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Introduction Recurrent cough is little researched in adults. We investigated the prevalence, risk factors, and consequences of recurrent cough, and compared the results to those of isolated chronic cough. Methods Cross-sectional email survey in an elderly community-based population. Recurrent cough was defined as [greater than or equal to] 3 cough episodes within one year (each lasting [greater than or equal to] 1 week) and no current chronic cough. Isolated chronic cough was defined as current cough lasting [greater than or equal to] 8 weeks and no recurrent cough. Results The prevalence of recurrent cough was 3.8% among all respondents (n = 5983). Recurrent cough was associated with asthma (aOR 3.32 (95% CI 2.13-5.18)), chronic rhinosinusitis (2.91 (1.89-4.46)), family history of chronic cough (2.59 (1.88-3.56)), analgesic intolerance (2.13 (1.27-3.57)), male gender (1.92 (1.39-2.66)), gastro-esophageal reflux disease (1.73 (1.21-2.47)), obstructive sleep apnoea (1.69 (1.23-2.32)), symptom sum (1.12 per symptom (1.03-1.22)), and younger age (0.96 per year (0.93-1.00)). Isolated chronic cough was associated with chronic rhinosinusitis (3.45 (2.39-4.97)), asthma (2.17 (1.38-3.41), gastro-esophageal reflux disease (1.80 (1.32-2.47)), family history of chronic cough (1.80 (1.35-2.41)), obstructive sleep apnoea (1.49 (1.12-2.00)), symptom sum (1.18 per symptom (1.10-1.27)), and body mass index (0.96 per unit (0.93-1.00)). Among subjects with recurrent and isolated chronic cough, the prevalence of depressive symptoms were 7.7% and 4.2%, p = 0.11, the Leicester Cough Questionnaire total scores 15.2 (14.6-15.8) and 16.3 (16.0-16.6), P = 0.001, and the mean number of yearly cough-related doctor`s visits 0.58 (0.45-0.71) and 0.36 (0.19-0.53), P = 0.007, respectively. Conclusion The risk factors and consequences of recurrent and isolated chronic cough were comparable. Recurrent cough seems beneficial to address in cough evaluation., Author(s): Johanna Tuulikki Kaulamo [sup.1] [sup.3], Anne Marika Lätti [sup.1] [sup.2], Heikki Olavi Koskela [sup.1] [sup.2] Author Affiliations: (1) https://ror.org/00cyydd11, grid.9668.1, 0000 0001 0726 2490, School of Medicine, Institute of [...]

Purpose Enhanced responsiveness to external triggers is thought to reflect hypersensitivity of the cough reflex. It may involve an enhanced sensitivity of the afferent nerves in the airways and/or an abnormal processing of the afferent information by the central nervous system (CNS). The CNS processing of cough has been shown to involve the same regions as those in symptom amplification, a phenomenon that often manifests as multiple symptoms. The main purpose of the present study was to define whether the presence of several cough triggers is associated with multiple symptoms. Methods 2131 subjects with current cough responding to two email surveys filled in a comprehensive questionnaire about social background, lifestyle, general health, doctors' diagnoses and visits, symptoms, and medication. Multiple symptoms was defined as three or more non-respiratory, non-mental symptoms. Results A carefully controlled multiple regression analysis revealed that the number of cough triggers was the only cough characteristic associating with multiple non-respiratory, non-mental symptoms [aOR 1.15 (1.12-1.19) per one trigger, p < 0.001]. Among the 268 subjects with current cough both in the first survey and in the follow-up survey 12 months later, the repeatability of the trigger sum was good with an intraclass correlation coefficient of 0.80 (0.75-0.84). Conclusion The association between the number of the cough triggers and multiple symptoms suggests that the CNS component of cough hypersensitivity may be a manifestation of non-specific alteration in the CNS interpretation of various body sensations. The number of cough triggers is a repeatable measure of cough sensitivity., Author(s): Heikki O. Koskela [sup.1] [sup.2], Johanna T. Kaulamo [sup.1], Anne M. Lätti [sup.2] Author Affiliations: (1) grid.9668.1, 0000 0001 0726 2490, School of Medicine, University of Eastern Finland, , [...]

Introduction Cough-related healthcare-seeking has not been studied specifically in the elderly, although chronic cough is most prevalent among them. We studied the frequencies and predictors of any ([greater than or equal to] 1) and repeated ([greater than or equal to] 3) doctor's visits due to any cough episode during the past year, and due to the current cough episode. Methods This was a cross-sectional email survey among a Finnish community-based elderly population. Participants with current cough and age [greater than or equal to] 64 years were included in the analyses (n = 1109). Results The proportions of participants with [greater than or equal to] 1 and [greater than or equal to] 3 cough-related doctor's visits during the past year were 25.9% and 7.1%, respectively. Repeated visitors accounted for 55.9% of the visits during the past year. These visits first increased with cough duration but decreased after 5 years. In the multivariate analysis, bronchiectasis [aOR 3.22 (CI95% 1.08-9.58)], asthma [2.62 (1.56-4.40)], chronic sputum production [1.61 (0.94-2.76)], low self-assessed health status [1.40 (1.04-1.88)] and Leicester Cough Questionnaire total score [1.34 per tertile (1.10-1.62)] predicted repeated cough-related doctor's visits during the past year. The proportions of [greater than or equal to] 1 and [greater than or equal to] 3 doctor's visits due to current cough were 31.8% and 15.5%, respectively. Among participants with current chronic cough, 60.1% had not visited a doctor. Conclusion A minority of participants accounted for most of the cough-related doctor's visits during the past year, whereas most participants with chronic cough had never sought medical help for it. The heavy healthcare users were not those with the longest cough episodes. Repeated visitors due to cough were characterised by chronic phlegmy respiratory conditions, and quality-of-life impairment., Author(s): Johanna Tuulikki Kaulamo [sup.1] [sup.3], Anne Marika Lätti [sup.2], Heikki Olavi Koskela [sup.1] [sup.2] Author Affiliations: (1) grid.9668.1, 0000 0001 0726 2490, School of Medicine, Institute of Clinical Sciences, [...]

Introduction The prevalence of chronic cough increases with age. However, data on the prevalence and background disorders of cough subtypes in the elderly are scarce. The objective of this study was to identify the point prevalence and risk factors of acute, subacute, and chronic cough in an elderly community-based population. Methods This was a cross-sectional email survey amongst 26,205 members of the Finnish Pensioners' Federation during the COVID-19 pandemic in spring 2021. Results The response rate was 23.6% (6189). 5983 subjects aged at least 64 years were included in the analyses (mean 72.6 years, 66.3% female). The point prevalence of daily acute, subacute, and chronic cough were 1.4%, 0.7%, and 9.6%, respectively. Only 0.4% of the subjects had a COVID-19 infection. In the multivariate analyses, chronic rhinosinusitis, and obstructive sleep apnoea were common risk factors for all cough subtypes. Chronic cough had several risk factors; Bronchiectasis (OR 5.79 (CI95% 2.70-12.41)), current asthma (2.67 (2.02-3.54)), chronic rhinosinusitis (2.51 (1.94-3.24)), somatic symptom score (1.13 per symptom (1.07-1.19)), family history of chronic cough (1.88 (1.54-2.30)), gastro-oesophageal reflux disease (1.86 (1.50-2.32)), advanced age (1.20 per decade (1.02-1.40)), chronic obstructive pulmonary disease (1.74 (0.99-3.05)), dog ownership (1.42 (1.07-1.89)), and obstructive sleep apnoea (1.41 (1.16-1.73)). Conclusion Acute and subacute cough, as well as previous COVID-19 infection, were uncommon in this Finnish elderly population. The prevalence of chronic cough was higher than that previously found in younger adults. Chronic cough is a multifactorial disorder in the elderly., Author(s): Johanna Tuulikki Kaulamo [sup.2] [sup.3], Anne Marika Lätti [sup.1], Heikki Olavi Koskela [sup.1] [sup.2] Author Affiliations: (1) grid.410705.7, 0000 0004 0628 207X, Unit for Medicine and Clinical Research, Pulmonary [...]

Deep inspiration-provoked cough (DIPC) is a form of allotussia. Allotussia is thought to be a manifestation of cough reflex arc hypersensitivity but objective evidence about this is lacking. 36 subjects with chronic cough and 25 healthy subjects underwent mannitol and citric acid cough provocation tests. DIPC was defined as two or more coughs after deep inhalation of an empty mannitol capsule. Citric acid was administered utilizing a dosimetric nebulizer during controlled tidal breathing. Nine subjects demonstrated DIPC, 8/36 subjects with chronic cough and 1/25 healthy subjects (p = 0.048). The concentration of citric acid to provoke five or more coughs (C5) was 23.4 (63.8) mM among subjects with DIPC and 750 (2941) mM among the subjects without it (p = 0.006). The number of deep inspiration-provoked coughs correlated with the citric acid C5 (Rs -0.38, p = 0.002). In conclusion, DIPC, a form of allotussia, is associated with cough reflex arc hypersensitivity. Trial Registration Number. ClinicalTrials.gov database KUH5801136., Author(s): Heikki O. Koskela [sup.1] [sup.2], Hanna M. Nurmi [sup.1] [sup.2], Woo-Jung Song [sup.3] Author Affiliations: (1) grid.410705.7, 0000 0004 0628 207X, Unit for Medicine and Clinical Research, Pulmonary Division, [...]

Purpose: To clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them. Methods: An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years’ precipitation and temperature in each subjects’ home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea. Results: There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough [adjusted OR 1.80 (1.30–2.51) per 100 mm, p < 0.001, and 1.57 (1.19–2.07) per 100 mm, p = 0.001, respectively]. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices. Conclusion: Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there. [ABSTRACT FROM AUTHOR]

Purpose: Inhaled mannitol induces bronchoconstriction and cough. This study aimed to describe the cough response to mannitol among healthy adult subjects. Methods: 125 healthy subjects (aged 18–82 years, 52% females, 50% skin prick test positive) underwent a mannitol test. The coughs were recorded both simultaneously and afterwards from video recordings by two researchers. Three indices were evaluated: The cumulative number of coughs per cumulative dose of mannitol (CDR), cumulative provocative dose of mannitol to cause at least 5 coughs, and the maximal number of coughs provoked by any single mannitol dose. The test was repeated in 26 subjects after 3–7 days. Results: CDR showed the best repeatability with an intraclass correlation coefficient of 0.829. Gender was the only characteristics that associated with the cough response: The median CDR was 2.53 (interquartile range 0.45–7.01) coughs/100 mg among females and 0.787 (0.0–3.29) coughs/100 mg among males (p = 0.002). The interquartile range upper limits were defined as the cut-off limits for a normal response. The threshold for a statistically significant change in CDR was 6.26 coughs/100 mg. There was a close correlation between simultaneous- and video-assessed CDR (intraclass correlation coefficient 0.985). Conclusion: Females cough more than males in response to mannitol. CDR is the most suitable index to describe the cough responsiveness. The repeatability of the response is good. Video recording of the coughs is not mandatory. The cut-off limits for a normal cough response to mannitol were provided. [ABSTRACT FROM AUTHOR]

Introduction: Although β 2-adrenoceptor (β 2AR) agonists have been associated with a lower risk of Parkinson's disease (PD), the findings are inconclusive and may reflect confounding by indication. We studied the association between inhaled β 2AR agonists and risk of PD in persons with asthma or chronic obstructive pulmonary disease (COPD). Methods: The nested case-control study was conducted within a register-based Finnish Parkinson's disease study (FINPARK) and included 1406 clinically verified PD cases diagnosed during 1999– 2015, who also had asthma/COPD > 3 years before PD. PD cases were matched with up to seven controls by age, sex, duration of asthma/COPD, pulmonary diagnosis, and region (N = 8630). Cumulative and average annual exposure to short- and long-acting β 2AR agonists before a 3-year lag period was assessed with quartiles of defined daily doses (DDDs). Adjusted odds ratios (aORs) were calculated with 95% confidence intervals (CIs) using conditional logistic regression. Results: Cumulative exposure to either short- or long-acting β 2AR agonists was not associated with a risk of PD. With average annual exposure, a decreased risk was observed only for the highest quartile of long-acting β 2AR agonists (aOR 0.75; 95% CI 0.58– 0.97). In the stratified analysis the lowest risk estimates were observed among those with both asthma and COPD diagnoses. The suggestion of an inverse association was seen for the highest quartile of long-acting β 2AR agonists in asthma. Discussion: Higher levels of exposure to β 2AR agonists were not consistently associated with a reduced risk of PD. The inverse association in the highest category of average annual exposure to long-acting β 2AR agonists may be explained by unmeasured confounding, such as disease severity or smoking. [ABSTRACT FROM AUTHOR]