Abstract
BackgroundChronic cough is a common condition, but some patients have no evident medical explanation for their symptoms. A group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin. Chronic cough is usually a prominent symptom in these patients, and it has been suggested that they suffer from sensory hyperreactivity.Our main aim was to analyse, in a group of patients with chronic cough, the presence of symptoms induced by environmental factors such as chemicals, scents, and cold air, and to measure the social and emotional influences of these symptoms in relation to quality of life. A second aim was to pilot-test a Swedish translation of a cough-specific questionnaire.MethodsA total of 119 patients with chronic cough were asked to answer three different questionnaires: a local symptom questionnaire, the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), and the Nottingham Health Profile (NHP). In addition, a Swedish version of the Hull Airway Reflux Questionnaire (HARQ) was developed and answered by a subgroup of patients and healthy controls.ResultsSixty-two patients (52%) with mean cough duration of 10.6 years answered the local symptom questionnaire, the CSS-SHR, and the NHP. Of these, 39 (63%) claimed to have cough and other symptoms induced by chemicals and scents. Compared to population-based findings, the patients scored higher on the CSS-SHR, and the CSS-SHR score was significantly higher among chemical-sensitive individuals (p < 0.001). The NHP showed that the patients had a significantly reduced quality of life, which was most pronounced among chemical-sensitive individuals. The 31 patients who answered the HARQ had significantly higher scores (p < 0.0001) than 59 healthy controls.ConclusionsAmong patients with chronic cough, a majority claimed that environmental factors induced coughing. Both the CSS-SHR and the HARQ score systems seem to be valuable instruments in the mapping of cough patients, supporting the novel paradigm of a cough hypersensitivity syndrome. Our results emphasize that cough is a substantial burden to the patient, influencing daily living and quality of life.
Highlights
Chronic cough is a common condition, but some patients have no evident medical explanation for their symptoms
A discrete clinical entity has been suggested for patients with such chronic cough in combination with increased capsaicin cough sensitivity, in which the cough is often triggered by environmental stimuli, and the cough initially developed after an upper respiratory tract infection [7]
A similar group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin; it has been suggested that these patients suffer from sensory hyperreactivity (SHR) [9,10]
Summary
Chronic cough is a common condition, but some patients have no evident medical explanation for their symptoms. A group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin. A similar group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin; it has been suggested that these patients suffer from sensory hyperreactivity (SHR) [9,10]. The Hull Airway Reflux Questionnaire (HARQ) was developed by Morice et al to identify coughers, with a novel paradigm for understanding chronic cough [11] This paradigm, the ‘cough hypersensitivity syndrome’, includes patients with symptoms that may indicate a reflux disease, such as patients with a general hypersensitivity towards, for example, environmental irritants. The patients are classified as having a cough hypersensitivity syndrome that comprises both sensitivity to environmental irritants and augmented capsaicin cough response [12,13,14]
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