Risk Factors for Chronic Cough Among 14,669 Individuals From the General Population

  • Yunus Çolak
    Affiliations
    Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen

    The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
    Search for articles by this author
  • Børge G. Nordestgaard
    Affiliations
    The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen

    Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev
    Search for articles by this author
  • Lars C. Laursen
    Affiliations
    Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
    Search for articles by this author
  • Shoaib Afzal
    Affiliations
    The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen

    Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev
    Search for articles by this author
  • Peter Lange
    Affiliations
    Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen

    The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen

    Medical Unit, Respiratory Section, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre
    Search for articles by this author
  • Morten Dahl
    Correspondence
    CORRESPONDENCE TO: Morten Dahl, MD, DMSc, PhD, Department of Clinical Biochemistry, Zealand University Hospital Køge, Lykkebækvej 1, DK-4600, Køge, Denmark
    Affiliations
    The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

    Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen

    Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
    Search for articles by this author

      Background

      Risk factors for chronic cough in the general population have not been described systematically. We identified and ranked chronic cough risk factors at the individual and community level using data from 14,669 individuals from the Copenhagen General Population Study.

      Methods

      Severity of chronic cough was assessed using the Leicester Cough Questionnaire (LCQ). We ranked chronic cough risk factors based on magnitude of age-adjusted ORs at the individual level and of the population attributable risks (PARs) at the community level.

      Results

      Prevalence of chronic cough in the general population was 4% overall and 3% in never smokers, 4% in former smokers, and 8% in current smokers. Median score of the LCQ was 5.8 (25th-75th percentile, 5.0-6.3) for physical domain, 5.6 (25th-75th percentile, 4.6-6.3) for psychologic domain, 6.3 (25th-75th percentile, 5.5-6.8) for social domain, and 17.3 (25th- 75th percentile, 15.4-18.9) in total. At the level of the individual, age-adjusted ORs for the three top-ranked risk factors were 5.0 (95% CI, 1.4-18) for bronchiectasis, 2.6 (95% CI, 1.7-3.9) for asthma and 2.3 (95% CI, 1.5-3.4) for gastroesophageal reflux disease in never smokers, 7.1 (95% CI, 2.6-20) for bronchiectasis, 3.1 (95% CI, 2.2-4.4) for asthma and 2.2 (95% CI, 1.5-3.2) for occupational exposure to dust/fumes in former smokers, and 1.9 (95% CI, 1.3-2.9) for airflow limitation in current smokers. At the level of the community, the three top-ranked risk factors were female sex (PAR, 19%), asthma (PAR, 10%), and gastroesophageal reflux disease (PAR, 8%) in never smokers; abdominal obesity (PAR, 20%), low income (PAR, 20%), and asthma (PAR, 13%) in former smokers; and airflow limitation (PAR, 23%) in current smokers.

      Conclusions

      Risk factors for chronic cough differ at the level of the individual and community, and by smoking status. Strategies to prevent and treat modifiable chronic cough risk factors should be tailored accordingly.

      Key Words

      Abbreviations:

      PAR ( population attributable risk)
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chung K.F.
        • Pavord I.D.
        Prevalence, pathogenesis, and causes of chronic cough.
        Lancet. 2008; 371: 1364-1374
        • Song W.J.
        • Chang Y.S.
        • Faruqi S.
        • et al.
        The global epidemiology of chronic cough in adults: a systematic review and meta-analysis.
        Eur Respir J. 2015; 45: 1479-1481
        • Song W.J.
        • Chang Y.S.
        • Faruqi S.
        • et al.
        Defining chronic cough: a systematic review of the epidemiological literature.
        Allergy Asthma Immunol Res. 2016; 8: 146-155
        • Desalu O.O.
        • Salami A.K.
        • Fawibe A.E.
        Prevalence of cough among adults in an urban community in Nigeria.
        West Afr J Med. 2011; 30: 337-341
        • Ford A.C.
        • Forman D.
        • Moayyedi P.
        • Morice A.H.
        Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms.
        Thorax. 2006; 61: 975-979
        • Fujimura M.
        Frequency of persistent cough and trends in seeking medical care and treatment-results of an internet survey.
        Allergol Int. 2012; 61: 573-581
        • Gibson P.G.
        • Vertigan A.E.
        Management of chronic refractory cough.
        BMJ. 2015; 351: h5590
        • Irwin R.S.
        • Baumann M.H.
        • Bolser D.C.
        • et al.
        Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines.
        Chest. 2006; 129: 1S-23S
        • Morice A.H.
        • Fontana G.A.
        • Sovijarvi A.R.
        • et al.
        The diagnosis and management of chronic cough.
        Eur Respir J. 2004; 24: 481-492
        • Morice A.H.
        • McGarvey L.
        • Pavord I.
        Recommendations for the management of cough in adults.
        Thorax. 2006; 61 suppl 1: i1-i24
        • Pavord I.D.
        • Chung K.F.
        Management of chronic cough.
        Lancet. 2008; 371: 1375-1384
        • Çolak Y.
        • Afzal S.
        • Nordestgaard B.G.
        • Lange P.
        Characteristics and prognosis of never-smokers and smokers with asthma in the Copenhagen General Population Study. A prospective cohort study.
        Am J Respir Crit Care Med. 2015; 192: 172-181
        • Ingebrigtsen T.S.
        • Marott J.L.
        • Rode L.
        • Vestbo J.
        • Lange P.
        • Nordestgaard B.G.
        Fibrinogen and alpha1-antitrypsin in COPD exacerbations.
        Thorax. 2015; 70: 1014-1021
        • Birring S.S.
        • Prudon B.
        • Carr A.J.
        • Singh S.J.
        • Morgan M.D.
        • Pavord I.D.
        Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ).
        Thorax. 2003; 58: 339-343
        • Thomsen R.W.
        • Lange P.
        • Hellquist B.
        • et al.
        Validity and underrecording of diagnosis of COPD in the Danish National Patient Registry.
        Respir Med. 2011; 105: 1063-1068
        • Adelborg K.
        • Sundbøll J.
        • Munch T.
        • et al.
        Positive predictive value of cardiac examination, procedure and surgery codes in the Danish National Patient Registry: a population-based validation study.
        BMJ Open. 2016; 6: e012817
        • Sundbøll J.
        • Adelborg K.
        • Munch T.
        • et al.
        Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study.
        BMJ Open. 2016; 6: e012832
        • Rix T.A.
        • Riahi S.
        • Overvad K.
        • Lundbye-Christensen S.
        • Schmidt E.B.
        • Joensen A.M.
        Validity of the diagnoses atrial fibrillation and atrial flutter in a Danish patient registry.
        Scand Cardiovasc J. 2012; 46: 149-153
        • Lee K.J.
        • Carlin J.B.
        Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation.
        Am J Epidemiol. 2010; 171: 624-632
      1. World Health Organization. Waist circumference and waist–hip ratio. Report of a WHO expert consultation, Geneva, 8-11 December 2008. http://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/. Accessed January 21, 2016.

        • Braunwald E.
        • Domanski M.J.
        • Fowler S.E.
        • et al.
        Angiotensin-converting-enzyme inhibition in stable coronary artery disease.
        N Engl J Med. 2004; 351: 2058-2068
        • Brugts J.J.
        • Arima H.
        • Remme W.
        • et al.
        The incidence and clinical predictors of ACE-inhibitor induced dry cough by perindopril in 27,492 patients with vascular disease.
        Int J Cardiol. 2014; 176: 718-723
        • Pfeffer M.A.
        • Braunwald E.
        • Moye L.A.
        • et al.
        Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators.
        N Engl J Med. 1992; 327: 669-677
        • Yusuf S.
        • Sleight P.
        • Pogue J.
        • Bosch J.
        • Davies R.
        • Dagenais G.
        Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.
        N Engl J Med. 2000; 342: 145-153
        • O'Donnell A.E.
        Bronchiectasis.
        Chest. 2008; 134: 815-823
        • Chalmers J.D.
        • Aliberti S.
        • Blasi F.
        Management of bronchiectasis in adults.
        Eur Respir J. 2015; 45: 1446-1462
      2. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). www.ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed July 1, 2017.

        • Pavord I.D.
        Eosinophilic phenotypes of airway disease.
        Ann Am Thorac Soc. 2013; 10 suppl: S143-S149
        • Jansen D.F.
        • Schouten J.P.
        • Vonk J.M.
        • et al.
        Smoking and airway hyperresponsiveness especially in the presence of blood eosinophilia increase the risk to develop respiratory symptoms: a 25-year follow-up study in the general adult population.
        Am J Respir Crit Care Med. 1999; 160: 259-264
        • Janson C.
        • Chinn S.
        • Jarvis D.
        • Burney P.
        Determinants of cough in young adults participating in the European Community Respiratory Health Survey.
        Eur Respir J. 2001; 18: 647-654
        • Dahl M.
        • Vestbo J.
        • Lange P.
        • Bojesen S.E.
        • Tybjærg-Hansen A.
        • Nordestgaard B.G.
        C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2007; 175: 250-255
        • Sood A.
        Obesity, adipokines, and lung disease.
        J Appl Physiol (1985). 2010; 108: 744-753
        • Thomsen M.
        • Dahl M.
        • Lange P.
        • Vestbo J.
        • Nordestgaard B.G.
        Inflammatory biomarkers and comorbidities in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2012; 186: 982-988
        • Thomsen M.
        • Ingebrigtsen T.S.
        • Marott J.L.
        • et al.
        Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease.
        JAMA. 2013; 309: 2353-2361
        • Leone N.
        • Courbon D.
        • Thomas F.
        • et al.
        Lung function impairment and metabolic syndrome: the critical role of abdominal obesity.
        Am J Respir Crit Care Med. 2009; 179: 509-516
        • Çolak Y.
        • Afzal S.
        • Lange P.
        • Nordestgaard B.G.
        Obese individuals experience wheezing without asthma but not asthma without wheezing: a Mendelian randomisation study of 85 437 adults from the Copenhagen General Population Study.
        Thorax. 2015; 71: 247-254
        • Çolak Y.
        • Marott J.L.
        • Vestbo J.
        • Lange P.
        Overweight and obesity may lead to under-diagnosis of airflow limitation: findings from the Copenhagen City Heart Study.
        COPD. 2015; 12: 5-13
        • Franssen F.M.
        • O'Donnell D.E.
        • Goossens G.H.
        • Blaak E.E.
        • Schols A.M.
        Obesity and the lung: 5. Obesity and COPD.
        Thorax. 2008; 63: 1110-1117
        • Nilsson M.
        • Johnsen R.
        • Ye W.
        • Hveem K.
        • Lagergren J.
        Obesity and estrogen as risk factors for gastroesophageal reflux symptoms.
        JAMA. 2003; 290: 66-72
        • Decalmer S.C.
        • Webster D.
        • Kelsall A.A.
        • McGuinness K.
        • Woodcock A.A.
        • Smith J.A.
        Chronic cough: How do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring?.
        Thorax. 2007; 62: 329-334
        • Kelsall A.
        • Decalmer S.
        • Webster D.
        • et al.
        How to quantify coughing: correlations with quality of life in chronic cough.
        Eur Respir J. 2008; 32: 175-179
        • Kelsall A.
        • Decalmer S.
        • McGuinness K.
        • Woodcock A.
        • Smith J.A.
        Sex differences and predictors of objective cough frequency in chronic cough.
        Thorax. 2009; 64: 393-398
        • Marsden P.A.
        • Smith J.A.
        • Kelsall A.A.
        • et al.
        A comparison of objective and subjective measures of cough in asthma.
        J Allergy Clin Immunol. 2008; 122: 903-907
        • Polley L.
        • Yaman N.
        • Heaney L.
        • et al.
        Impact of cough across different chronic respiratory diseases: comparison of two cough-specific health-related quality of life questionnaires.
        Chest. 2008; 134: 295-302
        • Boulet L.P.
        • Coeytaux R.R.
        • McCrory D.C.
        • et al.
        Tools for assessing outcomes in studies of chronic cough: CHEST guideline and expert panel report.
        Chest. 2015; 147: 804-814