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Highlights • Cough is a cardinal symptom in COPD and increases during exacerbation. • Cough and sputum production are associated with adverse outcomes in COPD. • Smoking, inflammation, neurogenic factors and comorbidities impact cough in COPD. • Detection of increased cough frequency may prove a useful predictor of exacerbation. Abstract Chronic obstructive pulmonary disease is predicted to become the 4th leading cause of death worldwide by 2030. The natural history of the disease includes progressive symptoms punctuated by acute exacerbations during which symptoms rapidly deteriorate. The resulting disability places significant burden on health and social care systems. Cough is the second most common symptom reported by COPD patients, is a source of significant distress and is associated with adverse outcomes. We discuss the importance of cough in COPD, its mechanism and the relationship between cough and COPD exacerbations. We review the literature and present original data relating to the investigation of cough during COPD exacerbation, its associations and potential benefits of cough monitoring. [ABSTRACT FROM AUTHOR]

Tracheobronchomalacia (TBM) is dynamic collapse of the trachea and bilateral mainstem bronchi leading to dyspnea, cough, and recurrent pneumonias. TBM is reported in 10-15% of patients with chronic obstructive pulmonary disease (COPD). Patients with TBM and COPD are not candidates for lung transplant, as TBM will still result in dynamic obstruction of the new allografts. A 70 year old male patient was diagnosed with COPD in 2012 and started on oxygen in 2019. He had worsening dyspnea with a chronic cough, presenting for lung transplant evaluation in 2022. His chest CT showed partial collapse of the right upper lobe, prompting a bronchoscopy notable for severe TBM (Figure 1A). His sputum culture was positive for stenotrophomonas and strep. pneumoniae, which were treated with antibiotics. He was listed for bilateral lung transplant with plan for concurrent tracheobronchoplasty (TBP). Once a suitable allograft was accepted, he was placed in left lateral decubitus position and a right posterolateral thoracotomy was used for the TBP with prolene mesh, which extended from proximal trachea to the mid bilateral mainstem bronchi. Next, the right pneumonectomy and lung transplant was performed with the bronchial anastomosis just distal to the end of the mesh. The thoracotomy was closed, and the patient was placed supine. The left lung transplant was performed via a left anterolateral thoracotomy. The initial P/F ratio was 532 mmHg. He was extubated on postoperative day (POD) 1, and on room air on POD 2. He was discharged on POD 13. A follow up bronchoscopy at 1 month showed resolution of his prior TBM (Figure 1B) with patent bilateral anastomoses. This report is the first known case of combined TBM and lung transplant. For patients with end-stage COPD and TBM, a combined TPS and bilateral lung transplant is technically feasible and safe. [ABSTRACT FROM AUTHOR]