Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults

S. Suresh; J. L. Perret; E. H. Walters; M. J. Abramson; G. Bowatte; C. Lodge; A. Lowe; B. Erbas; P. Thomas; G. S. Hamilton; A. B. Chang; S. C. Dharmage; D. S. Bui

doi:10.1016/j.pulmoe.2023.08.003

Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults

S. Suresh, J. L. Perret, E. H. Walters, M. J. Abramson, G. Bowatte, C. Lodge, A. Lowe, B. Erbas, P. Thomas, G. S. Hamilton, A. B. Chang, S. C. Dharmage, D. S. Bui

Child and Maternal Health

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Abstract

Background and objectives: While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes.

Methods: Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years.

Results: The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV₁/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough.

Conclusions: Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

Original language	English
Pages (from-to)	1-8
Number of pages	8
Journal	Pulmonology
Early online date	22 Sept 2023
DOIs	https://doi.org/10.1016/j.pulmoe.2023.08.003
Publication status	E-pub ahead of print - 22 Sept 2023

Bibliographical note

Funding Information:
We acknowledge the TAHS study participants and previous investigators. We thank Professor Mark Jenkins, PhD, Centre for Epidemiology & Biostatistics, The University of Melbourne, Victoria, a TAHS investigator, but not a co-author of this manuscript, for his assistance with obtaining funds and data collection. We also acknowledge all the respiratory scientists who collected data in the lung function laboratories of Tasmania, Victoria, Queensland and New South Wales; the research interviewers, data entry operators and research officers. Finally, we thank the Archives Office of Tasmania for providing data from the 1968 TAHS questionnaires. This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme (299901, 1021275) and NHMRC European collaborative grant scheme (1101313) as part of ALEC (Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript.

Funding Information:
This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme ( 299901 , 1021275 ) and NHMRC European collaborative grant scheme ( 1101313 ) as part of ALEC ( Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212 ); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript.

Publisher Copyright:
© 2023 Sociedade Portuguesa de Pneumologia

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10.1016/j.pulmoe.2023.08.003

86913883-oaE-pub ahead of print, 294 KBLicence: CC BY-NC-ND

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Suresh, S., Perret, J. L., Walters, E. H., Abramson, M. J., Bowatte, G., Lodge, C., Lowe, A., Erbas, B., Thomas, P., Hamilton, G. S., Chang, A. B., Dharmage, S. C., & Bui, D. S. (2023). Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults. Pulmonology, 1-8. Advance online publication. https://doi.org/10.1016/j.pulmoe.2023.08.003

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title = "Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults",

abstract = "Background and objectives: While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. Methods: Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. Results: The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. Conclusions: Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.",

keywords = "Chronic cough, Comorbidity, Cough phenotypes, Lung function",

author = "S. Suresh and Perret, {J. L.} and Walters, {E. H.} and Abramson, {M. J.} and G. Bowatte and C. Lodge and A. Lowe and B. Erbas and P. Thomas and Hamilton, {G. S.} and Chang, {A. B.} and Dharmage, {S. C.} and Bui, {D. S.}",

note = "Funding Information: We acknowledge the TAHS study participants and previous investigators. We thank Professor Mark Jenkins, PhD, Centre for Epidemiology & Biostatistics, The University of Melbourne, Victoria, a TAHS investigator, but not a co-author of this manuscript, for his assistance with obtaining funds and data collection. We also acknowledge all the respiratory scientists who collected data in the lung function laboratories of Tasmania, Victoria, Queensland and New South Wales; the research interviewers, data entry operators and research officers. Finally, we thank the Archives Office of Tasmania for providing data from the 1968 TAHS questionnaires. This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme (299901, 1021275) and NHMRC European collaborative grant scheme (1101313) as part of ALEC (Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript. Funding Information: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme ( 299901 , 1021275 ) and NHMRC European collaborative grant scheme ( 1101313 ) as part of ALEC ( Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212 ); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript. Publisher Copyright: {\textcopyright} 2023 Sociedade Portuguesa de Pneumologia",

year = "2023",

month = sep,

day = "22",

doi = "10.1016/j.pulmoe.2023.08.003",

language = "English",

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journal = "Pulmonology",

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TY - JOUR

T1 - Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults

AU - Suresh, S.

AU - Perret, J. L.

AU - Walters, E. H.

AU - Abramson, M. J.

AU - Bowatte, G.

AU - Lodge, C.

AU - Lowe, A.

AU - Erbas, B.

AU - Thomas, P.

AU - Hamilton, G. S.

AU - Chang, A. B.

AU - Dharmage, S. C.

AU - Bui, D. S.

N1 - Funding Information: We acknowledge the TAHS study participants and previous investigators. We thank Professor Mark Jenkins, PhD, Centre for Epidemiology & Biostatistics, The University of Melbourne, Victoria, a TAHS investigator, but not a co-author of this manuscript, for his assistance with obtaining funds and data collection. We also acknowledge all the respiratory scientists who collected data in the lung function laboratories of Tasmania, Victoria, Queensland and New South Wales; the research interviewers, data entry operators and research officers. Finally, we thank the Archives Office of Tasmania for providing data from the 1968 TAHS questionnaires. This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme (299901, 1021275) and NHMRC European collaborative grant scheme (1101313) as part of ALEC (Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript. Funding Information: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia under NHMRC project grant scheme ( 299901 , 1021275 ) and NHMRC European collaborative grant scheme ( 1101313 ) as part of ALEC ( Ageing Lungs in European Cohorts funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 633212 ); The University of Melbourne; Clifford Craig Medical Research Trust of Tasmania; the Victorian, Queensland & Tasmanian Asthma Foundations; The Royal Hobart Hospital; Helen MacPherson Smith Trust; and GlaxoSmithKline. The funding agencies had no direct role in the conduct of the study, the collection, management, statistical analysis and interpretation of the data, preparation or approval of the manuscript. Publisher Copyright: © 2023 Sociedade Portuguesa de Pneumologia

PY - 2023/9/22

Y1 - 2023/9/22

N2 - Background and objectives: While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. Methods: Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. Results: The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. Conclusions: Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

AB - Background and objectives: While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. Methods: Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into “explained cough” if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or “unexplained cough” if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. Results: The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being “unexplained”. Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. Conclusions: Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.

KW - Chronic cough

KW - Comorbidity

KW - Cough phenotypes

KW - Lung function

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U2 - 10.1016/j.pulmoe.2023.08.003

DO - 10.1016/j.pulmoe.2023.08.003

M3 - Article

AN - SCOPUS:85172016932

SN - 2531-0429

SP - 1

EP - 8

JO - Pulmonology

JF - Pulmonology

ER -

Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults

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