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

Abstract

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.

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

“…In this observational study, increased sputum eosinophilic inflammation was found in the CC group compared with the non-CC group. Our recently published study found that asthma patients with CC had elevated airway inflammation [ 14 ]. But M arsden et al .…”

“…In this study, cough severity and cough-related quality of life were assessed using a cough symptom score [ 14 ], cough VAS [ 22 ] and the Chinese version of the Leicester Cough Questionnaire (LCQ) [ 23 ]. The LCQ consists of 19 questions that cover three subdomains reflecting physical, social and psychological issues.…”

“…A recently published cross-sectional study found that CC in patients with asthma was associated with worse respiratory symptoms and greater healthcare utilisation [ 13 ]. Furthermore, we recently found that CC is associated with increased airway inflammation and worse clinical outcomes in asthma [ 14 ]. However, the clinical characteristics of asthma and CC in the older adult population remain largely unknown.…”

Evolving Concept of Severe Asthma: Transition From Diagnosis to Treatable Traits

“…Cough is a major symptom during asthma exacerbation causing severe distress, but has not been well investigated for its clinical relevance in the context of severe asthma. 46 80 81 Cough is more frequent in severe asthma than in non-severe asthma and associated with worse health-related QoL and asthma control. 81 Mechanisms underlying cough may overlap with, but are distinct from those of wheezing or breathlessness.…”

“… 46 80 81 Cough is more frequent in severe asthma than in non-severe asthma and associated with worse health-related QoL and asthma control. 81 Mechanisms underlying cough may overlap with, but are distinct from those of wheezing or breathlessness. However, as cough is not included in current asthma assessment tools, such as ACT or ACQ, poorly controlled cough often misguides clinicians to step up in asthma therapy.…”