The intensity of voluntary, induced, and spontaneous cough

TY - JOUR

T1 - The intensity of voluntary, induced, and spontaneous cough

AU - Lee, Kai K.

AU - Ward, Katie

AU - Rafferty, Gerrard F.

AU - Moxham, John

AU - Birring, Surinder S.

PY - 2015/12/22

Y1 - 2015/12/22

N2 - BACKGROUND: Th e intensity of cough is an important determinant of cough severity. Few studies have quantifi ed cough intensity in patients with chronic cough with objective measures. We investigated the intensity of voluntary, induced, and spontaneous cough in patients with chronic cough and healthy control subjects. METHODS: Patients with chronic cough and control subjects underwent physiologic assessment of the intensity of maximum voluntary, capsaicin-induced, and spontaneous cough. Assessments included measurement of gastric pressure (Pga) and esophageal pressure (Pes) during cough, peak cough flow (PCF), expiratory muscle strength (twitch gastric pressure [TwPga]), and cough compression phase duration (CPD). Subjective perception of cough intensity was assessed using a visual analog scale (VAS). RESULTS: Pes, Pga, and PCF during maximum voluntary cough were signifi cantly greater in patients with chronic cough compared with control subjects (P =.003-.042). There was no diff erence in TwPga between patients and control subjects. CPD was increased in female patients compared with control subjects (mean <SD, 0.50 <0.22 s vs 0.28 <0.17 s; P =.007). Mean <SD Pes during spontaneous cough was comparable to induced cough (128 <28 cm H2 O vs 122 <37 cm H2 O, P =.686) but less than maximum voluntary cough (170 <46 cm H2 O, P =.020). Median within-subject correlation coeffi cients between cough intensity VAS and Pes, Pga, and PCF were r = 0.82 to 0.86. CONCLUSIONS: Maximum voluntary cough intensity was increased in patients with chronic cough compared with control subjects. Th ere was no signifi cant diff erence in expiratory muscle contractility. Further studies should evaluate the compressive phase of cough in more detail. Physiologic measures of cough intensity correlated strongly with subjective perception of intensity in patients with chronic cough and may be relevant objective outcome measures for clinical studies.

AB - BACKGROUND: Th e intensity of cough is an important determinant of cough severity. Few studies have quantifi ed cough intensity in patients with chronic cough with objective measures. We investigated the intensity of voluntary, induced, and spontaneous cough in patients with chronic cough and healthy control subjects. METHODS: Patients with chronic cough and control subjects underwent physiologic assessment of the intensity of maximum voluntary, capsaicin-induced, and spontaneous cough. Assessments included measurement of gastric pressure (Pga) and esophageal pressure (Pes) during cough, peak cough flow (PCF), expiratory muscle strength (twitch gastric pressure [TwPga]), and cough compression phase duration (CPD). Subjective perception of cough intensity was assessed using a visual analog scale (VAS). RESULTS: Pes, Pga, and PCF during maximum voluntary cough were signifi cantly greater in patients with chronic cough compared with control subjects (P =.003-.042). There was no diff erence in TwPga between patients and control subjects. CPD was increased in female patients compared with control subjects (mean <SD, 0.50 <0.22 s vs 0.28 <0.17 s; P =.007). Mean <SD Pes during spontaneous cough was comparable to induced cough (128 <28 cm H2 O vs 122 <37 cm H2 O, P =.686) but less than maximum voluntary cough (170 <46 cm H2 O, P =.020). Median within-subject correlation coeffi cients between cough intensity VAS and Pes, Pga, and PCF were r = 0.82 to 0.86. CONCLUSIONS: Maximum voluntary cough intensity was increased in patients with chronic cough compared with control subjects. Th ere was no signifi cant diff erence in expiratory muscle contractility. Further studies should evaluate the compressive phase of cough in more detail. Physiologic measures of cough intensity correlated strongly with subjective perception of intensity in patients with chronic cough and may be relevant objective outcome measures for clinical studies.

UR - http://www.scopus.com/inward/record.url?scp=84946548577&partnerID=8YFLogxK

U2 - 10.1378/chest.15-0138

DO - 10.1378/chest.15-0138

M3 - Article

AN - SCOPUS:84946548577

SN - 0012-3692

VL - 148

SP - 1259

EP - 1267

JO - Chest

JF - Chest

IS - 5

ER -