Clinical Features of the Urge-To-Cough in Patients With Chronic Cough

Respir Med. 2015 Jun;109(6):701-7. doi: 10.1016/j.rmed.2015.03.011. Epub 2015 Apr 8.

Abstract

Background: The urge-to-cough is a consciously perceived compulsion, previously investigated in healthy volunteers inhaling irritants. We aimed to characterise the urge-to-cough and associated sensations in a group of chronic cough patients attending a specialist clinic.

Methods: 100 patients with chronic cough [mean age 60 yrs (±11.89), 71 female, median cough duration 7 yrs (IQR 11.13) completed an investigator-led survey describing aggravating and relieving factors for urge-to-cough, associated somatic sensations (quality, location, intensity) and emotions. Subjects rated each using a 5-point Likert scale (strongly disagree to strongly agree) or visual analogue scale (VAS). Cluster analysis identified groups of patients with similar patterns of responses.

Results: Subjects rated the severity of urge-to-cough highly (84.5 mm on VAS). The majority always cough in response to the urge-to-cough (91%), but fewer (69%) always experienced an urge-to-cough before coughing. The somatic sensations associated with the urge-to-cough were described as an irritation (86%) or tickle (73%), localised in the neck (75%). The urge-to-cough was triggered by various stimuli including smoky atmospheres (79%), talking (72%), cold temperatures (67%) and dry atmospheres (66%) and relieved by coughing (63%), and drinking (61%); in 42% nothing provided relief. Cluster analysis suggested two distinct patient groups, differing in the factors precipitating the urge-to-cough rather than quality or location of associated sensations.

Conclusion: The unifying characteristics of patients with chronic cough are a severe urge-to-cough associated with throat irritation, consistent with sensory neuronal dysfunction of vagal afferents. Precipitants of the urge-to-cough vary though, and can be used to classify sub-groups of patients who may share similar underlying pathophysiology.

Keywords: Chronic cough; Cluster analysis; Urge-to-cough.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chronic Disease
  • Cough / chemically induced
  • Cough / diagnosis
  • Cough / physiopathology*
  • Female
  • Humans
  • Irritants
  • Male
  • Middle Aged
  • Perception / physiology
  • Pharynx / pathology
  • Quality of Life
  • Reflex / physiology
  • Sensation / physiology
  • Sensory Receptor Cells / pathology
  • Surveys and Questionnaires

Substances

  • Irritants