Abstract
BackgroundChronic sputum production in the general population is historically associated with clinical indices including male sex and smoking history. However, its relationship with gastroesophageal reflux disease (GERD), which may prove an underlying factor in sputum production, is unclear. We aimed to clarify factors associated with sputum production in the general population in cross-sectional and longitudinal manners.MethodsIn the Nagahama study, a community-based cohort study, 9804 subjects were recruited between 2008 and 2010 (baseline assessment), 8293 of whom were followed from 2013 to 2015 (follow-up assessment). This study contained a self-completed questionnaire which included medical history, assessment of sputum production, and a frequency scale for symptoms of GERD. A Frequency Scale for Symptoms of Gastroesophageal Reflux Disease score of ≥ 8 was defined as GERD. In addition to the frequency of sputum production at each assessment, frequency of persistent sputum production defined as sputum production at both assessments was examined.ResultsFrequency of sputum production was 32.0% at baseline and 34.5% at follow-up. Multivariable analysis demonstrated that sputum production at baseline was significantly associated with GERD [odds ratio (OR), 1.92; 95% confidence interval (CI) 1.73–2.13] and post-nasal drip (PND) (OR, 2.40; 95% CI 2.15–2.68), independent of other known factors such as older age, male sex and smoking history. These associations between sputum production and GERD or PND were also observed at follow-up. In longitudinal analysis, 19.4% had persistent sputum production and 12.3% had transient sputum production, i.e., at baseline only. Multivariable analysis for risk of persistence of sputum production revealed that persistent sputum production was associated with GERD and PND, in addition to the known risk factors listed above. The proportion of subjects with GERD at both assessments was highest among subjects with persistent sputum production.ConclusionsCross-sectional and longitudinal analysis demonstrated an association in the general population between sputum production and GERD, as well as PND, independent of known risk factors. The presence of GERD should be assessed in patients complaining of sputum production.
Highlights
Chronic sputum production is a troublesome symptom associated with respiratory diseases and is reported in the general population [1, 2], with a prevalence ranging from 1.2 to 11.9%
Subjects who complained of sputum production at baseline had a higher frequency of known risk factors including older age, male sex, smoking history, chronic obstructive pulmonary disease (COPD), asthma, and sinusitis than those who did not (Table 2)
gastroesophageal reflux disease (GERD) was significantly associated with sputum production [odds ratio (OR), 1.92; 95% confidence interval (CI) 1.73– 2.13], which was independent of the known risk factors listed above
Summary
Chronic sputum production is a troublesome symptom associated with respiratory diseases and is reported in the general population [1, 2], with a prevalence ranging from 1.2 to 11.9%. Chronic sputum production may Morimoto et al Respir Res (2021) 22:6 be defined as sputum production lasting for at least 3 months per year for more than 1 year. In developed countries, including Japan, air pollution has improved and smoking prevalence has decreased [3], which may have changed the epidemiology and risk factors of sputum production over the last few decades. According to previous epidemiological studies, male sex, smoking history, and low socioeconomic status [1, 2, 4] are the established risk factors for sputum production. We aimed to clarify the factors associated with sputum production in the general population, focusing on the effects of GERD in both cross-sectional and longitudinal manners. Chronic sputum production in the general population is historically associated with clinical indices including male sex and smoking history. We aimed to clarify factors associated with sputum production in the general population in cross-sectional and longitudinal manners
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