Chronic Cough Group Research Articles

Validity and Reliability of the Arabic Cough Severity Index.

This study aimed to translate and validate the Cough Severity Index (CSI) into Arabic (A-CSI) and to evaluate its validity and reliability among patients with chronic cough. This cross-sectional descriptive questionnaire-based validation study was conducted at two tertiary hospitals in Riyadh, Saudi Arabia, between December 2023 and August 2024. The CSI was translated from English into Arabic using the forward-backward method. Its reliability was assessed using Cronbach's alpha and test-retest reliability. Its construct validity was assessed using exploratory factor analysis (EFA), and its internal consistency was assessed using Cronbach's alpha. Its discriminant validity was determined using the Mann-Whitney U test, and its reproducibility was evaluated using the intraclass correlation coefficient (ICC). Data were collected from 100 participants, 50 with chronic cough and 50 healthy controls. The mean age was 41.56 ± 14.28 years in the chronic cough group and 35.48 ± 10.02 years in the healthy control group. The A-CSI exhibited high reproducibility (ICC = 0.896) and excellent internal consistency (Cronbach's alpha = 0.966). EFA identified three factors explaining 66.41% of the variance, with all items having communalities > 0.3. The A-CSI exhibited significant discriminant validity between the chronic cough and healthy control groups (p < 0.001). The A-CSI is a reliable and valid tool for assessing chronic cough in Arabic-speaking patients, making it suitable for both clinical practice and research. Level 3.

Prescription patterns and symptom relief of antitussives and expectorants in patients with cough: a nationwide study in Korea.

Limited data are available on the prescription patterns and efficacy of antitussives and expectorants for patients with acute and chronic cough. This study examined the use and efficacy of these medications in a nationally representative sample of Korean patients. We examined 4,206,016 individuals from the National Health Insurance Service (NHIS)-National Health Information Database (NHID) between 2015 and 2017. Among them, a sample of 10% (n=420,602) was retrieved for the diagnosis of respiratory diseases using the International Classification of Diseases, 10th edition (ICD-10; J00-J99), or the prescription of antitussives and expectorants for cough (ICD-10; R05). The acute cough group included those who were prescribed medications within 4 weeks of initial diagnosis (prescription within 14 days), whereas the chronic cough group included patients who were prescribed medications within 16 weeks of initial diagnosis (prescription within 56 days). If the prescription was discontinued or not changed to an alternative drug after the initial prescription, these cases were considered to have achieved symptom relief. This study included 288,460 patients (971,065 cases) with acute cough and 5,888 patients (15,399 cases) with chronic cough. 'Expectorants, excluding combinations with cough suppressants' had the highest prescription rates in both groups (acute cough, 63.8%; chronic cough, 61.7%), and showed the highest symptom relief regardless of the number of medications prescribed (acute cough, 84.3%; chronic cough, 70.4%). 'Expectorants, excluding combinations with cough suppressants' were the most prescribed and effective medications for relieving cough symptoms in Korea patients. Further studies are needed to determine the optimal duration for using antitussives and expectorants in cough management.

Investigation of pepsin levels in bronchial lavage in patients with interstitial lung disease and chronic cough

AimPepsin is an enzyme that helps digest protein secreted only from the gastric chief cell in an inactive state. Pepsin is a good marker for acidic gastroesophageal reflux (GER). Its presence in sputum or saliva is considered pathologic. In GER, cough is stimulated by broncho-esophageal neurogenic reflex and aspiration of gastric contents into the airways. GER is the most common cause of cough. Gastric acid reflux is also thought to play a role in Interstitial Lung Disease (ILD) etiology. In many studies, pepsin and bile acid levels in bronchial lavage were high in patients with interstitial lung disease and chronic cough. In our study, we aimed to evaluate pepsin levels in bronchial lavage in patients with ILD and chronic cough and to investigate the relationship between symptoms and reflux treatment. MethodsBetween January 2021 and February 2022, 212 patients who underwent bronchoscopy in our tertiary clinic were evaluated. These patients were divided into three groups: 52 patients with interstitial lung disease, 81 patients with chronic cough, and 79 patients who underwent bronchoscopy with a pre-diagnosis of lung cancer as the control group. Bronchial lavage obtained by bronchoscopy was analyzed for pepsin levels. ResultsShortness of breath and cough were the most common symptoms in all three groups. Pepsin levels were 16.71 ± 8.6 ng/ml in the chronic cough group, 15.6 ± 8.9 ng/ml in the ILD group, and 10.58 ± 5.4 ng/ml in the lung cancer (control) group. Pepsin levels in the ILD and chronic cough group were statistically significantly higher than in the lung cancer group (p:0.00). There was no statistical difference between the ILD group and the chronic cough group regarding pepsin levels. It was found that pepsin levels were lower in the three groups who received anti-reflux treatment. There was no difference in pepsin levels between ILD subgroups. ConclusionPepsin levels in bronchial lavage were higher in the ILD and chronic cough groups. This suggests that reflux may be involved in the etiology of chronic cough and ILD. Low pepsin values in patients receiving anti-reflux therapy have shown that occult reflux may occur. In our study, the high level of pepsin in bronchial lavage, especially in the chronic cough and ILD group, may be instructive in the etiology and treatment planning of the disease.

Associations between abnormal sleep behavior and indoor environmental risk factors among children with a chronic cough in Wuxi, China: a cross-sectional study

BackgroundIndoor environmental factors, such as pet ownership, presence of cockroaches, mattress quality, fuel usage (gas or electricity), use of biomass for cooking and heating, exposure to tobacco smoke or household molds can significantly affect the sleep quality of children with chronic cough. However, data regarding the effects of indoor environmental conditions on sleep in this population are limited. This study aimed to assess the prevalence of abnormal sleep behaviors and to establish associations between indoor environmental factors and sleep behaviors among children with chronic cough in Wuxi, China.MethodsA cross-sectional design was employed in this study, involving children aged 3–18 years. Data on sociodemographic factors, allergies, home environmental exposures, and sleep characteristics of the participants were collected using paper-based questionnaires. The association between indoor environmental factors and sleep behaviors in children with chronic cough was analyzed using logistic regression models.ResultsThe findings demonstrated that the prevalence of chronic cough among children in Wuxi was 15.50%. The chronic cough group exhibited a significantly higher incidence of eczema, wheezing, rhinitis, food allergy, and nasosinusitis than the non-chronic cough group. In addition, children with chronic cough also tended to have a family history of sleep disorders and adenoid hypertrophy (P < 0.01). After adjusting for confounding factors, a significant association was observed between bruxism (teeth grinding) and chronic cough (sometimes: odds ratio [OR] = 1.04; confidence interval [CI] = 1.01–1.08; always: OR = 1.11; CI = 1.04–1.19; P < 0.01). Among children with chronic cough, recent home decoration was associated with sleepwalking (OR = 1.04; CI = 1.00–1.07; P < 0.05), mold exposure was associated with bruxism (OR = 1.15; CI = 1.0–1.31; P < 0.05), and carpet use at home was associated with apnea (OR = 1.09; CI = 1.02–1.17; P < 0.05), twitching during sleep (OR = 1.13; CI = 1.00–1.27; P < 0.01) and morning headache (OR = 1.14; CI = 1.05–1.23; P < 0.01).ConclusionChildren with chronic cough are more prone to some abnormal sleep behaviors than children without chronic cough. Household decoration within a year, household mold exposure, and carpet use were all significantly positively associated with abnormal sleep behaviors in children with chronic cough. Our study provides novel insights into the impact of the indoor environment on children’s sleep and the occurrence of chronic cough, offering guidance for tailored health promotion programs for families.

Epidemiological Investigation of Chronic Cough in Chongqing

Objective to investigate the incidence and risk factors of chronic cough in Chongqing urban residents aged 18-80 years. Methods a questionnaire was designed, and the incidence and related data of chronic cough among residents aged 18-80 years in Chongqing urban area were statistically analyzed in the form of community field questionnaire. Results a total of 1851 questionnaires were used, of which 1804 were valid. The total incidence of chronic cough was 11.64%, Before the prevalence of covid-19, it was 10.65%, The prevalence of covid-19 was 12.14%. Multivariate analysis of chronic cough showed that the patients were 50 years old or older (or=2.063, 95% CI 1.476-2.883, P&lt;0.05), P&lt;0.05), Senior high school and below (or=0.601, 95% CI 0.430-0.840, P&lt;0.05), 497, 95% CI 1. 784-3. 494, P&lt;0.05), Smoking (or=2.055, 95% CI 1.465-2.882, P&lt;0.05), P&lt;0.05), Drinking (or=2.415, 95% CI 1.692-3.446, P&lt;0.05), P&lt;0.05), Infection with covid-19 (or=1.902, 95% CI 1.387-2.608, P&lt;0.05), P&lt;0.05) the incidence of chronic cough in residents was significantly increased. Multivariate analysis of the severity of chronic cough showed that the risk of severe chronic cough in patients aged 50 years and over was 3.584 times higher than that in patients aged less than 50 years (or=3.584, 95% CI 1.304-9.846, P&lt;0.05), P&lt;0.05), Secondly, the influence of season on cough severity was also statistically significant (or=3.689, 95% CI 1.233-11.038, P&lt;0.05), P&lt;0.05). Multiple correspondence analysis (MCA) of chronic cough related factors showed that the severity of cough was moderately correlated with the impact on life and mood. Conclusion the incidence of chronic cough during the epidemic period of new coronavirus is increased. The incidence of chronic cough is higher in residents aged 50 and above, with lower education (high school and below), smoking and drinking, complicated with chronic respiratory diseases, and infected with covid-19. Chronic cough in patients aged 50 years and above is more serious, and chronic cough significantly affects the daily life and mood of residents. It is necessary to pay attention to the chronic cough group and get timely and effective diagnosis and treatment.

Interaction effect of chronic cough and ageing on increased risk of exacerbation in patients with asthma: a prospective cohort study in a real-world setting.

Older adults with asthma have the greatest burden and worst outcomes, and there is increasing evidence that chronic cough (CC) is associated with asthma severity and poor prognosis. However, the clinical characteristics of older adult patients with both asthma and CC remain largely unknown. Participants with stable asthma underwent two cough assessments within 3 months to define the presence of CC. Patients were divided into four groups based on CC and age (cut-off ≥60 years). Multidimensional assessment was performed at baseline, followed by a 12-month follow-up to investigate asthma exacerbations. Logistic regression models were used to explore the interaction effect of CC and age on asthma control and exacerbations. In total, 310 adult patients were prospectively recruited and divided into four groups: older CC group (n=46), older non-CC group (n=20), younger CC group (n=112) and younger non-CC group (n=132). Compared with the younger non-CC group, the older CC group had worse asthma control and quality of life and increased airflow obstruction. The older CC group showed an increase in moderate-to-severe exacerbations during the 12-month follow-up. There was a significant interaction effect of CC and ageing on the increased moderate-to-severe exacerbations (adjusted risk ratio 2.36, 95% CI 1.47-3.30). Older asthma patients with CC have worse clinical outcomes, including worse asthma control and quality of life, increased airway obstruction and more frequent moderate-to-severe exacerbations, which can be partly explained by the interaction between CC and ageing.

Predictors of treatment response to pregabalin in unexplained or refractory chronic cough

BackgroundPatients with chronic cough (>8 weeks) often remain symptomatic after appropriate investigations and therapeutic trials. Prior research has shown a benefit in certain individuals from pregabalin, but clinical improvement is quite unpredictable and variable. ObjectiveThe main objective of this study was to identify the demographic and clinical characteristics associated with a higher likelihood of cough improvement with a trial of pregabalin therapy. Methods50 consecutive patients with chronic cough were enrolled in this prospective cohort study. Subjects were prescribed pregabalin 75 mg oral qhs for 4 weeks followed by 75 mg oral bid. Leicester Cough Questionnaire (LCQ) was completed at treatment initiation and after 3 months of therapy. A comparison was performed between treatment responders (LCQ total score improvement ≥1.3) and non-responders. Results56% of patients reported a LCQ total score improvement ≥1.3 (minimal clinically important difference). Responders to pregabalin therapy were more likely to have refractory (with underlying pulmonary disease) versus unexplained chronic cough (p = 0.01). Patients with significant improvement were also on average more symptomatic at baseline (mean LCQ total score 10.2 versus 13.0, p < 0.01). No significant relationship was identified with age, gender, body mass index, history of anxiety and/or depression, cigarette smoking history, or cough duration (p > 0.05). The unexplained chronic cough group had a strong female predominance (85.7% versus 40.9% for refractory cough, p < 0.01). ConclusionThis is the first study that has investigated clinical predictors of treatment response to pregabalin in chronic cough patients. Further research is needed to develop therapies for subjects who do not improve with currently available neuromodulating medications.

Atypical Activation of Laryngeal Somatosensory-Motor Cortex During Vocalization in People With Unexplained Chronic Cough

Unexplained chronic cough is common and has substantial negative quality-of-life implications, yet its causes are not well understood. A better understanding of how peripheral and central neural processes contribute to chronic cough is essential for treatment design. To determine if people with chronic cough exhibit signs of abnormal neural processing over laryngeal sensorimotor cortex during voluntary laryngeal motor activity such as vocalization. This was a cross-sectional study of a convenience sample of participants with chronic cough and healthy participants. Testing was performed in an acoustically and electromagnetically shielded chamber. In a single visit, electroencephalographic (EEG) signals were recorded from participants with chronic cough and healthy participants during voice production. The chronic cough group participants presented with unexplained cough of 8 weeks or longer duration with prior medical evaluation including negative results of chest imaging. None of the participants had a history of any neurologic disease known to impair vocalization or swallowing. Data collection for the healthy control group occurred from February 2 to June 28, 2018, and for the chronic cough group, from November 22, 2021, to June 21, 2022. Data analysis was performed from May 1 to October 30, 2022. Participants with or without chronic cough. Event-related spectral perturbation over the laryngeal area of somatosensory-motor cortex from 0 to 30 Hz (ie, θ, α, and β bands) and event-related coherence as a measure of synchronous activity between somatosensory and motor cortical regions. The chronic cough group comprised 13 participants with chronic cough (mean [SD] age, 63.5 [7.8] years; 9 women and 4 men) and the control group, 10 healthy age-matched individuals (mean [SD] age, 60.3 [13.9] years; 6 women and 4 men). In the chronic cough group, the typical movement-related desynchronization over somatosensory-motor cortex during vocalization was significantly reduced across θ, α, and β frequency bands when compared with the control group. This cross-sectional study found that the typical movement-related suppression of brain oscillatory activity during vocalization is weak or absent in people with chronic cough. Thus, chronic cough affects sensorimotor cortical activity during the asymptomatic voluntary activation of laryngeal muscles.

Impact of high-risk of obstructive sleep apnea on chronic cough: data from the Korea National Health and Nutrition Examination Survey

BackgroundChronic cough is an extremely common clinical symptom of various diseases. However, the relationship between obstructive sleep apnea (OSA) and chronic cough in the general population has not been sufficiently studied.MethodsUsing the 2019 Korean National Health and Nutrition Examination Survey data, we identified a group at high-risk of OSA via the STOP-Bang questionnaire and determined the association between OSA and chronic cough by a regression model.ResultsOf the eligible 4,217 participants, 97.1% and 2.9% were classified into the non-chronic cough and chronic cough groups, respectively. The chronic cough group had higher STOP-Bang scores than those of the group without chronic cough (2.32 ± 1.38 vs. 2.80 ± 1.39; P < 0.001). In the group at high-risk of OSA, 40.4% and 52.0% of participants scored ≥ 3 in STOP-Bang, depending on the absence or presence of chronic cough (P = 0.012), respectively. Chronic cough independently correlated with impaired lung function (forced expiratory volume in one second ≥ 50–<80% predicted value, P = 0.001; <50, P < 0.001), low household income (P = 0.015), and a group at high-risk of OSA (STOP-Bang score 3–4, P = 0.004; 5–8, P < 0.001). Obesity I had a protective role against the occurrence of chronic cough (P = 0.023).ConclusionA high-risk for OSA is a significant risk factor for chronic cough. OSA should be considered when evaluating chronic cough patients.

Study on the Relationship Between Bronchoalveolar Lavage Fluid Cell Count, Th1/Th2 Cytokines and Pulmonary Function in Patients with Cough Variant Asthma

This study aimed to compare lung function and airway inflammation among cough variant asthma (CVA), chronic cough and classical asthma (CA) and investigate the relationship between these indicators and their possible mechanisms of action in the progression of CVA to CA. 36 patients with chronic cough, 39 patients with CA, and 57 patients with CVA were included in this study. Pulmonary function tests, bronchial provocation tests and FeNO tests were performed. The patients' bronchoalveolar lavage fluid (BALF) was collected, the cells in BALF were counted, and the levels of Th1 and Th2 cytokines were detected. The neutrophils, lymphocytes, and eosinophils in BALF in the CA and CVA groups were significantly higher than those in the chronic cough group. Also, they were negatively correlated with FEV1, FVC, and FEV1/FVC and positively correlated with IgE and FeNO. The expression of Th2-related cytokines was increased in CVA and CA patients, and it was positively correlated with FEV1, FVC and FEV1/FVC and negatively correlated with IgE and FeNO, while the results of Th1-related cytokines were the opposite of those for Th2-related cytokines. CVA differs from asthma and chronic cough in terms of Th1/Th2 cytokines and lung function and provides a reference for understanding the disease mechanism of early clinical progression of CVA to CA.

Chronic cough in asthma is associated with increased airway inflammation, more comorbidities, and worse clinical outcomes.

Background: Cough is often the most prominent and intractable symptom reported by patients with asthma, but few studies have explored the characteristics of patients with asthma and with chronic cough (CC) in a real-world setting. Methods: In a prospective cohort study, patients ages ≥ 18 years with stable asthma were consecutively recruited at the West China Hospital, Sichuan University. The patients were classified as having asthma with CC (the CC group) or asthma with non-CC (the non-CC group) after 3 months of optimized asthma therapy according to standard guidelines. Multidimensional assessment was performed at baseline, followed by a 12-month follow-up to assess asthma exacerbations. Results: Of 323 patients with asthma, 127 patients were assigned to the CC group and 196 patients were assigned to the non-CC group. The participants with CC were older and had more airflow obstruction; worse asthma control and quality of life; increased airway inflammation; upper respiratory tract infection as a trigger; and more comorbidities, such as psychological dysfunction, rhinitis, chronic obstructive pulmonary disease, and bronchiectasis. They reported greater work productivity loss and daily activity impairment, and increased moderate-to-severe exacerbations. Conclusion: The participants with asthma and with CC had a significant disease burden, with increased exacerbations, health-care utilization, and impaired work productivity and daily activity. These observations indicated potential clinical implications in patients with asthma and with CC, and call for more attention to this aspect of asthma.

Cough Severity Index: Validation in Brazilian Portuguese

To develop a validity profile for the cough severity index in the Brazilian Portuguese language (CSI-Br). The study sample consisted of 100 participants divided into Chronic Cough Group (CG; 50 individuals with a mean age of 46.4; standard deviation [SD]: 11.7) and Healthy Control Group (HCG; 50 individuals with a mean age of 33.0 [SD: 12.3]). The data collection procedures were as follows: (a) application of CSI-Br for all participants; (b) application of the Voice Handicap Index (VHI)-10 and the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ-Br) in the CG; (c) application of CSI-Br for test-retest reliability with an interim of between 2-14 days. The CSI-Br validation was composed of five stages: construct validity, reliability, reproducibility, convergent validity, and discriminant validity. In construct validity, the instrument identified two factors and explained 67.6% of the total variance. The reliability had a value of a=0.914. Reproducibility showed an ICC value of 0.909. CSI-Br showed a negative correlation with VHI-10 and a positive correlation with LHQ-Br in convergent validity. In discriminant validity, all items and factors differentiated participants in the CG from those in the HCG. The ten-item CSI-Br with two factors is reliable and valid for analyzing the severity of chronic cough symptoms in Brazilian individuals.

Effect of Chronic Cough on Voice Measures in Patients With Dysphonia

Measuring the impact of chronic cough on voice quality can be difficult and challenging in daily practice. Evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We hypothesized that the presence of chronic cough plays a role in patients' perception of dysphonia severity, leading to a mismatch between the subjective, objective, and perceptual evaluations. A retrospective chart review involving patients with a diagnosis of dysphonia and a complete speech voice evaluation was performed. A total of 311 patients were stratified into two different groups according to the presence of chronic cough. A total of 151 patients were assigned to the dysphonia and chronic cough group, while 160 patients were assigned to the dysphonia only group. During the initial evaluation, patients completed the Voice Handicap Index (VHI)-30, Glottal Function Index (GFI), and Reflux Symptoms Index (RSI). Voice evaluation also included aerodynamic/acoustic measures and the application of the GRBAS scale by a speech-language specialist. A paired t test and a linear regression analysis were used to compare subjective, perceptual, and aerodynamic/acoustic measures in both groups. The mean VHI-30 and GFI were elevated in both groups but significantly lower among patients with dysphonia and chronic cough when compared to patients with dysphonia only (P= 0.01). Additionally, a significantly higher RSI was found among patients with dysphonia and chronic cough (P< 0.01). No difference in aerodynamic/acoustic measures was found between groups (P> 0.05). Our linear regression model demonstrated a significant effect of the presence of chronic cough on the VHI-30, RSI, and GFI questionnaires (P< 0.05). Our model also found that the VHI-30 is a significant predictor for the (G), (B), (A), and (S) components of the GRBAS scale (P< 0.05). The presence of chronic cough has a significant impact on the different patient-reported outcome measures, including VHI-30, RSI, and GFI. The use of VHI-30 as a predictor for the GRBAS scale reinforces the importance of subjective and perceptual assessment among patients with voice disorders and establishes a new area for exploration.

&lt;em&gt;Helicobacter&amp;nbsp;pylori&lt;/em&gt; is associated with weakened pulmonary function and reduced incidence of allergic conditions in patients with chronic cough

The present study aimed to investigate the potential association between Helicobacter pylori (a H. pylori) positive state and chronic cough. A clinical observational study with systematic analysis was performed, including 278 patients with complaints of chronic cough and 148 healthy controls. a H. pylori positive state was present in 61.2% of the patients in the chronic cough group and 68.9% in the chronic refractory cough group, as opposed to 43.9% in the control group. There was a significant improvement in 65.5% of the patients with chronic refractory cough following successful a H. pylori eradication therapy. In addition, patients with chronic cough exposed to a H. pylori exhibited decreased pulmonary function with a decrease in forced expiratory volume in 1 sec by 84 ml, a decrease in the forced vital capacity by 53 ml and a decrease in maximal vital capacity by 46 ml. The difference was even more obvious in the chronic refractory cough group. The allergy status differed significantly according to age between a H. pylori-positive and -negative cases in the cough variant asthma and allergic cough groups. Among patients aged <40 years, a H. pylori-positive cases had a lower prevalence of atopy and lower total serum immunoglobin E levels compared with a H. pylori-negative cases. However, there was no significant association between a H. pylori status and C-reactive protein levels, erythrocyte sedimentation rate or eosinophil count in the peripheral blood. In conclusion, the present study demonstrated that a H. pylori infection may be a factor associated with chronic cough and it may be associated with a decline in pulmonary function and reduced incidence of allergic conditions. Thus, a H. pylori may represent a target for the treatment of chronic cough.

Prevalence and Characteristics of Chronic Cough in Adults Identified by Administrative Data.

International Classification of Diseases-9/10 codes for chronic cough (CC) do not exist, limiting investigation. To develop a computerized algorithm to determine CC prevalence and its characteristics. 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. Prevalence of CC and comparison of clinical characteristics between specialist-diagnosed and event-diagnosed CC subgroups. 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. 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.

378 Resting Upper Esophageal Sphincter Pressure Is Elevated in Proton Pump Inhibitor-Refractory Chronic Cough Patients and May Be a Marker for Laryngeal Hypersensitivity

INTRODUCTION: Chronic cough is difficult to treat when unresponsive to proton-pump inhibitor (PPI) and sinus therapy. In this setting it is presumed to be neurogenic in etiology. Despite the role of the upper esophageal sphincter (UES) as a barrier to laryngopharyngeal reflux disease, it has not been well characterized in chronic cough patients. We aim to assess UES tonicity in patients with PPI-refractory chronic cough and otherwise intact esophageal motor function. METHODS: Patients with a Chicago Classification diagnosis of normal esophageal motility on high-resolution esophageal manometry (HRM) on studies performed for the indication of chronic cough were retrospectively studied. All studies were performed at a GI motility lab at a tertiary care center from January 2013 to August 2018. Patients with prior cervical spinal surgery, foregut surgery, gastroparesis, severe pulmonary disease or manometric hiatal hernia were excluded. All HRM were performed with a solid-state assembly with a 4.2 mm outer diameter catheter. Upper esophageal resting pressure and residual pressure (mmHg) were recorded from HRM studies and compared to a control group of patients with normal esophageal motility on studies performed for an indication of non-cardiac chest pain. Available pH-metry tests in chronic cough patients were also reviewed for acid exposure time. RESULTS: Fourteen patients with chronic cough (mean age 63 ± 25, 71% female) and twenty patients with non-cardiac chest pain (mean age 55 ± 14, 60% female) were included. Median resting UES pressure (mmHg) was higher in the chronic cough group (80) vs the chest pain group (50.8) with a p value of 0.004 (Figure 1). There was no difference in residual UES pressure (3.5 in chronic cough vs 3.15 in chest pain). A total of 12 pH studies were performed in chronic cough patients; 9 of these were on PPI. Median distal acid exposure time % was 1.35 [IQR 0.5-6]. CONCLUSION: UES hypertonicity found in PPI-refractory chronic cough patients may be a marker of laryngeal hypersensitivity. A second possibility is that primary UES dysfunction is the cause of cough in this subgroup.

Translation and Cross-Cultural Adaptation of the Newcastle Laryngeal Hypersensitivity Questionnaire to Brazilian Portuguese

To translate and cross-culturally adapt the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) to the Brazilian Portuguese language. The translation and cross-cultural adaptation procedures were performed in five stages: translation, synthesis, back-translation, committee review, and pretest performance. At the end of the first four stages, a questionnaire was produced in Brazilian Portuguese, known as the Questionário Newcastle de Hipersensibilidade Laríngea (LHQ-Br). This version was given as a pretest to 31 participants with laryngeal hypersensitivity: 14 were in the muscle tension dysphonia clinical group, 10 in the refractory chronic cough group, and seven in the globus pharyngeus group. There was a difference in the frequency of occurrence choices in question five ("my throat is blocked"; P = 0.007) and question eight ("I have a sensation of something pushing on my chest"; P = 0.026), but in both questions, the frequency choice of "never" was significantly higher than the other options in all three clinical groups. The relative frequency of participants picking the 'nonapplicable' option in all clinical groups for all questions was zero. This study showed satisfactory results for the translation and cross-cultural adaptation of the LHQ to Brazilian Portuguese (LHQ-Br).

Increased expression of TRPV1 in patients with acute or chronic cough after lung cancer surgery.

BackgroundWe investigated preoperative and postoperative TRPV1, bradykinin (BK), and prostaglandin e‐2 (PGE2) levels in patients who underwent lung cancer surgery and evaluated the correlations between these levels and the development of acute or chronic cough after surgery.MethodsWe evaluated 60 patients with non‐small cell lung cancer who underwent lobectomy at our center between August and October 2018. TRPV1, BK, and PGE2 levels were determined by enzyme‐linked immunosorbent assay and postoperative cough was assessed using the visual analog scale (VAS).ResultsThe postoperative serum TRPV1, BK, and PEG2 levels of the 60 patients were significantly higher than the preoperative levels (P < 0.001). Thirty‐five patients (58.3%) were diagnosed with acute cough (VAS ≥ 60 mm), and 25 were diagnosed with non‐acute cough (41.7%). Three days after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the acute cough group than in the non‐acute cough group (P < 0.001). Twenty‐two patients (36.7%) were diagnosed with chronic cough (VAS ≥ 60 mm), and 25 (62.3%) were diagnosed with non‐chronic cough. Eight weeks after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the chronic cough group than in the non‐chronic cough group (P < 0.05).ConclusionsThe postoperative TRPV1, BK and PGE2 levels were significantly higher than the preoperative levels. The TRPV1 level was also higher in patients with an acute or chronic cough than in patients without. Postoperative acute or chronic cough symptoms can be improved and alleviated by blocking the TRPV1 pathway.

Serum Vitamin D Levels in Children with Recurrent Respiratory Infections and Chronic Cough.

To evaluate serum vitamin D levels in cases of recurrent respiratory infections and chronic cough and to investigate the effect of vitamin D therapy on recurrence of the diseases. This prospective observational study was performed by comparing serum vitamin D levels in children with recurrent respiratory infections, chronic cough and healthy children. One-hundred-one children with chronic cough, ninety-eight children with recurrent respiratory infections and one-hundred-twenty-four healthy children were enrolled in the study. A structured questionnaire was completed to collect data on demography, diet, duration of breastfeeding, vitamin D supplementation and family history for allergic diseases. In patients with low serum vitamin D levels (<20ng/ml), vitamin D therapy was administered in addition to conventional treatment for the diseases. Patients were followed up for 6mo and their complaints were evaluated. Mean serum 25(OH) vitamin D level in the recurrent respiratory infections group was 11.97 ± 4.04ng/ml, chronic cough group was 13.76 ± 4.81ng/ml and control group was 31.91 ± 18.79ng/ml. Comparison of serum 25(OH) vitamin D levels between the study groups revealed a statistically significant difference (p < 0.05). 25(OH)D deficiency in children was associated with increased frequency of recurrent respiratory infections and chronic cough. To conclude, administration of supplementary vitamin D may be useful in the treatment and preventation of recurrent respiratory infections and chronic cough.

Pulmonary function assessment in the early phase of patients with smoke inhalation injury from fire.

Fire smoke contains toxic gases and numerous chemical compounds produced by incomplete combustion, and may cause injury to the airways. Increased airway reactivity, as well as a decrease in lung function, has been reported as a sequela of smoke inhalation injury. This study was undertaken to assess lung functions in the early phase of patients with smoke inhalation damage from fires. A total of 15 patients with fire smoke inhalation (fire smoke group) and 15 subjects with chronic cough but no previous history of lung disease (chronic cough group) were enrolled. For diagnosis of inhalation injury, we performed bronchoscopy, high-resolution computed tomography (HRCT), as well as arterial carboxyhemoglobin (COHb) at admission. Clinical characteristics, pulmonary function tests (PFTs) and mannitol bronchial provocation tests (BPTs) were analyzed and compared between the two groups. In fire smoke group, initial COHb levels and the PaO2/FiO2 ratio were (14.8±18.49)% and 425.7±123.68, respectively. Of seven patients performing HRCT, 4 (57.1%) showed the CT findings compatible with lung involvement of inhalation injury. Post bronchodilator value of the percent of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were (76.0±24.27)% and (79.8±27.82)%, respectively. Pre-and post- bronchodilator forced expiratory flow between 25% and 75% of the FVC (FEF25-75) and the percent predicted FEF25-75 were 2.41±1.47 vs. 2.65±1.45 L (P=0.045), and (68.7±37.29)% vs. (76.4±36.70)% (P=0.031), respectively. Two patients (13.3%) had positive bronchodilator response (BDR). In fire smoke and chronic cough group, all the subjects showed mannitol BPTs within normal limits. Fire smoke inhalation leads to mild obstructive small airway disease pattern of pulmonary function in the early phase of patients with fire smoke damage. Further studies, however, need to be followed to identify the relationship between airway narrowing to inhaled mannitol and smoke inhalation injury.