Chronic Cough Research Articles

Eosinophilic bronchitis – Chronic cough with a treatable trait

Eosinophilia in sputum is an important finding in patients with chronic cough, as it identifies a treatable trait with available therapy that is well tolerated and can be effective. While most patients have airway hyperresponsiveness or airway obstruction which define asthma, an important number of cases lack these features of bronchoconstriction but sputum induction still demonstrates excess eosinophilia, indicating eosinophilic bronchitis without asthma. Unfortunately, this test is largely limited to research centers and speciality cough clinics, but associated measures of allergic airway inflammation can be used to support the diagnosis. While the mechanisms that initiate and drive non-asthmatic eosinophilic bronchitis (NAEB) are not well understood, there is emerging evidence that eosinophils and inflammatory mediators are important contributors of nerve sensitivity, a hallmark of chronic cough. Inhaled steroids form the major treatment used in non-asthmatic eosinophilic bronchitis (NAEB). Novel targeted therapies for asthma known as biologics are likely to be tried in the common and debilitating condition of chronic cough, while their efficacy in NAEB is yet to be seen.

Causal Relationships Between Emotional Instability and Respiratory Diseases: A Mendelian Randomization Analysis.

In the past few years, there has been a growing fascination with the connection between mental well-being and respiratory conditions. However, the causal relationship between personality traits and respiratory diseases remains largely unknown. This study aimed to investigate the link between genetically predicted emotional instability and eight respiratory conditions using a two-sample Mendelian randomization (MR) analysis. In a GWAS dataset from the UK Biobank, SNPs linked to emotional instability were discovered among 204,412 participants of European descent. Genetic information for lung cancer, pulmonary fibrosis, pneumonia, and bronchiectasis was obtained from the European Bioinformatics Institute (EBI). While data for chronic obstructive pulmonary disease (COPD), pulmonary embolism, chronic cough, and asthma was collected from the UK BioBank. An MR study was carried out to investigate how specific single nucleotide polymorphisms (SNPs) impact the likelihood of developing the eight respiratory conditions listed. Our main approach for the initial screening was the utilization of inverse variance weighting (IVW). Multiplicity was assessed using the MR-Egger regression test, while heterogeneity was evaluated with Cochran's Q test. To ensure the reliability of the findings, a leave-one-out analysis was conducted. IVW found evidence that emotional instability had a significant causal effect on the increased risk of COPD (OR = 1.009; 95% CI = 1.001-1.017; P = 0.022), pneumonia (OR = 1.648; 95% CI = 1.036-2.622; P = 0.035), chronic cough (OR = 1.077; 95% CI = 1.013-1.145; P = 0.017) and increased risk of asthma (OR = 1.073; 95% CI = 1.026-1.123; P = 0.002) had a significant causal relationship. This association remained strong in the case of potential confounders, including smoking. Additionally, the instrumental variable weighted method in this study did not find any indication of a causal link between emotional instability and lung cancer, pulmonary embolism, pulmonary fibrosis, and bronchiectasis (all P > 0.05). The research discovered a link between emotional instability and a higher likelihood of developing COPD, pneumonia, chronic cough, and asthma. This study also found that emotional instability was not causally associated with lung cancer, pulmonary embolism, pulmonary fibrosis, and bronchiectasis.

Sex Differences in Chronic Cough Epidemiology: The Korean Cough Study Group.

Chronic cough is a common symptom encountered by healthcare practitioners. The global prevalence of chronic cough is 9.6%, with a female predominance. The aim of our study is to reveal the sex differences in prevalence and severity of chronic cough in South Korea, stratified by age and etiology. This study included adult patients with chronic cough who were recruited from 19 respiratory centers in South Korea. Patients completed the cough numeric rating scale (NRS) and COugh Assessment Test (COAT) questionnaire to assess the severity and multidimensional impact of cough. Among the 625 patients, 419 (67.0%) were females, with a male-to-female ratio of 1:2.03. The mean age was 49.4 years, and the median duration of cough was 12 weeks. The mean NRS and COAT scores were 5.5 ± 1.8 and 9.5 ± 3.6, respectively. Female patients were older (45.3 ± 15.4 vs. 51.6 ± 15.2, P < 0.001) and more likely to have asthma/cough variant asthma (CVA) (26.7% vs. 40.8%, P = 0.001) than male patients. There was no difference in the duration or severity of cough between sexes, regardless of the cause. The male-to-female ratio was lower for upper airway cough syndrome (UACS), asthma/CVA, and gastro-esophageal reflux disease (GERD), but not for eosinophilic bronchitis (EB) or unexplained cough. The mean age of female patients was higher in UACS and asthma/CVA, but not in EB, GERD, or unexplained cough. The majority (24.2%) fell within the age category of 50s. The proportion of females with cough increased with age, with a significant rise in the 50s, 60s, and 70-89 age groups. The severity of cough decreased in the 50s, 60s, and 70-89 age groups, with no significant sex differences within the same age group. The sex disparities in prevalence and severity of cough varied significantly depending on the age category and etiology. Understanding the specific sex-based difference could enhance comprehension of cough-related pathophysiology and treatment strategies.

Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough.

The current available diagnostic criteria for gastroesophageal reflux-related chronic cough (GERC) dominated by non-acid reflux is imperfect. The post-reflux swallow-induced peristaltic wave index (PSPWI) is a parameter reflecting esophageal clearance function. This study aims to investigate its diagnostic value for non-acid GERC. This study sought to compare the diagnostic value of PSPWI in different types of GERC, particularly non-acid GERC, and explore the clinical significance of PSPWI in the diagnosis of non-acid GERC through diagnostic experiments. A retrospective analysis was performed based on 223 patients with suspected GERC who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) in the outpatient clinic of our department from August 2016 to June 2021. Their clinical information, laboratory test results, and treatment responses were assessed and the underlying etiologies of chronic cough were categorized. The predictive value of the PSPWI in diagnosing different types of GERC, especially non-acid GERC, was analyzed and compared. A total of 195 patients with chronic cough who met the inclusion criteria underwent MII-pH monitoring. 143 patients had a definitive diagnosis of GERC, including 98 with acid GERC and 45 with non-acid GERC. The diagnostic value of PSPWI alone was moderate for GERC with an area under the working curve (AUC) 0.760, but poor for non-acid GERC with an AUC of 0.569. However, PSPWI < 39.8% combining with acid exposure time (AET) ⩽ 6.2% demonstrated a moderate diagnostic value for non-acid GERC, with an AUC of 0.722. When PSPWI < 39.8% combined with a non-acid reflux ratio >68.75%, the diagnostic value for non-acid GERC was improved (AUCROC = 0.80 versus AUCROC = 0.722, p < 0.05), which was significantly superior to non-acid symptom index (AUCROC = 0.804 versus AUCROC = 0.550, p < 0.05) and non-acid symptom association probability (AUCROC = 0.804 versus AUCROC = 0.571, p < 0.05). PSPWI < 39.8% and AET ⩽ 6.2% have demonstrated good diagnostic value for non-acid GERC. The diagnostic value was further improved when combined with non-acid reflux ratio >68.75%.

Sex-related disparities in cough-associated symptoms across different age groups.

Sex-related disparities in the prevalence of chronic cough have been consistently reported globally, with varying male-to-female ratios. This study aimed to evaluate sex-related differences by comparing correlations between cough-related symptoms in males and females of different age groups. Adult patients with chronic cough who completed the Leicester Cough Questionnaire (LCQ) were recruited from 16 respiratory centers. Correlation networks were constructed based on Spearman's correlation coefficients in males and females of various age groups. The distinct relationships of cough-related symptoms between subgroups were validated by an independent cohort. A total of 255 patients were enrolled in this study (male-to-female ratio, 1:1.71). The following LCQ items were highly correlated: embarrassment and interference with daily work, anxiety, and interference with overall life enjoyment/feeling of being fed up, interference with daily work and overall life enjoyment, interference with overall life enjoyment and feeling of being fed up, and feeling of being fed up and annoyance to partner/family/friends. The patterns of these correlations between LCQ items varied in males and females of different ages. The strongest interrelationship was observed in male patients aged >50 years old, which was similar to those in the validation cohort. The correlation patterns between cough-related symptoms vary significantly according to age and sex. Understanding the mechanisms underlying the development of cough-related symptoms may facilitate sex- and age-specific strategies for chronic cough.

Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis.

Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals' lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies. The primary objectives of this study were to assess respondents' perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships. Qualitative study. This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes. A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0-24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents. RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals' lived experiences may inform the development of RCC and UCC therapeutic strategies.

Diagnosed and undiagnosed cough-related stress urinary incontinence in women with refractory or unexplained chronic cough: Its impact on general health status and quality of life.

Background: Stress urinary incontinence (SUI) is common in women with chronic cough but may be overlooked. Objective: To determine the frequency of underdiagnosis of cough-related SUI and its impact on women's general health status and quality of life (QoL). Methods: Data were analyzed for 147 women with refractory/unexplained chronic cough. Relevant details were collected from clinical charts and a patient-completed survey. General health status was assessed using the EuroQoL visual analogue scale (EQ-VAS) and QoL with the cough-specific Leicester Cough Questionnaire (LCQ). Results: Women were classified into diagnosed (n = 32; 21.8%) or undiagnosed (n = 33; 22.4%) cough-related SUI, and no SUI (n = 82; 55.6%) groups. Women with versus without cough-related SUI perceived poorer health status and greater impact of cough on everyday lives. Mean LCQ scores were significantly lower in cough-related SUI groups versus no SUI group. In multivariate analysis, the presence of cough-related SUI was significantly associated with lower EQ-VAS and LCQ scores. Conclusion: In our cohort, 44% of women had cough-related SUI, and half were undiagnosed. Irrespective of diagnosis, impairment to everyday lives and QoL was similar. Diagnosing cough-related SUI may identify additional patients who can benefit from therapies to suppress cough and improve QoL.

Nepridržavanje pedijatara primarne zdravstvene zaštite u Srbiji najnovijih upustava za lečenje akutnog i hroničnog kašlja kod dece

Introduction: Cough is the most frequent symptom in children and can indicate various pathological conditions. Several international guidelines have been published with a purpose of standardizing and improving the assessment and management of cough. Non-adherence to guidelines often leads to a suboptimal quality of patient care. Our aim was to investigate the adherence of Serbian primary care pediatricians to the latest international guidelines on cough diagnosis and management. Methods: The study included pediatricians working in primary health care centers in Serbia. They were given a questionnaire designed by a team of pediatric pulmonologists which included questions about the choice of diagnostic and therapeutic approaches in acute and chronic cough. Results: Most of primary care pediatricians assessed the value of international guidelines as fair. However, nearly 70% stated that they prescribed herbal syrup for acute cough. Chronic cough is treated mostly with ivy extract, bronchodilators and antihistamines. A majority of doctors declared positive opinion of herbal medicaments and negative opinion of alternative medicine. About 73% stated that they did not use the chest x-ray as a part of diagnostic procedure. Conclusion: Serbian pediatricians do not adhere to international guidelines in relation to diagnosis and treatment of cough. The reasons for non-adherence to guidelines should be further investigated.

Characteristics of adults with potential refractory chronic cough identified using an algorithm designed for administrative claims databases: A descriptive study.

Objective As population-based studies describing the characteristics of patients with refractory chronic cough (RCC) are sparse, the objective of this descriptive study was to identify and describe such patients using an algorithm developed for administrative claims databases and requiring validation in future. Methods We identified adults with chronic cough (N = 782,121) from Optum Clinformatics™ Data Mart as individuals with a 'cough event' (primary cough event; based on ICD codes/relevant prescriptions) and ≥2 cough events in the 56-180 preceding days. We applied several exclusion criteria to identify potential RCC cases and stratified them into probable, possible, and unlikely RCC cohorts by the number of cough events during 1-year follow up (≥3, 1-2 or 0 events, respectively). Patient characteristics were described during the year before the primary cough event and follow up. Results 16.8% (n = 131,772) of patients with chronic cough were potential RCC cases: 25.8% probable, 35.9% possible and 38.3% unlikely. The majority were female (66.4-70.5%); median age was 53-60 years. The most common comorbidities and cough-associated complications at baseline were: allergic rhinitis (30.7-39.1%), hypertension (37.3-47.7%), gastro-oesophageal reflux disease (23.7-34.3%), asthma (18.1-27.3%), insomnia (6.3-8.3%) and stress incontinence (2.5-3.9%). Among probable RCC cases, use of several medications was higher during follow up versus baseline: 52.7% versus 49.0% (cough treatments), 73.3% versus 69.0% (respiratory drugs), 40.5% versus 34.2% (gastrointestinal drugs) and 58.8% versus 56.1% (psychotherapeutics). Conclusion Our algorithm requires validation but provides a starting point to identify patients with RCC in claims databases in future studies.

Systematic literature review of treatments used for refractory or unexplained chronic cough in adults.

Refractory or unexplained chronic cough (RCC or UCC) is difficult to manage and is usually treated by the off-label use of drugs approved for other indications. The objectives of this systematic literature review (SLR) were to identify and characterize the current published body of evidence for the efficacy and safety of treatments for RCC or UCC. The SLR was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The SLRs pre-defined population included patients ≥18 years of age who were diagnosed with chronic cough. The review was not restricted to any intervention type or study comparator, nor by timeframe. A total of 20 eligible publications from 19 unique trials were included. Seventeen of these trials were randomized controlled trials and most (14/17) were placebo-controlled. There was considerable variability between trials in the definition of RCC or UCC, participant exclusion and inclusion criteria, outcome measurement timepoints, and the safety and efficacy outcomes assessed. Several trials identified significant improvements in cough frequency, severity, or health-related quality of life measures while participants were on treatment, although these improvements did not persist in any of the studies that included a post-treatment follow-up timepoint. In the absence of an approved therapy, placebo remains the most common comparator in trials of potential RCC or UCC treatments. The between-study comparability of the published evidence is limited by heterogeneity of study design, study populations, and outcomes measures, as well as by concerns regarding study size and risk of bias.

Bronchogenic cyst in a child presenting with chronic cough and wheezing: a case report

Bronchogenic cyst in a child presenting with chronic cough and wheezing: a case report

Development of a disease-specific health utility score for chronic obstructive pulmonary disease from a discrete choice experiment patient preference study.

While patient input to health technology assessment (HTA) has traditionally been of a qualitative nature, there is increasing interest to integrate quantitative evidence from patient preference studies into HTA decision making. Preference data can be used to generate disease-specific health utility data. We generated a health utility score for patients with chronic obstructive pulmonary disease (COPD) and consider its use within HTAs. Based on qualitative research, six symptoms were identified as important to COPD patients: shortness of breath, exacerbations, chronic cough, mucus secretion, sleep disturbance, and urinary incontinence. We employed a discrete choice experiment (DCE) and the random parameter logistic regression technique to estimate utility scores for all COPD health states. The relationship between patients' COPD health utility scores, self-perceived COPD severity, and EQ-5D-3L utility scores was analyzed, with data stratified according to disease severity and comorbidity subgroups. The COPD health utility score had face validity, with utility scores negatively correlated with patients' self-perceived COPD severity. The correlation between the COPD health utility scores and EQ-5D-3L values was only moderate. While patient EQ-5D-3L scores were impacted by comorbidities, the COPD health utility score was less impacted by comorbid conditions. Our COPD utility measure, derived from a DCE, provides a patient-centered health utility score and is more sensitive to the COPD health of the individual and less sensitive to other comorbidities. This disease-specific instrument should be considered alongside generic health-related quality of life instruments when valuing new COPD therapies in submissions to licensing and reimbursement agencies.

How to identify and manage prolonged acute and chronic cough in pre-school children

How to identify and manage prolonged acute and chronic cough in pre-school children

Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center.

This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures. Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients' outcomes were recorded. Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction. Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

Laparoscopic repair of hiatal hernia after minimally invasive esophagectomy

Postoperative hiatal hernia is a rare and specific complication after esophagectomy. This complication leads to emergency and affects mortality. Incidence of this complication has increased due to the great number of minimally invasive procedures over the past decades. In addition, chronic cough, preoperative hiatal hernia and transhiatal approach also increase the risk of recurrent hernias. Most post-esophagectomy hiatal hernias do not require emergency surgery. About 70% of patients have symptoms reducing the quality of life. About 25% of cases are asymptomatic and discovered incidentally during follow-up examinations. The role of surgery for asymptomatic post-esophagectomy hernias is a matter of debate because the risk of symptoms or complications is poorly predictable. Surgical treatment is the only radical method for symptomatic or complicated hernias. However, there is still no consensus regarding surgical approach and technique. Most surgeons prefer open surgery fearing severe adhesive process and other technical difficulties. Laparoscopic approach is widely accepted as the "gold standard" for primary hiatal hernia. However, minimally invasive access for post-esophagectomy hiatal hernias is not sufficiently studied and described in several case reports. Currently, it is very important to study the risk factors of hiatal hernias after esophagectomy. We present successful laparoscopic repair of hiatal hernia after hybrid McKeown esophagectomy.

Safety profile of drugs used in non-cystic fibrosis bronchiectasis: a narrative review

Non-cystic fibrosis bronchiectasis is a long-term lung disease characterised by abnormal dilatation of the bronchi, with patients experiencing chronic productive cough and recurrent exacerbations. Currently, there are no licensed drugs for use in bronchiectasis while clinical trials have been conducted to either test new drugs or repurpose existing ones. These drugs target the underlying pathophysiology of bronchiectasis which is known to include infection, inflammation, mucus hypersecretion and retention. Most of the drugs used in daily clinical practice for bronchiectasis are off-label with no randomised trials exploring their safety. This review aims at exploring the safety profile of drugs frequently used in clinical practice to manage bronchiectasis, including antibiotics (e.g. macrolides, aminoglycosides, polymyxins, fluoroquinolones, aztreonam), mucoactive therapy (e.g. hypertonic saline, mannitol, DNase and carbocisteine), anti-inflammatory therapy (inhaled corticosteroids) and drugs currently in development for use in bronchiectasis (e.g. brensocatib, benralizumab and itepekimab).

Isolated Pulmonary Langerhans Cell Histiocytosis in a Child

Abstract A 4-year-old boy presented with a history of chronic cough for the past 1 year that was progressing for the last 2 weeks. History of intermittent fever with breathlessness was there. The child had received antibiotics, nebulization, and oral steroids, but was never prescribed inhaled steroids, as no wheeze was documented. As the X-ray chest was not showing any significant findings, a computerized tomography chest was done that showed septal thickening, and reticulonodular pattern bilaterally without bronchiectasis or mediastinal lymphadenopathy. Bronchoscopy was done and the lavage fluid found CD1a and S-100-positive cells suggestive of pulmonary Langerhans cell histiocytosis. There was no other organ involvement.

Reflux Symptom and Sign Instrument: A New Instrument to Diagnose Pediatric Laryngopharyngeal Reflux

Abstract Introduction: Laryngopharyngeal reflux (LPR) is commonly found in children, usually connected to airway problems. LPR remains controversial as no standardized diagnostic instrument. Diagnostic tools available have been validated mostly in adults, i.e. Reflux Symptom Index (RSI) and reflux finding score (RFS). Objective: The objective of the study was to obtain a cost-effective, simple, convenient, noninvasive instrument with good diagnostic outcome. Methods: We compared RSI and RFS with esophageal double probe 24-h pHmetry results. A total of 29 children were recruited, aged 5–18 years. The inclusion criterion was phlegmy throat, frequent odynophagia, sensation of a lump in the throat, throat clearing, choking episodes, hoarseness, and chronic cough for at least 4 weeks. The subjects underwent nasopharyngolaryngoscopy and pHmetry insertion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using three scenarios. Results: The Reflux Symptoms-Sign Instruments (RSII), consisting of frequent throat clearing, annoying cough, choking, vocal cords abnormalities, and subglottic edema has a cutoff score of 4 and demonstrated 75% sensitivity, 77% specificity, 80% PPV, and 71% NPV. Conclusions: The RSII has shown a good diagnostic result in diagnosing LPR in children.

Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer.

Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue. Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs. Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group. Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

A comparison between a gastroesophageal reflux disease questionnaire-based algorithm and multichannel intraluminal impedance-pH monitoring for the treatment of gastroesophageal reflux-induced chronic cough.

Empiric therapy with multichannel intraluminal impedance-pH monitoring (MII-pH) has been used for the initial treatment of gastroesophageal reflux-induced chronic cough (GERC). However, an algorithm based on the gastroesophageal reflux disease questionnaire (GerdQ) has the potential to achieve a simple, structured, and effective treatment approach for patients with GERC. This study compared the efficacy of anti-reflux therapy based on GerdQ (new structured pathway, NSP) with medical treatment after MII-pH examination (ordinary clinical pathway, OCP) in the management of GERC. For the NSP, we adapted the GerdQ score to establish the basis for a treatment algorithm. For the OCP, treatment was determined using the MII-pH examination results. The non-inferiority (NI) hypothesis was used to evaluate NSP versus OCP. Overall, the NSP and OCP-based therapeutic algorithms have similar efficacy for GERC [NI analysis: 95% confidence interval (CI), -4.97 to 17.73, p = 0.009; superiority analysis: p = 0.420]. Moreover, the cough symptom scores and cough threshold improved faster in the NSP group than in the OCP group at week 8 (p < 0.05). In the subgroup analyses using the GerdQ and GerdQ impact scale (GIS) scores, patients with low-likelihood GERC (GerdQ < 8) were more likely to benefit from OCP (NI analysis: 95% CI, -19.73 to 18.02, p = 0.213). On the other hand, in patients with high-likelihood and low-reflux impact GERC patients (GerdQ > 8 and GIS < 4), the NSP arm was not inferior to the standard treatment of OCP (NI analysis: 95% CI, -8.85 to 28.21%, p = 0.04; superiority analysis: p = 0.339), indicating that GerdQ- and GIS-guided diagnosis and management of patients with GERC could be an alternative to MII-pH management, especially in settings with reduced medical resources. The use of the GerdQ algorithm should be considered when handling patients with GERC in the primary care setting. This research was registered in the Chinese Clinical Trials Registry (ChiCTR-ODT-12001899).