three cough-related encounters within 56-120 days. RESULTS Forty-one patients were surveyed. Mean cough severity was 4.5 (scale 0-9). Chronic cough-related problems included embarrassment (66%), fatigue (56%), and anxiety or depression (49%). Testing was judged insufficient by 44%. Only 28% were satisfied with treatment; 20% reported abandoning treatment due to ineffectiveness. Interview themes (N = 30) included frustration with diagnostic uncertainty, and feelings of therapeutic futility. Some reported psychological distress. Work and socializing were commonly disrupted. CONCLUSION Diagnostic uncertainty, perceived limitations of testing, and treatment failures suggest needs for better approaches to evaluating and treating chronic cough. Special attention to identifying and addressing mental health issues appears warranted.
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Affiliation(s)
- Michael Weiner
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | | | - Tayler Gowan
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sean A Baird
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Paul Dexter
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Eskenazi Health, Indianapolis, IN, USA
| | | | | | | | - Jacob Pell
- Indiana University, Indianapolis, IN, USA
| | | | - Tasneem Talib
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA
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Chao W, You-Qin M, Hong C, Hai-Ying Z, Su-Xue J, Lan X, Zhong W. Effect of Capsaicin Atomization on Cough and Swallowing Function in Patients With Hemorrhagic Stroke: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:503-512. [PMID: 36716393 DOI: 10.1044/2022_jslhr-22-00296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients with hemorrhagic stroke have high mortality and disability rates. Nevertheless, early rehabilitation interventions can improve their outcomes. We aimed to apply capsaicin atomization as early intervention to patients with hemorrhagic stroke and explore improvements in cough and swallowing functions. METHOD Patients with hemorrhagic stroke were randomly divided into the control group, which received routine care, and the intervention group, which underwent the capsaicin solution nebulization scheme in addition to routine care. Differences in the presence/absence of cough reflex and number of coughs in response to capsaicin, the presence/absence of swallowing reflex in response to water, the presence/absence of postswallow residue, substance P (SP) concentration, and pulmonary inflammation between the two groups were determined before and after the intervention. RESULTS A total of 53 patients with hemorrhagic stroke were included. Results showed no statistically significant difference in cough reflex in both groups after the intervention (p > .05). The degree of cough in the intervention group was stronger than that in the control group (p = .046). No statistically significant difference was observed in the number of patients with swallowing reflex in response to water between the groups (p > .05). The presence/absence of postswallow residue of the intervention group was stronger than that of the control group (p = .032). No statistically significant difference was observed between the Glasgow Coma Scale scores of the groups after the intervention (p > .05). SP in the intervention group was significantly increased (p = .031). The Clinical Pulmonary Infection Score was significantly lower in the control group, and the difference was statistically significant (p = .028). CONCLUSIONS Capsaicin nebulization can help enhance the number of coughs in response to capsaicin, reduce postswallow residue, and increase the level of SP in patients with hemorrhagic stroke and has a positive effect on pulmonary inflammation. This study provides intervention points for cough and swallowing rehabilitation after a hemorrhagic stroke. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21956903.
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Affiliation(s)
- Wu Chao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mao You-Qin
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Hong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhang Hai-Ying
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Su-Xue
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Lan
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wang Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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11
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Schelfhout J, Nguyen AM, Birring SS, Bacci ED, Vernon M, Muccino DR, La Rosa C, Smith JA. Validation and Meaningful Change Thresholds for an Objective Cough Frequency Measurement in Chronic Cough. Lung 2022; 200:717-724. [PMID: 36348054 PMCID: PMC9675653 DOI: 10.1007/s00408-022-00587-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Objective cough frequency is used to assess efficacy of chronic cough (CC) treatments. The objective of this study was to explore the relationship between objective cough frequency and cough-specific patient-reported outcomes (PROs) and estimate a clinically meaningful change threshold (MCT) for objective cough frequency. METHODS Data collected in a phase 2b study in participants with refractory or unexplained CC were used to investigate the relationship between 24-h cough frequency (measured using an ambulatory cough monitor) and cough-specific PROs (i.e., cough severity visual analog scale, cough severity diary, Leicester Cough Questionnaire). Convergent validity was assessed using Spearman ρ. An MCT for 24-h cough frequency was estimated using the patient global impression of change (PGIC) scale as an anchor. RESULTS Correlations between 24-h cough frequency and cough-specific PROs at baseline, Week 4, and Week 12 were significant (P < 0.0001) but low to moderate in strength (ρ = 0.30-0.58). Participants categorized as very much improved/much improved (i.e., PGIC of 1 or 2) or minimally improved (i.e., PGIC of 3) had mean 24-h cough frequency reductions of 55% and 30%, respectively. Receiver operating characteristic curve analysis suggested that a 24-h cough frequency reduction of 38% optimizes sensitivity and specificity for predicting a PGIC score of 1-3. CONCLUSION Objective 24-h cough frequency is significantly associated with cough-specific PROs, but cough frequency and PROs most likely capture distinct aspects of CC. A ≥ 30% reduction in 24-h cough frequency is a reasonable MCT to define treatment response in CC clinical trials.
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Affiliation(s)
| | | | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, 2nd Floor Education and Research Centre, University of Manchester and Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
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12
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Abstract
Cough assessment is central to the clinical management of respiratory diseases, including tuberculosis (TB), but strategies to objectively and unobtrusively measure cough are lacking. Acoustic epidemiology is an emerging field that uses technology to detect cough sounds and analyze cough patterns to improve health outcomes among people with respiratory conditions linked to cough. This field is increasingly exploring the potential of artificial intelligence (AI) for more advanced applications, such as analyzing cough sounds as a biomarker for disease screening. While much of the data are preliminary, objective cough assessment could potentially transform disease control programs, including TB, and support individual patient management. Here, we present an overview of recent advances in this field and describe how cough assessment, if validated, could support public health programs at various stages of the TB care cascade. Zimmer et al. discuss the importance of cough assessment in clinical management of tuberculosis (TB). They describe how acoustic epidemiology, which uses recording devices and artificial intelligence to detect, record and analyze cough, can be used in TB control and individual patient management.
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13
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Gabaldón-Figueira JC, Keen E, Giménez G, Orrillo V, Blavia I, Doré DH, Armendáriz N, Chaccour J, Fernandez-Montero A, Bartolomé J, Umashankar N, Small P, Grandjean Lapierre S, Chaccour C. Acoustic surveillance of cough for detecting respiratory disease using artificial intelligence. ERJ Open Res 2022; 8:00053-2022. [PMID: 35651361 PMCID: PMC9149391 DOI: 10.1183/23120541.00053-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Research questionCan smartphones be used to detect individual and population-level changes in cough frequency that correlate with the incidence of coronavirus disease 2019 (COVID-19) and other respiratory infections?MethodsThis was a prospective cohort study carried out in Pamplona (Spain) between 2020 and 2021 using artificial intelligence cough detection software. Changes in cough frequency around the time of medical consultation were evaluated using a randomisation routine; significance was tested by comparing the distribution of cough frequencies to that obtained from a model of no difference. The correlation between changes of cough frequency and COVID-19 incidence was studied using an autoregressive moving average analysis, and its strength determined by calculating its autocorrelation function (ACF). Predictors for the regular use of the system were studied using a linear regression. Overall user experience was evaluated using a satisfaction questionnaire and through focused group discussions.ResultsWe followed-up 616 participants and collected >62 000 coughs. Coughs per hour surged around the time cohort subjects sought medical care (difference +0.77 coughs·h−1; p=0.00001). There was a weak temporal correlation between aggregated coughs and the incidence of COVID-19 in the local population (ACF 0.43). Technical issues affected uptake and regular use of the system.InterpretationArtificial intelligence systems can detect changes in cough frequency that temporarily correlate with the onset of clinical disease at the individual level. A clearer correlation with population-level COVID-19 incidence, or other respiratory conditions, could be achieved with better penetration and compliance with cough monitoring.
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14
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Symptoms of the Eruption of Permanent Teeth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063301. [PMID: 35328989 PMCID: PMC8955642 DOI: 10.3390/ijerph19063301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022]
Abstract
This prospective study examined a population of 520 urban and rural children aged 5 to 9 years. Every 2−4 weeks, the clinical symptoms accompanying primary tooth replacement such as a cough, a runny nose, pain, and body temperature were assessed in each child’s medical records. The authors were able to show in a statistically significant manner that the frequency, time, and type of cough were strongly related to the type of erupting teeth (p < 0.001 for each relationship). A cough dependent on the type of erupting teeth was observed in 86% to 92% of the examined children, with a morning bronchial cough being connected with an eruption of the lower teeth, and an eruption of the upper teeth producing an all-day pharyngeal cough caused by mucus secretions dripping down the back of the throat. A statistically significant relationship was also confirmed between the type of erupting teeth and the incidence of a runny nose (p < 0.001), the frequency of a runny nose (p < 0.001), and the time when runny nose symptoms occurred (p < 0.001). This study shows that the period when primary dentition is replaced with permanent teeth in children is characterized by a physiological cough and a runny nose.
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15
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Kruizinga MD, Zhuparris A, Dessing E, Krol FJ, Sprij AJ, Doll RJ, Stuurman FE, Exadaktylos V, Driessen GJA, Cohen AF. Development and technical validation of a smartphone-based pediatric cough detection algorithm. Pediatr Pulmonol 2022; 57:761-767. [PMID: 34964557 PMCID: PMC9306830 DOI: 10.1002/ppul.25801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Coughing is a common symptom in pediatric lung disease and cough frequency has been shown to be correlated to disease activity in several conditions. Automated cough detection could provide a noninvasive digital biomarker for pediatric clinical trials or care. The aim of this study was to develop a smartphone-based algorithm that objectively and automatically counts cough sounds of children. METHODS The training set was composed of 3228 pediatric cough sounds and 480,780 noncough sounds from various publicly available sources and continuous sound recordings of 7 patients admitted due to respiratory disease. A Gradient Boost Classifier was fitted on the training data, which was subsequently validated on recordings from 14 additional patients aged 0-14 admitted to the pediatric ward due to respiratory disease. The robustness of the algorithm was investigated by repeatedly classifying a recording with the smartphone-based algorithm during various conditions. RESULTS The final algorithm obtained an accuracy of 99.7%, sensitivity of 47.6%, specificity of 99.96%, positive predictive value of 82.2% and negative predictive value 99.8% in the validation dataset. The correlation coefficient between manual- and automated cough counts in the validation dataset was 0.97 (p < .001). The intra- and interdevice reliability of the algorithm was adequate, and the algorithm performed best at an unobstructed distance of 0.5-1 m from the audio source. CONCLUSION This novel smartphone-based pediatric cough detection application can be used for longitudinal follow-up in clinical care or as digital endpoint in clinical trials.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Eva Dessing
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Fas J Krol
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Department of pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
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16
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Keen EM, True EJ, Summers AR, Smith EC, Brew J, Grandjean Lapierre S. High-throughput digital cough recording on a university campus: A SARS-CoV-2-negative curated open database and operational template for acoustic screening of respiratory diseases. Digit Health 2022; 8:20552076221097513. [PMID: 35558638 PMCID: PMC9087241 DOI: 10.1177/20552076221097513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Respiratory illnesses have information-rich acoustic biomarkers, such as cough, that
can potentially play an important role in screening populations for disease risk. To
realize that potential, datasets of paired acoustic-clinical samples are needed for the
development and validation of acoustic screening models, and protocols for collecting
acoustic samples must be efficient and safe. We collected cough acoustic signatures at a
high-throughput SARS-CoV-2 testing site on a college campus. Here, we share logistical
details and the dataset of acoustic cough signatures paired with the gold standard in
SARS-CoV-2 testing of SARS-CoV-2 genomic sequences using qRT-PCR. Methods Cough recordings were collected in winter-spring 2021 at a rural residential college
(Sewanee, TN, USA), where approximately 2000 students were tested for SARS-CoV-2 on a
weekly basis. Cough collection was managed by student volunteers using custom
software. Results 4302 coughs were recorded from 960 participants over 11 weeks. All coughs were COVID-19
negative. Approximately 30 s were required to check-in a participant and collect their
cough. Conclusion The value of acoustic screening tools depends upon our ability to develop and implement
them reliably and quickly. For that to happen, high-quality datasets and logistical
insights must be collected and shared on an ongoing basis.
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Affiliation(s)
- Eric M. Keen
- Sewanee: The University of the South, Sewanee, TN, USA
- Hyfe, Inc., Wilmington, DE, USA
| | - Emily J. True
- Sewanee: The University of the South, Sewanee, TN, USA
| | | | | | | | - Simon Grandjean Lapierre
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montréal, Québec, Canada
- Immunopathology Axis, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
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17
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Gómez RM, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortega-Martell JA, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19. World Allergy Organ J 2021; 14:100618. [PMID: 34963794 PMCID: PMC8666560 DOI: 10.1016/j.waojou.2021.100618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/30/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | - Samar A. Idriss
- Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, France, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, MA, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, NL, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNS School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, Shelbyville Rd, Louisville, KY, 9800, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, France, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and Univ, of Veterinary Medicine Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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18
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Wu C, Zhang Y, Yang L, Shen F, Ma C, Shen M. Effect of Capsaicin Atomization-Induced Cough on Sputum Excretion in Tracheotomized Patients After Hemorrhagic Stroke: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4085-4095. [PMID: 34694869 DOI: 10.1044/2021_jslhr-21-00151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Timely and effective removal of respiratory secretions is of great significance for tracheotomized patients. The purpose of this study is to investigate the effectiveness of capsaicin nebulization to stimulate cough to promote early clearance of respiratory secretions in tracheotomized patients after hemorrhagic stroke. Method This study implemented a randomized controlled design. Sixty-three patients who were tracheotomized following a hemorrhagic stroke completed this randomized controlled trial. In the control group, 33 cases were given a routine care after tracheotomy. In the intervention group, 30 cases were given a capsaicin solution nebulization in addition to the routine care. The daily sputum output and the number of sputum suctioning were observed. The differences in sputum viscosity, cough function, and Clinical Pulmonary Infection Score (CPIS) were compared between the two groups before and after the intervention. Vital sign changes during capsaicin nebulization and suctioning were compared between the two groups in a pilot study. Results The daily sputum output of the capsaicin intervention group was significantly higher than that of the control group (p < .05). The number of sputum suctioning of capsaicin group was less than that of the control group after intervention (p < .05). The CPIS score of the capsaicin group was lower than that of the control group (p < .05) after a 1-week intervention. Patients' heart rate, respiratory rate, and oxygen saturation during capsaicin nebulization were not statistically different from those during routine sputum suctioning (p > .05). Conclusions Capsaicin atomization-induced cough can effectively promote sputum excretion of hemorrhagic stroke patients undergoing tracheotomy and has a good safety profile. The Clinical Trial registration number of this study is ChiCTR2000037772 (http://www.chictr.org.cns). Supplemental Material https://doi.org/10.23641/asha.16821352.
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Affiliation(s)
- Chao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yijie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fang Shen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Ma
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meifen Shen
- Nursing Department, Dushu Lake Affiliated Hospital of Soochow University, Suzhou, China
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19
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Martin Nguyen A, Bacci ED, Vernon M, Birring SS, Rosa CL, Muccino D, Schelfhout J. Validation of a visual analog scale for assessing cough severity in patients with chronic cough. Ther Adv Respir Dis 2021; 15:17534666211049743. [PMID: 34697975 PMCID: PMC8552382 DOI: 10.1177/17534666211049743] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients with chronic cough experience considerable burden. The cough
severity visual analog scale (VAS) records patients’ assessment of cough
severity on a 100-mm linear scale ranging from “no cough” (0 mm) to “worst
cough” (100 mm). Although cough severity scales are widely used in clinical
practice and research, their use in patients with refractory or unexplained
chronic cough has not been formally validated. Methods: This analysis includes data from a phase 2b randomized controlled trial of
the P2X3-receptor antagonist gefapixant for treatment of refractory or
unexplained chronic cough (NCT02612610). Cough severity VAS scores were
assessed at baseline and Weeks 4, 8, and 12. The cough severity VAS was
validated using several outcomes, including the Cough Severity Diary (CSD),
Leicester Cough Questionnaire (LCQ), patient global impression of change
(PGIC) scale, and objective cough frequency. Validation metrics included
test–retest reliability, convergent and known-groups validity,
responsiveness, and score interpretation (i.e., clinically meaningful change
threshold). Results: The analysis included 253 patients (median age, 61.0 years; females, 76%).
Test–retest reliability of the cough severity VAS was moderate (intraclass
correlation coefficient, 0.51). The cough severity VAS had acceptable
convergent validity with other related measures (Pearson r
of 0.53 and -0.41 for CSD and LCQ total scores, respectively;
p < 0.0001 for each). Known-groups validity was
supported by significant differences in mean cough severity VAS scores
across severity groups defined using CSD, LCQ, and cough frequency tertiles.
A large effect size was observed in patients with the greatest improvements
in PGIC (Cohen d = -1.8). A ⩾ 30-mm reduction in the cough
severity VAS was estimated as a clinically meaningful change threshold for
clinical trials in chronic cough. Conclusions: The cough severity VAS is a valid and responsive measure. A cough severity
VAS reduction of ⩾ 30 mm can discriminate clinically meaningful changes in
chronic cough severity in clinical studies.
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Affiliation(s)
| | | | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
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Mann J, Goh NSL, Holland AE, Khor YH. Cough in Idiopathic Pulmonary Fibrosis. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:751798. [PMID: 36188759 PMCID: PMC9397801 DOI: 10.3389/fresc.2021.751798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Chronic cough is experienced by most patients with idiopathic pulmonary fibrosis (IPF). It is often the first symptom and is associated with reduced quality of life, increased rates of depression and anxiety, more severe physiological impairment, and disease progression. Although not fully understood, recent gains in understanding the pathophysiology of chronic cough in IPF have been made. The pathophysiology is likely multifactorial and includes alterations in mucous production and clearance, architectural distortion, and increased cough reflex sensitivity, suggesting a role for targeted therapies and multidisciplinary treatment. Modifiable comorbidities can also induce cough in patients with IPF. There is a renewed emphasis on measuring cough in IPF, with clinical trials of novel and repurposed therapies for chronic cough emerging in this population. This review provides an update on the clinical characteristics, pathophysiology, and measurement of chronic cough in patients with IPF and summarizes recent developments in non-pharmacological and pharmacological therapies.
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Affiliation(s)
- Jennifer Mann
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Jennifer Mann
| | - Nicole S. L. Goh
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, VIC, Australia
| | - Anne E. Holland
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, VIC, Australia
- Yet Hong Khor
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21
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Pekacka-Egli AM, Kazmierski R, Lutz D, Kulnik ST, Pekacka-Falkowska K, Maszczyk A, Windisch W, Boeselt T, Spielmanns M. Predictive Value of Cough Frequency in Addition to Aspiration Risk for Increased Risk of Pneumonia in Dysphagic Stroke Survivors: A Clinical Pilot Study. Brain Sci 2021; 11:brainsci11070847. [PMID: 34202226 PMCID: PMC8301865 DOI: 10.3390/brainsci11070847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. METHODS This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration-Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. RESULTS 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. CONCLUSION Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors.
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Affiliation(s)
- Anna Maria Pekacka-Egli
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
| | - Radoslaw Kazmierski
- Department for Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, 61701 Poznan, Poland;
- Department of Neurology, University of Zielona Gora, 65046 Zielona Gora, Poland
| | - Dietmar Lutz
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London SW17 0RE, UK;
| | - Katarzyna Pekacka-Falkowska
- Department for History and Philosophy of Medicine, Poznan University of Medical Sciences, 61701 Poznan, Poland;
| | - Adam Maszczyk
- Department for Methodology, Statistics, and Informatics Systems, Institute of Sport Science, Academy of Physical Education in Katowice, 40065 Katowice, Poland;
| | - Wolfram Windisch
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Department of Pneumology, Cologne Merheim Hospital Kliniken der Stadt Koeln GmbH, 51109 Koeln, Germany
| | - Tobias Boeselt
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Phillips University Marburg, 35037 Marburg, Germany;
| | - Marc Spielmanns
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
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22
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Cohn JR. More Tools for the Toolbox: Interpreting Coughing Patients' Clues. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:433-434. [PMID: 33429710 DOI: 10.1016/j.jaip.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Affiliation(s)
- John R Cohn
- Allergy & Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Philadelphia, Pa; The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
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Otoshi T, Nagano T, Izumi S, Hazama D, Katsurada N, Yamamoto M, Tachihara M, Kobayashi K, Nishimura Y. A novel automatic cough frequency monitoring system combining a triaxial accelerometer and a stretchable strain sensor. Sci Rep 2021; 11:9973. [PMID: 33976286 PMCID: PMC8113562 DOI: 10.1038/s41598-021-89457-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
Objective evaluations of cough frequency are considered important for assessing the clinical state of patients with respiratory diseases. However, cough monitors with audio recordings are rarely used in clinical settings. Issues regarding privacy and background noise with audio recordings are barriers to the wide use of these monitors; to solve these problems, we developed a novel automatic cough frequency monitoring system combining a triaxial accelerator and a stretchable strain sensor. Eleven healthy adult volunteers and 10 adult patients with cough were enrolled. The participants wore two devices for 30 min for the cough measurements. An accelerator was attached to the epigastric region, and a stretchable strain sensor was worn around their neck. When the subjects coughed, these devices displayed specific waveforms. The data from all the participants were categorized into a training dataset and a test dataset. Using a variational autoencoder, a machine learning algorithm with deep learning, the components of the test dataset were automatically judged as being a “cough unit” or “non-cough unit”. The sensitivity and specificity in detecting coughs were 92% and 96%, respectively. Our cough monitoring system has the potential to be widely used in clinical settings without any concerns regarding privacy or background noise.
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Affiliation(s)
- Takehiro Otoshi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Shintaro Izumi
- Graduate School of System Informatics, Kobe University, 1-1-Rokkodaicho. Nada-ku, Kobe, Hyogo, 657-0013, Japan
| | - Daisuke Hazama
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Naoko Katsurada
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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24
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Zeiger RS, Schatz M, Hong B, Li Q, Stern JA, Takhar HS, Weaver JP, Bali V, Schelfhout J, Chen W. Patient-Reported Burden of Chronic Cough in a Managed Care Organization. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1624-1637.e10. [PMID: 33227523 DOI: 10.1016/j.jaip.2020.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The burden of chronic cough (CC) requires better understanding. OBJECTIVE To determine the severity, health status, and health care resource utilization among patients with CC identified by electronic health records on 2 visits separated by ≥1 year. METHODS Information on cough-related burden was collected through survey from patients with CC, including validated questionnaires (the cough health status Leicester Cough Questionnaire [LCQ], the cough hypersensitivity Hull Airway Reflux Questionnaire [HARQ], and the Cough Quality of Life Questionnaire [CQLQ]), CC-associated respiratory and gastrointestinal comorbidities, and treatment responses. Spearman correlation coefficients were reported to examine the associations among the LCQ, HARQ, and CQLQ. Patient demographics and patient-reported CC features were compared between males and females, and among ethnic groups using Robust Poisson regression models. RESULTS The survey was completed by 565 patients who were 64.8 ± 12.6 years, 75.8% female, and 60.4% white. CC duration was 8.6 ± 10.5 years with an average weekly severity of 5.3 ± 2.3 (maximum 10). The LCQ score was 11.3 ± 3.9 (maximum 21). The HARQ score was 33.3 ± 13.6 (normal ≤13). The CQLQ score was 56.9 ± 17.5 (maximum 112, worse with higher scores). The Spearman rank correlations were high between the LCQ and HARQ (-0.65), the LCQ and CQLQ (-0.80), and the HARQ and CQLQ (0.69). Patients with CC-associated respiratory and gastrointestinal comorbidities generally showed similar results regarding the above questionnaires. Treatment responses were suboptimal. Women compared with men and non-whites compared with whites reported significantly worse cough severity and poorer LCQ, HARQ, and CQLQ scores. CONCLUSIONS CC is self-reported as a burdensome condition, particularly in women and non-white minorities, which markedly affects daily living with inadequate response to treatments.
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Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
| | - Benjamin Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Qiaowu Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Julie A Stern
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Harpreet S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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25
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Lai K. Preface for special series on the Third International Cough Conference. J Thorac Dis 2020; 12:5177-5178. [PMID: 33145094 PMCID: PMC7578478 DOI: 10.21037/jtd-2020-icc-preface] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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26
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Cohn JR. Cough Frequency and Asthma: What Counts? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:662-663. [PMID: 32037112 DOI: 10.1016/j.jaip.2019.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- John R Cohn
- Allergy & Immunology Section, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
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27
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Hall JI, Lozano M, Estrada-Petrocelli L, Birring S, Turner R. The present and future of cough counting tools. J Thorac Dis 2020; 12:5207-5223. [PMID: 33145097 PMCID: PMC7578475 DOI: 10.21037/jtd-2020-icc-003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The widespread use of cough counting tools has, to date, been limited by a reliance on human input to determine cough frequency. However, over the last two decades advances in digital technology and audio capture have reduced this dependence. As a result, cough frequency is increasingly recognised as a measurable parameter of respiratory disease. Cough frequency is now the gold standard primary endpoint for trials of new treatments for chronic cough, has been investigated as a marker of infectiousness in tuberculosis (TB), and used to demonstrate recovery in exacerbations of chronic obstructive pulmonary disease (COPD). This review discusses the principles of automatic cough detection and summarises key currently and recently used cough counting technology in clinical research. It additionally makes some predictions on future directions in the field based on recent developments. It seems likely that newer approaches to signal processing, the adoption of techniques from automatic speech recognition, and the widespread ownership of mobile devices will help drive forward the development of real-time fully automated ambulatory cough frequency monitoring over the coming years. These changes should allow cough counting systems to transition from their current status as a niche research tool in chronic cough to a much more widely applicable method for assessing, investigating and understanding respiratory disease.
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Affiliation(s)
- Jocelin Isabel Hall
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Manuel Lozano
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - Luis Estrada-Petrocelli
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,Facultad de Ingeniería, Universidad Latina de Panamá, Panama City, Panama
| | - Surinder Birring
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK.,Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Richard Turner
- Department of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Mazzone SB, McGarvey L. Mechanisms and Rationale for Targeted Therapies in Refractory and Unexplained Chronic Cough. Clin Pharmacol Ther 2020; 109:619-636. [PMID: 32748976 PMCID: PMC7983941 DOI: 10.1002/cpt.2003] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022]
Abstract
Chronic cough, defined as a cough lasting > 8 weeks, is a common medical condition that exerts a substantial physical, mental, and social burden on patients. A subset of patients with chronic cough are troubled with a cough that persists despite optimal treatment of presumed associated common and uncommon conditions (refractory chronic cough; RCC) or in which no diagnosable cause for cough can be identified despite extensive assessment (unexplained chronic cough; UCC). Many of these patients exhibit clinical features of cough hypersensitivity, including laryngeal paresthesia, hypertussia, and allotussia. Over-the-counter cough remedies are ineffective and can lead to intolerable side effects when used for RCC/UCC, and the lack of approved treatments indicated for these conditions reflects a major unmet need. An increased understanding of the anatomy and neurophysiology of protective and pathologic cough has fostered a robust clinical development pipeline of several targeted therapies for RCC/UCC. This manuscript reviews the mechanisms presumed to underly RCC/UCC together with the rationale and clinical evidence for several targeted therapies currently under clinical investigation, including transient receptor potential channel antagonists, P2X3-receptor antagonists, voltage-gated sodium channel blockers, neuromodulators, and neurokinin-1-receptor antagonists. Finally, we provide an overview of targets that have been investigated in preclinical models of cough and other airway diseases that may hold future promise for clinical studies in RCC/UCC. Development of targeted therapies with different sites of action may foster a precision medicine approach to treat this heterogeneous, underserved patient population.
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Affiliation(s)
- Stuart B Mazzone
- Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK
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Zeiger RS, Schatz M, Butler RK, Weaver JP, Bali V, Chen W. Burden of Specialist-Diagnosed Chronic Cough in Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1645-1657.e7. [PMID: 32059869 DOI: 10.1016/j.jaip.2020.01.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/31/2019] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The burden of chronic cough (CC) in patients seeking specialist care is infrequently researched. OBJECTIVE To describe patient characteristics and disease burden associated with specialist-diagnosed CC. METHODS Using administrative pharmacy and medical data, we identified patients aged 18 to 85 years with CC diagnosed by pulmonologists, allergists, otolaryngologists, or gastroenterologists. Patients were stratified into 4 subgroups on the basis of the presence or absence of common respiratory diseases or gastroesophageal reflux disease (GERD). Clinical features and health care resource utilization (HCRU) in the baseline and outcome years were compared between the CC subgroups. The baseline factors associated with persistence of CC and a comparison of the CC cohort to a matched noncough cohort were also determined. RESULTS The 11,290 patients with specialist-diagnosed CC were aged about 61 years and 66.7% were females. The CC cohort experienced frequent GERD (44.1%), asthma (31.2%), obesity (24.3%), upper airway cough syndrome (20.4%), common cough complications (19.4%), and hospitalizations (9.8%). The patients with CC with both respiratory disease and GERD exhibited at baseline and follow-up the most common cough comorbidities, higher HCRU, specialist care, and dispensed respiratory and nonrespiratory medications including proton pump inhibitors, antitussives, psychotherapeutics, oral corticosteroids, and antibiotics compared with the other subgroups. A 40.6% persistence of CC occurred similarly between CC subgroups. In addition, patients with CC in the matched analysis experienced significantly more comorbidities, laboratory evaluations, HCRU, and antitussives than patients without cough. CONCLUSIONS Specialist-diagnosed CC was associated with considerable disease burden, particularly among those with both respiratory disease and GERD. In addition, CC burden was more pronounced than in matched patients without cough.
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Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
| | - Rebecca K Butler
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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30
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Zeiger RS, Xie F, Schatz M, Hong BD, Weaver JP, Bali V, Schelfhout J, Chen W. Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data. Perm J 2020; 24:1-3. [PMID: 33482968 DOI: 10.7812/tpp/20.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT International Classification of Diseases-9/10 codes for chronic cough (CC) do not exist, limiting investigation. OBJECTIVE To develop a computerized algorithm to determine CC prevalence and its characteristics. DESIGN This observational study using administrative data identified hierarchically patients aged 18 to 85 years with CC from 2013 to 2016. First, a specialist-diagnosed CC group was identified using an internal CC encounter code during an outpatient visit to a pulmonologist, allergist, otolaryngologist, or gastroenterologist. Subsequently, an event-diagnosed CC group was identified based on clinical notes through natural language processing, ICD-9/ICD-10 cough codes, and dispensed antitussives. MAIN OUTCOME MEASURES Prevalence of CC and comparison of clinical characteristics between specialist-diagnosed and event-diagnosed CC subgroups. RESULTS A total of 50,163 patients with CC of more than 8 weeks were identified. Of these, 11,290 (22.5%) were specialist diagnosed, and 38,873 (77.5%) were event diagnosed. The CC cohort was 57.4 ± 16.5 years of age; 67.6% were female. The overall prevalence was 1.04% (95% confidence interval = 1.03-1.06) in 2016. Prevalence in 2016 was higher in female patients (1.21%) than in male patients (0.81%), higher in patients aged 65 to 85 years (2.2%) than in patients aged 18 to 44 years (0.43%), and higher in Blacks (1.38%) than in Whites (1.21%). Compared with patients with event-diagnosed CC, patients with specialist-diagnosed CC exhibited significantly higher frequencies of laboratory tests and respiratory and nonrespiratory comorbidities and dispensed medication and lower frequency of pneumonia, all-cause and respiratory-cause emergency department visits and hospitalizations, and dispensed antitussives. CONCLUSIONS We identified a CC cohort using electronic data in a managed care organization. Prevalences varied by sex, age, and ethnicity. Clinical characteristics varied between specialist-diagnosed and event-diagnosed CC.
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Affiliation(s)
- Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Fagen Xie
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Michael Schatz
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Benjamin D Hong
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
| | - Jessica P Weaver
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Wansu Chen
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, CA
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Fukuhara A, Saito J, Birring SS, Sato S, Uematsu M, Suzuki Y, Rikimaru M, Watanabe N, Saito M, Kawamata T, Umeda T, Togawa R, Sato Y, Koizumi T, Hirai K, Minemura H, Nikaido T, Kanazawa K, Tanino Y, Munakata M, Shibata Y. Clinical Characteristics of Cough Frequency Patterns in Patients with and without Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:654-661. [PMID: 31541769 DOI: 10.1016/j.jaip.2019.08.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cough is a frequent symptom of asthma. Cough frequency (CoFr) monitoring devices are now available to objectively measure cough counts and offer a novel endpoint to assess asthma. However, little is known about CoFr in asthma. OBJECTIVE The aims were, first, to determine whether unique features of CoFr exist in asthmatic and nonasthmatic patients and, secondly, to evaluate relationships between CoFr and pathophysiological parameters of asthma. METHODS In the current study, 73 asthmatic and 63 nonasthmatic patients suffering from persistent cough were enrolled. At study entry, the Leicester Cough Questionnaire (LCQ health status), cough visual analog scale (VAS), Leicester Cough Monitor (LCM), fractional exhaled nitric oxide (FeNO) measurements, and spirometry were performed. In asthmatic patients, the bronchial hyperresponsiveness (BHR) test was conducted if applicable. In 28 asthmatic and 17 nonasthmatic patients, LCQ, VAS, and LCM were examined before and after treatment. RESULTS CoFr during nighttime (asleep) was significantly higher in asthmatic patients than in nonasthmatic patients. Twenty-four-hour CoFr significantly decreased after appropriate treatment and was correlated with changes in VAS and LCQ in all patients. The improvement in cough in asthmatic patients was greater during nighttime than during daytime (awake). CoFr in asthmatic patients was significantly correlated with BHR, but not with FeNO. CONCLUSIONS In asthmatic patients, nocturnal CoFr can be associated with BHR, was significantly higher before treatment, but improved more after treatment compared with nonasthmatic patients. Monitoring nocturnal CoFr may provide unique and valuable information on making an early prediction of therapeutic effects in asthma.
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Affiliation(s)
- Atsuro Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Junpei Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Suguru Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Manabu Uematsu
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhito Suzuki
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Natsumi Watanabe
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mikako Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takaya Kawamata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Umeda
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tatsuhiko Koizumi
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenichiro Hirai
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | | | - Yoko Shibata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
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32
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Gibson PG. Chronic Cough. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1762. [PMID: 31279463 DOI: 10.1016/j.jaip.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Peter G Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.
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33
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Turner RD, Birring SS. Chronic cough: ATP, afferent pathways and hypersensitivity. Eur Respir J 2019; 54:13993003.00889-2019. [PMID: 31164438 DOI: 10.1183/13993003.00889-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Richard D Turner
- Dept of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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