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Background: The role and impact of chronic cough in individuals with COPD have not been described in the general population. This study hypothesized that comorbid chronic cough is a marker of disease severity in individuals with COPD.Methods: This study identified individuals with COPD and chronic cough, and recorded respiratory symptoms, health-care utilizations, lung function, and inflammatory biomarkers in blood in a nested cohort of 43,271 adults from the Copenhagen General Population Study (CGPS).Results: Among 43,271 individuals from the general population, 8,181 (19%) experienced COPD, of whom 796 (10%) had chronic cough. Individuals with COPD and chronic cough had a Leicester Cough Questionnaire median (25th-75th percentiles) total score of 17.7 (16.0-18.9), corresponding to 5.9 (5.3-6.3) for the physical domain, 5.6 (4.9-6.3) for the psychological domain, and 6.3 (5.8-6.8) for the social domain. Among individuals with COPD, those with chronic cough vs those without chronic cough more often experienced sputum production (60% vs 8%), wheezing (46% vs 14%), dyspnea (66% vs 38%), chest pain/tightness (9% vs 4%), nighttime dyspnea (8% vs 3%), episodes of acute bronchitis/pneumonias in the last 10 years (45% vs 25%), and ≥ 3 general practitioner visits in the past 12 months (53% vs 37%). Furthermore, these individuals had lower FEV1 % predicted (81% vs 89%) and FEV1/FVC (0.64 vs 0.66), as well as higher levels of high-sensitivity C-reactive protein, fibrinogen, leukocytes, neutrophils, eosinophils, and IgE in blood.Conclusions: Comorbid chronic cough in individuals with COPD is associated with a more severe disease in terms of more respiratory symptoms and health-care utilizations, lower lung function, and increased inflammation in blood. [ABSTRACT FROM AUTHOR]

Background: Prediction of future lung function will enable the identification of individuals at high risk of developing COPD, but the trajectory of lung function decline varies greatly among individuals. This study involved the development and validation of an individualized prediction model of lung function trajectory and risk of airflow limitation in the general population.Methods: Data were obtained from the Framingham Offspring Cohort, which included 4,167 participants ≥ 20 years of age and who had ≥ 2 valid spirometry assessments. The primary outcome was prebronchodilator FEV1; the secondary outcome was the risk of airflow limitation (defined as FEV1/FVC less than the lower limit of normal). Mixed effects regression models were developed for individualized prediction, and a machine learning algorithm was used to determine essential predictors. The model was validated in two large, independent multicenter cohorts (N = 2,075 and 12,913, respectively).Results: With 20 common predictors, the model explained 79% of the variation in FEV1 decline in the derivation cohort. In two validation datasets, the model had low error in predicting FEV1 decline (root mean square error range, 0.18-0.22 L) and high discriminative power in predicting risk of airflow limitation (C-statistic range, 0.86-0.87). This model was implemented in a freely accessible website-based application, which allows prediction based on flexible sets of predictors (http://resp.core.ubc.ca/ipress/FraminghamFEV1).Conclusions: The individualized predictor is an accurate tool to predict long-term lung function trajectories and risk of airflow limitation in the general population. This model enables identifying individuals at higher risk of COPD, who can then be targeted for preventive therapies. [ABSTRACT FROM AUTHOR]

Background: Chronic bronchitis (CB) increases risk of COPD exacerbations. We have shown that the St. George's Respiratory Questionnaire (SGRQ) CB definition identifies patients with a similar clinical phenotype as classically defined CB. Whether the SGRQ CB definition is a predictor of future COPD exacerbations is unknown.Methods: We analyzed 7,557 smokers with normal spirometry and Global Initiative for Chronic Obstructive Lung Disease stage 1-4 COPD in the Genetic Epidemiology of COPD study with longitudinal follow-up data on exacerbations. Subjects were divided into classic CB+ or classic CB-, using the classic definition. In addition, subjects were divided into SGRQ CB+ or SGRQ CB-. Exacerbation frequency and severe exacerbation frequency were determined in each group. Multivariable linear regressions were performed for exacerbation frequency with either classic CB or SGRQ CB and relevant covariates.Results: There were 1,434 classic CB+ subjects and 2,290 SGRQ CB+ subjects. The classic CB+ group had a greater exacerbation frequency compared with the classic CB- group (0.69 ± 1.26 vs 0.36 ± 0.90 exacerbations per patient per year; P < .0001) and a greater severe exacerbation frequency (0.26 ± 0.74 vs 0.13 ± 0.46 severe exacerbations per patient per year; P < .0001). There were similar differences between the SGRQ CB+ and SGRQ CB- groups. In multivariable analysis, both SGRQ CB and classic CB were independent predictors of exacerbation frequency, but SGRQ CB had a higher regression coefficient. In addition, SGRQ CB was an independent predictor of severe exacerbation frequency whereas classic CB was not.Conclusions: The SGRQ CB definition identified more subjects at risk for future exacerbations than the classic CB definition. SGRQ CB was at least a similar if not better predictor of future exacerbations than classic CB. [ABSTRACT FROM AUTHOR]

Background: We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful?Methods: We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading.Results: With respect to acute cough (< 3 weeks), only three studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. The subjects resided on three continents: North America, Europe, and Asia. With respect to subacute cough (duration, 3-8 weeks), only two studies met our criteria for quality assessment, and both had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were postinfectious cough and exacerbation of underlying diseases such as asthma, COPD, and upper airway cough syndrome (UACS). The subjects resided in countries in Asia. With respect to chronic cough (> 8 weeks), 11 studies met our criteria for quality assessment, and all had a high risk of bias. As predicted by the 2006 guidelines, the most common causes were UACS from rhinosinus conditions, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, combinations of these four conditions, and, less commonly, a variety of miscellaneous conditions and atopic cough in Asian countries. The subjects resided on four continents: North America, South America, Europe, and Asia.Conclusions: Although the quality of evidence was low, the published literature since 2006 suggests that CHEST's 2006 Cough Guidelines and management algorithms for acute, subacute, and chronic cough in adults appeared useful in diagnosing and treating patients with cough around the globe. These same algorithms have been updated to reflect the advances in cough management as of 2017. [ABSTRACT FROM AUTHOR]

In recent years, numerous studies have generated data supporting the hypothesis that extracellular adenosine 5'-triphosphate (ATP) plays a major role in obstructive airway diseases. Studies in animal models and human subjects have shown that increased amounts of extracellular ATP are found in the lungs of patients with COPD and asthma and that ATP has effects on multiple cell types in the lungs, resulting in increased inflammation, induction of bronchoconstriction, and cough. These effects of ATP are mediated by cell surface P2 purinergic receptors and involve other endogenous inflammatory agents. Recent clinical trials reported promising treatment with P2X3R antagonists for the alleviation of chronic cough. The purpose of this review was to describe these studies and outline some of the remaining questions, as well as the potential clinical implications, associated with the pharmacologic manipulation of ATP signaling in the lungs. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the effects of aerosolized adenosine 5'-triphosphate (ATP) in smokers and patients with chronic obstructive pulmonary disease (COPD). Topics discussed include the findings which suggest a potential mechanistic role for ATP in COPD and cough and a comparison between ATP and adenosine monophosphate (AMP).

The article discusses the case of a 19-year-old woman with asthma who was presented to the hospital due to a month-history of cough and progressive dyspnea. It notes that the patient has been sent to the operating room for an open biopsy of the mass detected at the right iliacus muscle that extends into the upper thigh. Tests results have led to the diagnosis of alveolar soft part sarcoma (ASPS). It describes ASPS as a rare soft-tissue tumor that is prevalent among adolescents and young adults.

The article focuses on a study on the long-term safety and efficacy of indacaterol in managing patients with chronic obstructive pulmonary disease (COPD). The study determines whether the long-acting β2-agonist (LABA) can still be effective beyond 12 weeks of treatment. It discusses results related to adverse events such as nasopharyngitis and cough. It concludes that indacaterol, taken once daily for a year, offers effective and sustained bronchodilation to COPD patients.

The article presents the study on the features associated with chronic cough and sputum production in patients with chronic obstructive pulmonary disease (COPD) in France. Researchers reviewed data from 17 university hospitals in the country. Results of the study found no significant difference between groups for age, body mass index and comorbidities. It was concluded that chronic cough and sputum production are linked with frequent COPD exacerbations.

The article evaluates the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of nonasthmatic eosinophilic bronchitis (NAEB). The results indicate that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of NO suggested little likelihood of NAEB for the nonasthamtic patients with chronic cough.

The article presents a case study of a 68-year-old man having chronic obstructive pulmonary disease (COPD) along with stage IV bladder cancer. For neutropenic fever, he was admitted to the hospital and he also complained of shortness of breath, cough with blood streaking and green sputum. Fever persisted despite therapy with broad-spectrum antibiotics and recovery of neutrophil counts.

The article reports on a study which has examined airway wall thickness by CT in adult patients with chronic cough. The study found that walls of central airways are thickened in patients with cough variant asthma (CVA). It has also been found in the study that cough hypersensitivity is a characteristic feature of chronic dry cough. It also shows that the increase of thickness in CVA group was greater than in nonasthmatic chronic cough group.

The article cites a study on the relationship between the objective monitoring with cough challenge and subjective assessments in Chronic Obstructive Pulmonary Disease (COPD) patients. The study established the relationship between the subjective assessment of cough and cough reflex sensitivity with the time spent coughing in COPD patients. The study indicated that cough monitoring in stable COPD can be used to define the correlation between objective coughing and cough-related quality of life.

The article studies the clinical applications of induced sputum as a noninvasive measure of airway inflammation. The identification of sputum eosinophilia has the greatest clinical value because it predicts a favorable response to corticosteroids and can therefore guide treatment. Protocols aimed at normalizing the sputum eosinophil count in asthma and chronic obstructive pulmonary disease management have markedly reduced exacerbations without an overall increase in therapy. The value of sputum may be used to direct novel antineutrophilic therapies.

The article presents information on uncommon causes of cough. It focuses on identification of substantial number of uncommon or rare pulmonary and nonpulmonary disorders. Cough leads to respiratory diseases such as asthma or bronchitis. Cough is characterized as the most common respiratory symptom encountered by clinicians. Chronic cough, defined as cough lasting for more than 8 weeks, may interfere with patients' normal daily activities. Tracheobronchomegaly is an uncommon disorder that includes dilatation of the tracheobronchial tree and recurrent bouts of bronchitis and lung infections.

The article analyzes the pathogenesis, natural history, diagnosis, and therapeutics of chronic cough due to nonasthmatic eosinophilic bronchitis. One of the common cause of chronic cough is nonasthmatic eosinophilic bronchitis. The condition is manifested as a corticosteroid-responsive chronic cough in nonsmokers without airway function abnormalities that characterize asthma. A further characterization of the condition has been made possible by the development of safe and noninvasive processes of examining airway inflammation using induced sputum.

The article presents evidence for the diagnosis and treatment of cough due to chronic bronchitis. Chronic bronchitis is a bronchi disease where there is occurrence of cough and sputum expectoration when other respiratory or cardiac causes for the chronic productive cough are not considered. It is a cough phlegm syndrome and is caused by the interplay of noxious inhaled agents host factors. This interaction results in chronic inflammation in the walls and lumen of the airways. Researchers have found that avoidance is the most effective way to reduce or eliminate cough in patients with chronic bronchitis.

The article describes the anatomy and neurophysiology of the cough reflex. Due to aspiration, the inhalation of particulate matter, pathogens, accumulated secretions, postnasal drip, inflammation, etc., cough occurs. An important protective role is played by cough in the airways and lungs. But cough may become excessive and nonproductive in diseases like asthma, lungs obstructive diseases, gastroesophageal reflux disease, and upper airway cough syndrome due to a variety of rhinosinus conditions.

This article presents information on a study to analyze the cough response and the management of asthma. Fifteen healthy subjects, 16 steroid-naive subjects with asthma, and 16 subjects with steroid-treated asthma were challenged with isotonic histamine, hypertonic saline solution, and hypertonic histamine. Hypertonic histamine challenge is a novel method for assessing airway responsiveness, and can be regarded as the combination of a direct and an indirect airway challenge. When analyzing the cough response to the challenges, special attention was paid to the degree of induced bronchoconstriction.

This article focuses on a study related to the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to gastroesophageal reflux disease (GERD) before and 3 months after laparoscopic Toupet fundoplication. GERD is among the most common causes of chronic cough in all age groups, exceeded in frequency only by postnasal drip syndrome and asthma. Moreover, chronic cough can be the sole presenting manifestation of GERD. However, up to 75% patients with GERD-induced cough may have no GI symptoms. In this preliminary study in a group of GERD patients with chronic cough before antireflux surgery, the researchers observed the relationship between subjective and objective evaluations of cough and means of CACT values.

Study objectives: To analyze the physiologic effects and tolerance of mechanical insufflationexsufflation (MI-E) for patients with chronic ventilatory failure of various etiologies. Design: Prospective clinical trial. Setting: Rehabilitation unit of a university hospital. Patients or participants: Thirteen patients with amyotrophic lateral sclerosis (ALS), 9 patients with severe COPD, and 7 patients with other neuromuscular disorders (oNMDs) with chronic airway secretion encumbrance and decreases in oxyhemoglobin saturation (SpO2). Interventions: Pressures of MI-E of 15 cm H2O, 30 cm H2O, and 40 cm H2O were cycled to each patient, with 3 s for insufflation and 4 s for exsufflation. One application was six cycles at each pressure for a total of three applications. Measurements and results: We continuously evaluated respiratory inductance plethysmography (RIP) and SpO2 during every application. Peak cough flow (PCF) and dyspnea (Borg Scale) were also measured before the first and after the last application. The technique was well tolerated in all patient groups. Median SpO2 improved significantly (p < 0.005) in all patient groups. Median PCF improved significantly (p ×< 0.005) in the ALS and oNMD groups from 170 to 200 L/min and from 180 to 220 L/min, respectively, and dyspnea improved significantly in the patients with oNMDs and patients with COPD from 3 to 1 and from 2 to 0.75, respectively. Breathing pattern characteristics (RIP) did not deteriorate after MI-E in any patient groups. Inspiratory flow limitation significantly decreased at the highest MI-E pressures for the ALS group. Conclusions: Our results confirm good tolerance and physiologic improvement in patients with restrictive disease and in patients with obstructive disease, suggesting that MI-E may be a potential complement to noninvasive ventilation for a wide variety of patient groups. [ABSTRACT FROM AUTHOR]

Study objectives: To define whether coughing during mannitol challenge is a nonspecific side effect of this challenge or is associated with asthma. Design: A prospective study. Setting: University hospital. Participants: Thirty-seven steroid-naive, asthmatic subjects and 10 healthy subjects. Measurements: The participants completed a symptom questionnaire, recorded peak expiratory flows (PEFs), and underwent spirometry, skin tests, and bronchial provocations with mannitol, histamine, and cold air. Seventeen of the asthmatic subjects were treated with budesonide, 800 µg per day, and the measurements were repeated after 3 and 6 months of treatment. Coughs were recorded during the mannitol challenges, and the cough sensitivity was expressed as the cumulative number of coughs divided by the cumulative dose of mannitol. Results: The asthmatic subjects coughed more during the mannitol challenge than the healthy subjects (8.3 coughs per 100 mg [95% confidence interval (CI), 6.2 to 11.0] vs 1.1 coughs per 100 mg [95% CI, 0.4 to 3.0]; p < 0.0001). Even those asthmatic subjects who did not develop bronchoconstriction after the maximal cumulative dose of mannitol (635 mg) coughed significantly more than the healthy subjects (53 coughs [95% CI, 34 to 72] vs 12 coughs [95% CI, 4 to 21]; p = 0.003). Budesonide treatment decreased the cough sensitivity (p = 0.023), which was significantly associated with improvements in overall symptom frequency, cough frequency, diurnal PEF variation, FEV1, and bronchial hyperresponsiveness. Conclusions: Coughing during mannitol challenge is associated with asthma and occurs independently of bronchoconstriction. It can be used to study the mechanisms of asthmatic cough. Furthermore, the measurement of the mannitol-provoked coughing may be useful both in the diagnosis of asthma as well as in the assessment of the effects of an anti-inflammatory therapy on this common disorder. [ABSTRACT FROM AUTHOR]

Background: A patient report of respiratory symptoms in COPD is essential to successfully monitoring disease, adjusting treatment, and evaluating outcomes. Objective: To develop empirically based guidelines for interpreting mean changes in symptom scores using the Breathlessness, Cough, and Sputum Scale (BCSS). Methods: Analyses were performed on data from three multinational trials (n = 2,971). Mean changes in BCSS score with treatment were examined by physician and patient ratings of treatment efficacy, juxtaposed with percentage change in symptoms, statistical effect size (ES), ΔFEV[sub 1], and change in St. George Respiratory Questionnaire (SGRQ) score. BCSS scores during an exacerbation were examined relative to changes in peak expiratory flow and rescue medication use. Results: Mean baseline BCSS total score was 5.2 ± 2 (± SD); 90% of scores were between 2 and 9. Highly efficacious treatment (n = 257; physician rating) was associated with a ΔBCSS total score of -1.3 ± 1.8, representing a 24% improvement (ES = 0.7), and corresponding to a 10% improvement in FEV[sub 1] and ΔSGRQ score total of -10.3 ± 13.8. Similar changes in BCSS score were observed during recovery from an exacerbation (n = 713; -1.3 ± 1.8). Mean change with moderately efficacious treatment (n = 965) was -0.7 ± 1.8, a 13% improvement (ES = 0.3) corresponding to ΔSGRQ total score of -6.8 ± 12.6. Mildly efficacious treatment (n = 891) was associated with a change of -0.35, a 7% improvement (ES = 0.18), with a ΔFEV[sub 1] <1% and ΔSGRQ total score of -2.6 ± 11.7. Conclusions: Patient-reported daily symptom data are sensitive to change and useful for both observational studies and controlled clinical trials of patients with COPD. A mean ΔBCSS total score >1.0 represents substantial symptomatic improvement, changes of approximately 0.6 can be interpreted as moderate, and changes of 0.3 can be considered small. [ABSTRACT FROM AUTHOR]

Background: There are several reports showing that expiratory muscle strength and endurance can be impaired in patients with COPD. This muscle weakness may have clinically relevant implications. Expiratory muscle training tended to improve cough and to reduce the sensation of respiratory effort during exercise in patients other than those with COPD. Methods: Twenty-six patients with COPD (FEV[sub 1] 38% predicted) were recruited for the study. The patients were randomized into two groups: group 1, 13 patients were assigned to receive specific expiratory muscle training (SEMT) daily, six times a week, each session consisting of 1/2 h of training, for 3 months; and group 2, 13 patients were assigned to be a control group and received training with very low load. Spirometry, respiratory muscle strength and endurance, 6-min walk test, Mahler baseline dyspnea index (before), and the transitional dyspnea index (after) were measured before and after training. Results: The training-induced changes were significantly greater in the SEMT group than in the control group for the following variables: expiratory muscle strength (from 86 ± 4.1 to 104 ± 4.9 cm H[sub 2]O, p < 0.005; mean difference from the control group, 24%; 95% confidence interval, 18 to 32%), expiratory muscle endurance (from 57 ± 2.9% to 76 ± 4.0%, p < 0.001; mean difference from the control group, 29%; 95% confidence interval, 21 to 39%), and in the distance walked in 6 min (from 262 ± 38 to 312 ± 47 m, p < 0.05; mean difference from the control group, 14%; 95% confidence interval, 9 to 20%). There was also a small but not significant increase (from 5.1 ± 0.9 to 5.6 ± 0.7, p = 0.14) in the dyspnea index. Conclusions: The expiratory muscles can be specifically trained with improvement of both strength and endurance in patients with COPD. This improvement is associated with increase in exercise performance and no significant change in the sensation of dyspnea in daily activities. [ABSTRACT FROM AUTHOR]

The article presents abstracts of the poster presentations at the Chest 2006 conference about cough. They include "Dysphagia Associated With Persistent Cough," "The Management of Chronic Cough in a Tertiary Care Center: An Asian Perspective," and "Characterization of Lower Respiratory Tract Inflammation and Its Relationship With Computerized Tomographic Findings in Bronchial Asthma."

Presents a case of obstructive lung disease with chronic cough and exertional dyspnea. Findings of the fiberoptic bronchoscopy; Findings of the thoracic computed tomography; Prevalence of tracheobronchomalacia; Inspection of the flow-volume loop.