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The Predicative Clinical Features Associated with Chronic Cough That Has a Single Underlying Cause

  • Author Footnotes
    ∗ These are co-first authors.
    Kefang Lai
    Correspondence
    Corresponding author: Kefang Lai, MD, PhD, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou 510120, Guangdong, P. R. China.
    Footnotes
    ∗ These are co-first authors.
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Author Footnotes
    ∗ These are co-first authors.
    Wenzhi Zhan
    Footnotes
    ∗ These are co-first authors.
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Author Footnotes
    ∗ These are co-first authors.
    Hu Li
    Footnotes
    ∗ These are co-first authors.
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Fang Yi
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Wen Peng
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Jianmeng Zhou
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Jiaman Tang
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Liting Zhang
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Li Long
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Ruchong Chen
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Wei Luo
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Qiaoli Chen
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Mei Jiang
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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  • Author Footnotes
    ‡ Senior author.
    Nanshan Zhong
    Footnotes
    ‡ Senior author.
    Affiliations
    State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
    Search for articles by this author
  • Author Footnotes
    ∗ These are co-first authors.
    ‡ Senior author.

      Background

      Few studies have investigated the usefulness of the clinical characteristics of cough in the diagnosis of chronic cough.

      Objective

      To evaluate the diagnostic value of clinical characteristics and concomitant symptoms of chronic cough in predicting its cause.

      Methods

      We recruited adult patients with chronic cough as a primary presenting symptom and identified those with a single underlying cause. Clinical features of cough were recorded with a custom-designed questionnaire and the relationships between clinical features and cause of cough were analyzed.

      Results

      A total of 1162 patients with a single underlying cause were enrolled. Nocturnal cough alone was a predictor of cough variant asthma (odds ratio [OR], 2.037; 95% CI, 1.003-4.139) with high specificity (97.6%) and low sensitivity (8.1%). Heartburn (OR, 2.671; 95% CI, 1.544-4.620), belching (OR, 2.536; 95% CI, 1.620-3.971), and acid regurgitation (OR, 2.043; 95% CI, 1.299-3.212) indicated gastroesophageal reflux–related cough with high specificity (85.5%-94.9%) and low sensitivity (22.8%-40.7%). Cough after meals had a high specificity (91.2%) and a low sensitivity (24.8%) for gastroesophageal reflux–related cough. Postnasal dripping (OR, 2.317; 95% CI, 1.425-3.767) and history of sinusitis (OR, 4.137; 95% CI, 2.483-6.892) were indicators for upper airway cough syndrome with high specificity (80.8% and 90.2%, respectively). Rhinitis/sinusitis-related symptoms showed moderate sensitivity (72.9%); however, they showed mild specificity (46.1%) for upper airway cough syndrome.

      Conclusions

      Cough timing, several concomitant symptoms associated with gastroesophageal reflux or rhinitis/sinusitis, and medical history are useful to indicate common causes of chronic cough.

      Key words

      Abbreviations used:

      COVID-19 (Coronavirus disease 2019), CVA (Cough variant asthma), EB (Eosinophilic bronchitis), GERC (Gastroesophageal reflux–related cough), OR (Odds ratio), UACS (Upper airway cough syndrome)
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