Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ)

Automatic cough detection via a multi-sensor smart garment using machine learning

Coughing behavior is associated with conditions such as sleep apnea, asthma, and chronic obstructive pulmonary disorder and can severely affect quality of life in those affected. In this context, coughing quantification is often important, but routinely performed via questionnaires. This approach is dependent on patient compliance or recall, which may affect validity and be especially difficult for nocturnal coughs. Manual review of audio recordings is potentially more accurate, but raises privacy concerns due to the collection and review of sensitive audio-data by a human annotator. Today, machine learning approaches are increasingly used to quantify coughs; however, algorithms often rely on microphone recordings, resulting in the same privacy issues, especially if data are sent to a remote server for analysis. The aims of this study are to determine if (1) a suite of sensors, excluding microphone recordings, can accurately detect coughs unobtrusively and (2) what the relative importance of each sensor-type on model performance may be. Data from 44 healthy young adult participants performing on-demand coughs and other tasks (breathing, talking, throat clearing, laughing, sniffing) in supine and sitting conditions were collected for this observational, cross-sectional study using a multi-sensor smart-garment device. Synchronized video was used to annotate tasks. Three-dimension acceleration, respiration (inductance plethysmography), and electrical activity (electrocardiography) signals were extracted into 1 s strips and binarized into coughs and non-coughs. Data were split into train and test sets using an inter-subject 80:20 split, ensuring that data from a particular participant are found in a single set. This procedure was repeated 10 times with different random inter-subject splits to assess the variability of results. Statistical and frequency-based features were computed and used as inputs to a Random Forest Classifier to predict classes (cough vs not-cough). Model hyperparameters were tuned to maximize F1-score using five-fold cross validation of the training set. Final model performance was assessed using F1-score, precision, and recall (sensitivity) on the test sets with mean (standard deviation) reported. Single sensor models based on acceleration, respiration, or electrocardiography revealed F1 scores of 92.6 (1.2)%, 88.9 (3.2)%, and 77.5 (3.4)%, respectively. Overall, the dual (acceleration, respiration) sensor model achieved the highest performance (F1-score 93.0 (1.1)%, precision 84.2 (4.2)%, and recall 95.5 (1.6)%). The multi-modal wearable device was able to distinguish coughs from other respiratory maneuvers, with acceleration and respiration sensors providing the most valuable information. Future studies could implement this approach for remote monitoring of coughs in patients suffering from coughing symptoms.

Camlipixant in Refractory Chronic Cough: A Phase 2b, Randomized, Placebo-controlled Trial (SOOTHE)

Rationale: There is no broadly accessible treatment for patients with refractory chronic cough, a disease characterized by chronic cough that persists despite treatment for other cough-related etiologies or has no identified underlying cause. Objectives: SOOTHE (NCT04678206), a phase 2b, randomized, placebo-controlled trial, evaluated the efficacy and safety of P2X3 antagonist camlipixant in adults with refractory chronic cough (cough duration, ⩾1 yr; baseline awake cough frequency, ⩾25 coughs/h). Methods: After a single-blind, 16-day placebo run-in, patients were randomized (1:1:1:1) to receive camlipixant 12.5, 50, or 200 mg twice daily or placebo for 4 weeks. The primary endpoint was change from baseline to Day 28 in objective 24-hour cough frequency. Secondary endpoints included cough severity and cough-related quality of life. Measurements and Main Results: Overall, 310 patients were randomized. A statistically significant reduction in placebo-adjusted 24-hour cough frequency was seen in the 50 mg (-34.4%; 95% confidence interval, -50.5 to -13.3; P = 0.0033) and 200 mg (-34.2%; 95% confidence interval, -50.7 to -12.2; P = 0.0047) camlipixant arms. All camlipixant arms showed a trend for greater improvement in cough severity visual analog scale and Leicester Cough Questionnaire scores over placebo. Camlipixant was well tolerated with no serious treatment-emergent adverse events reported. Taste alteration occurred in 4.8-6.5% of patients in camlipixant arms (vs. 0% with placebo); these were usually mild-moderate. Conclusions: Camlipixant treatment reduced cough frequency and improved patient-reported outcomes in patients with refractory chronic cough, with an acceptable safety profile. Clinical trial registered with www.clinicaltrials.gov (NCT04678206).

The efficacy and safety of Fluticasone Furoate/Umeclidinium/vilanterol (FF/UMEC/VI) on cough symptoms in adult patients with asthma, a randomized double-blind, placebo-controlled, parallel group study: Chronic Cough in Asthma (COCOA) study

BACKGROUND

Persistent cough bothers many patients with asthma because it worsens their quality of life; therefore, it must be remedied immediately. The efficacy of triple therapy as a first-line treatment for cough remains unclear. To evaluate the effectiveness and safety of the triple therapy against persistent cough, the clinical effect of regular treatment with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) or placebo in adult patients with asthma was investigated.

METHODS

This randomized, double-blind, placebo-controlled, parallel-group multicenter trial recruited asthma patients with persistent cough from hospitals and primary care clinics between June 2022 and December 2023. Participants were randomly given FF/UMEC/VI 200/62.5/25 µg or placebo for 6 wk. The primary endpoint was the average change in the cough symptom score from baseline to week 6. Secondary outcomes were effectiveness on cough-related disease burdens (asthma control questionnaire [ACQ]-5, Leicester cough questionnaire [LCQ] and nighttime awakening). Furthermore, lung function and adverse events were evaluated.

RESULTS

The decrease from baseline in the cough symptom score at week 6 was significantly greater in the FF/UMEC/VI group than in the placebo group (p = 0.006). The ACQ-5 scores showed a greater decrease in the FF/UMEC/VI group than in the placebo group. The change from baseline in morning and evening FEV1 increased in the FF/UMEC/VI group as with the results of peak expiratory flow. No significant adverse events associated with FF/UMEC/VI were noted.

CONCLUSIONS

In asthma patients with persistent cough, FF/UMEC/VI showed an early response and a significant effect on cough and lung function for 6 wk of treatment.

This study is registered with jRCTs031210412.

Predictive factors for neuromodulator response in patients with nonacid gastroesophageal reflux-induced chronic cough: a retrospective data analysis

Background

Nonacid gastroesophageal reflux-induced cough (GERC) remains understudied, with limited research on effective treatment options. Recently, neuromodulators such as gabapentin and baclofen have shown promise in managing nonacid GERC.

Objectives

This study aimed to identify factors associated with response to neuromodulator therapy in nonacid GERC.

Study design

A retrospective study.

Methods

We analyzed medical records of patients diagnosed with nonacid GERC who received gabapentin or baclofen as an add-on therapy enrolled between December 2019 and January 2024. Retrospective analysis of general information, cough-related questionnaires, MII-pH parameters, and other assessments was conducted to establish a regression analysis model for identifying multiple factors associated with neuromodulator response.

Results

In this retrospective cohort study, data from 184 patients were analyzed, with 106 (57.6%) classified as responders and 78 (42.4%) as nonresponders. Clinical factors significantly associated with neuromodulator efficacy included gender (OR = 4.324, p = 0.027), age (OR = 0.803, p = 0.002), and exposure to cough-aggravating factors (OR = 6.345, p < 0.001). Furthermore, multiple regression analysis further identified specific Hull Airway Reflux Questionnaire (HARQ) items-"Cough with certain foods" (OR = 2.523, p = 0.034), "Cough with eating" (OR = 4.445, p < 0.001), and "Cough brought on by singing or speaking" (OR = 5.003, p = 0.007)-as significant predictors. Additionally, Medication Adherence Questionnaire (MAQ) items such as "Forgetfulness" (OR = 0.257, p = 0.005) and "Stopping medication when "feeling better" (OR = 0.787, p = 0.017) were also identified as significant predictors of treatment response.

Conclusion

Neuromodulators can relieve nonacid GERC in patients unresponsive to standard anti-reflux therapy. Factors such as male gender, younger age, less exposure to cough irritants, and higher HARQ and lower MAQ scores can effectively predict the efficacy of neuromodulators.

Phase 2 study design and analysis approach for BBT-877: an autotaxin inhibitor targeting idiopathic pulmonary fibrosis

INTRODUCTION

Proof-of-concept (POC) studies are vital in determining the feasibility of further drug development, primarily by assessing preliminary efficacy signals with credible endpoints. However, traditional POC studies in idiopathic pulmonary fibrosis (IPF) can suffer from low credibility due to small sample sizes and short durations, leading to non-replicable results in larger phase III trials. To address this, we are conducting a 24-week POC study with 120 patients with IPF, using a statistically supported sample size and incorporating exploratory CT-based imaging biomarkers, to support decision-making in the case of non-significant primary endpoint results. This approach aims to provide data to enable a robust decision-making process for advancing clinical development of BBT-877.

METHODS AND ANALYSIS

In this phase II, double-blind, placebo-controlled study, approximately 120 patients with IPF will be randomised in a 1:1 ratio to receive placebo or 200 mg of BBT-877 two times per day over 24 weeks, with stratification according to background use of an antifibrotic treatment (pirfenidone background therapy, nintedanib background therapy or no background therapy). The primary endpoint is absolute change in forced vital capacity (FVC) (mL) from baseline to week 24. Key secondary endpoints include change from baseline to week 24 in %-predicted FVC, diffusing capacity of the lung for carbon monoxide, 6 min walk test, patient-reported outcomes, pharmacokinetics and safety, and tolerability. Key exploratory endpoints include eLung-based CT evaluation and biomarker-based assessment of pharmacodynamics.

ETHICS AND DISSEMINATION

This study is being conducted following the Declaration of Helsinki principles, Good Clinical Practice guidance, applicable local regulations and local ethics committees. An independent data monitoring committee unblinded to individual subject treatment allocation will evaluate safety and efficacy data on a regular basis throughout the study. The results of this study will be presented at scientific conferences and peer-review publications.

TRIAL REGISTRATION NUMBER

NCT05483907.

Efficacy and Safety of Superior Laryngeal Nerve Block in the Management of Neuropathic Cough: A Systematic Review

OBJECTIVES

To systematically review the efficacy and safety, both short and long-term, of superior laryngeal nerve block (SLNB) for managing neuropathic cough.

METHODS

A literature search was conducted using the keywords "Superior laryngeal nerve block," "Neurogenic Cough," "Neuropathic Cough," and "Refractory Chronic Cough." The primary outcome was cough-specific quality of life (QoL), evaluated with validated patient-reported outcome measures (PROMs) such as the Leicester Cough Questionnaire (LCQ), Cough Severity Index (CSI), and Hull Airway Reflux Questionnaire (HARQ). Additional data included SLNB technique, cough duration, use of neuromodulators and Behavioral Cough Suppression Therapy (BCST), injection frequency, vocal fold dysfunction (VFD), and adverse events. Quality assessments used the Methodological Index for Non-Randomized Studies (MINORS) criteria.

RESULTS

Ten studies comprising 625 patients were included. The average cough duration prior to intervention was 78 months, with a mean follow-up of 5.01 months. Patients received an average of 2.5 injections. Short-term outcomes showed consistent improvements in PROMs and cough perception. Long-term outcomes (beyond three months) were reported in four studies, with minimal variations but no statistical comparisons to baseline scores. Significant heterogeneity was noted across studies, including differences in assessment protocols and adjunctive therapies. No significant adverse events were reported.

CONCLUSION

SLNB is a safe and effective treatment for refractory chronic cough, either alone or with systemic medications. However, the variability among studies highlights the need for standardized protocols and further research with long-term follow-up to confirm its efficacy.

How Will a Treatable Traits Approach Reshape Clinical Practice in Chronic Cough?

Chronic cough, which affects 5%-18% of adults, has traditionally been considered a symptom defined by its duration. However, recent advances in understanding the pathophysiology of chronic cough have prompted the concept that chronic cough may exist as a distinct clinical entity driven by neuronal dysregulation and cough hypersensitivity. This evolving perspective recognizes various treatable traits and clinical characteristics which support the notion of cough as a disease entity and beyond that of a symptom-based classification. Initially developed for asthma and chronic obstructive pulmonary disease, the treatable traits approach has now been extended to chronic cough management, offering a more personalized treatment model. It focuses on identifying modifiable traits that significantly impact patient outcomes. However, challenges remain in implementing this model, including the need for trait validation, biomarker development, staff training, and the integration of new therapies. Despite these challenges, the treatable traits approach provides a promising framework for refining chronic cough management strategies and improving patient care.

Development and Validation of Cough Hypersensitivity Assessment Test

BACKGROUND

Cough hypersensitivity is an important clinical and pathophysiologic feature of chronic cough, which involves chemical, mechanical, and thermal stimuli and sensory dysfunction. Currently, there is a need for a comprehensive method to evaluate cough hypersensitivity.

OBJECTIVE

To develop and validate a questionnaire to assess the degree of cough hypersensitivity.

METHODS

The initial items of the Cough Hypersensitivity Assessment Test (CHAT) were made based on a literature review, experts' opinions, and clinical practice. Items were reduced after investigation involving patients with chronic cough. Dimensional allocation, internal reliability, test-retest reliability, construct validity, responsiveness, and cutoff value were determined in the final stage.

RESULTS

The final version of CHAT on a 5-point Likert scale (0-4) includes 18 items consisting of three dimensions: environmental triggers, daily life triggers, and tussive symptoms, with total score ranging from 0 to 72. There was significant difference in CHAT-18 scores between patients and healthy controls (P < .001). Cronbach α for CHAT was 0.832 and intraclass correlation coefficient for CHAT was 0.884. Construct validity was demonstrated with a multitrait-multimethod matrix. There was good responsiveness after treatment. The cutoff value of CHAT was 18 for cough hypersensitivity. There was a mild to moderate correlation between capsaicin cough sensitivity and tussive symptoms and the total score of CHAT.

CONCLUSIONS

The CHAT comprehensively covers a range of cough triggers and shows robust internal reliability, test-retest reliability, construct validity, and responsiveness. This may be useful for measuring cough hypersensitivity.

Effect of Behavioral Cough Suppression Therapy Delivered via Telehealth

OBJECTIVES/HYPOTHESIS

Behavioral cough suppression therapy (BCST) has demonstrated up to 88% effectiveness at treating refractory chronic cough (RCC). With onset of the COVID-19 pandemic, along with many other medical services, BCST shifted to telehealth delivery. Our group hypothesized that BCST delivered via telemedicine by a specialized Speech-Language Pathologist would be comparable to previously reported response to treatment for in-person settings.

STUDY DESIGN

Retrospective review.

METHODS

An Emory IRB approved, retrospective review of electronic medical records was completed for RCC patients who received BCST via telehealth from March 2020 through January 2022 at Emory Voice Center. Patients were included in the study if they had a diagnosis of RCC, were referred for BCST, were seen for at least one therapy session in the telehealth setting, and provided Cough Severity Index (CSI) data pre and post-treatment. Patients were excluded if they had incomplete datasets, a known pulmonary condition, structural laryngeal disorders, smoking history, dysphagia, and ACE-inhibitor use. Change in CSI score pre- and post-treatment was calculated to determine treatment effect. Paired-samples t-tests were conducted to compare pre-and post-treatment CSI score change.

RESULTS

Fifty-one RCC patients were included in this study; 88% were female with an average age of 60 years (SD = 12.68). Post-treatment CSI scores were significantly lower than pretreatment CSI scores (P < 0.0001). These findings are comparable to historical documented CSI change achieved with in-person BCST.

CONCLUSIONS

This study provides preliminary evidence of the efficacy of BCST via telehealth for treating RCC. The findings of this study support the continued flexibility in speech-language pathology service delivery to include in-person and telehealth platforms for RCC beyond the COVID-19 pandemic.

Viscoelastic characteristics of spontaneous sputum obtained from patients with chronic productive cough in comparison to bronchial asthma

BACKGROUND

Chronic respiratory diseases are known to be associated with alterations in mucus rheology, but limited information is available regarding chronic cough. The aim of this study was to determine the sputum rheology in chronic productive cough (CPC) in comparison to bronchial asthma (BA).

METHODS

The viscoelasticity profiles of spontaneous sputum obtained from 26 patients with CPC (10 sinobronchial syndrome [SBS], 16 non-SBS) and 25 patients with BA (12 mild-persistent, 7 moderate, and 6 severe) were analyzed by rheometry in a single center. The non-SBS group included fungus-associated chronic cough, post-COVID-19 cough, bronchorrhea, and unexplained chronic cough.

RESULTS

Viscoelastic modulus (G∗) and viscous modulus (G″) of the SBS group were similar to those of the total BA group. Although critical strain (γC) and critical stress (σC) tended to be larger in the BA group, and the former was comparable between the non-SBS group and the moderate or severe BA group. In the non-SBS group, G″ was closely correlated with FeNO, and γC was inversely correlated with respiratory function, as in the BA group, but no such correlations were observed in the SBS group.

CONCLUSIONS

Quantitative rheological analysis revealed unique viscoelastic characteristics of spontaneous sputum and altered association with clinical biomarkers in the non-SBS group, in which the profile was more similar to BA than SBS in CPC. This new rheometer can identify features of sputum in patients with CPC that cannot be detected by conventional methods. Further investigations of sputum rheology in CPC are warranted to understand its pathogenesis.

Palliative care education as an integrated component of pulmonary rehabilitation: A real-world mixed-methods feasibility study

AIM

To explore the feasibility of integrating palliative care education in pulmonary rehabilitation (PR).

METHODS

A mixed-methods feasibility study was conducted in people with chronic respiratory diseases enrolled in 12-weeks outpatient hospital-based PR. A session about palliative care was integrated in the education content. Feasibility was assessed by attendance to the palliative care session, feasibility and acceptability of outcome assessment, acceptability of the intervention and undesirable effects. After PR, two focus groups were carried out. Descriptive and inductive thematic analyses were performed.

RESULTS

Out of 44 individuals referred to PR, 14 were excluded, six declined to participate and two were referred to another rehabilitation programme. Twenty-two people with chronic respiratory diseases started PR, however, six had discontinued the programme at the time of the palliative care session. Attendance to this session was 81 % (n = 13/16; 11 chronic obstructive pulmonary disease, 1 severe asthma and 1 interstitial lung disease; 77 % men, 65 ± 9 years-old, FEV1 41 ± 21 % of predicted). Outcome assessment was completed in 77 % (n = 10/13) of participants and lasted approximately 90 minutes. Three themes were identified from the focus groups: daily living with a chronic respiratory disease, meaningful care and demystifying misconceptions. Participants found the intervention and outcome assessment acceptable. An improvement in knowledge and change of attitude towards palliative care was considered a major effect of the palliative care session. No undesirable effects were reported.

DISCUSSION

Integrating an education session about palliative care in PR is feasible, meaningful for people with chronic respiratory diseases, and has no undesirable effects. A randomised controlled study is being prepared to strengthen these results.

Efficacy and Safety of Fexuprazan Versus Esomeprazole for Gastroesophageal Reflux Disease-Related Chronic Cough: A Randomized, Double-Blind, Active-Controlled Exploratory Trial

PURPOSE

Potassium-competitive acid blockers (P-CABs) are a newer class of acid suppressants with convenient dosing and a rapid onset of action, while showing efficacy comparable to proton pump inhibitors (PPIs) in treating peptic symptoms of gastroesophageal reflux disease (GERD). This study aimed to assess the effect of P-CABs on GERD-related chronic cough.

METHODS

This randomized, double-blind, active-controlled, exploratory trial evaluated adults with chronic cough (≥ 8 weeks) and a recent physician diagnosis of GERD or peptic symptoms (< 1 month). Participants were randomized (1:1) to receive either fexuprazan 40 mg or esomeprazole 40 mg (PPI) once daily for eight weeks, along with matched placebos. The primary endpoint was the change in Leicester Cough Questionnaire (LCQ) score from baseline. Secondary endpoints included changes in the cough severity Numerical Rating Scale (NRS) and Reflux Disease Questionnaire (RDQ) scores. Safety was evaluated through monitoring adverse events.

RESULTS

Of the 190 subjects recruited, 161 met the selection criteria and were randomized, and 146 completed the trial. The participants were predominantly female (74.3%, mean age 39 ± 12 years). After 8 weeks of treatment, cough-related quality of life improved significantly, with comparable LCQ scores change between the groups (fexuprazan: 4.9 ± 4.0 vs. esomeprazole: 5.3 ± 3.8, p = 0.558). Changes in cough severity NRS and RDQ scores were also similar between the groups. Adverse events were comparable and consisted mostly of mild symptoms.

CONCLUSION

These findings support the potential of P-CABs as a promising alternative to PPIs for patients with chronic cough requiring acid-suppressive therapy.

Predicting Outcomes using DIGital TechnologY in patients with Interstitial Lung Disease (PRODIGY-ILD): Protocol for a Prospective Cohort Study

INTRODUCTION

Interstitial lung disease (ILD) patients may develop a progressive phenotype usually characterised by progressive pulmonary fibrosis. While this condition is life-limiting, wide variations in its clinical course have made it difficult to predict the rate of disease progression, onset of acute exacerbations and mortality. New approaches are needed to predict the clinical course of ILD, to enable treatment planning, evaluation and clinical trial design. Advances in digital health technologies have facilitated the ability to collect 'real-time' data to monitor diseases. These data, including physiological measures, activity indices and patient-reported outcomes, may be useful as components of new outcome predictors. The objective of this study is to first deploy comprehensive data collection enabling deep profiling of patients with ILD and to use these data to develop better predictors of outcome. Finally, these predictions will be evaluated based on real observed outcomes for individual patients.

METHODS AND ANALYSIS

This study is a prospective cohort study with 50 participants.

INCLUSION CRITERIA

Age 18 years or older with a diagnosis of ILD and the ability to provide written informed consent.

EXCLUSION CRITERIA

Age under 18 years or unwilling to wear a smartwatch for the duration of the study. Participants will be provided with a smartwatch to passively collect biometric data. These data will be combined with clinical history and course, in addition to a set of patient-reported outcome measures. Participants will be followed for 3 years to assess the rate of disease progression, occurrence of acute exacerbations and mortality. Initial data will be used to develop clinical prediction models. These models will be further evaluated for accuracy using regular follow-up data.

ETHICS AND DISSEMINATION

This study was approved by the St. Vincent's University Hospital Research Ethics Committee, Dublin, Ireland (reference no: RS23-023). Results will be presented at medical conferences and disseminated via peer-reviewed journals.

Effectiveness of ensitrelvir for cough caused by COVID-19 Omicron variant in patients with asthma

In the post-acute coronavirus disease 2019 (COVID-19) period, patients with asthma had a significantly higher risk of cough than patients without a history of asthma. In particular, cases with persistent cough were increased during the Omicron variant epidemic. In this study, we evaluated the efficacy of ensitrelvir for the treatment of cough associated with COVID-19 Omicron variants in patients with asthma. This follows the Strengthening the Reporting of Observational Studies in Epidemiology statement. A total of 223 patients were registered in this study: 121 patients chose ensitrelvir, and 102 patients chose symptomatic treatment. Cough severity, frequency, and cough-specific quality of life were evaluated using the Japanese version of the Leicester Cough Questionnaire (J-LCQ). J-LCQ documented at baseline on days 4, 7, and 14 for all patients showed a steady improvement over time in both groups. In the mixed model for repeated measures model, which accounts for repeated measurements, the change in J-LCQ score from baseline was 2.1 points higher in the ensitrelvir group (P <0.001). Additionally, patients who were using triple inhaled therapy at baseline showed a 2.3-point higher change in J-LCQ score from baseline (P <0.001). Multiple regression analysis was performed at days 4, 7, and 14, with the change in J-LCQ score from baseline as the dependent variable. Ensitrelvir was associated with scores that were 3.1 points higher on day 4, 3.5 points higher on day 7, and 2.0 points higher on day 14 compared with symptomatic treatment (P <0.001 for all). In conclusion, our results demonstrated that early administration of ensitrelvir may be effective as a treatment for cough due to the COVID-19 Omicron variant.

IMPORTANCE

We evaluated the efficacy of ensitrelvir for the treatment of cough due to coronavirus disease 2019 (COVID-19) Omicron variant in patients with asthma. A total of 223 patients were registered in this study: 121 patients chose ensitrelvir, and 102 patients chose symptomatic treatment. Cough severity, frequency, and cough-specific quality of life were evaluated using the Japanese version of the Leicester Cough Questionnaire (J-LCQ). Multiple regression analysis was performed at days 4, 7, and 14, with the change in J-LCQ score from baseline as the dependent variable. Ensitrelvir was associated with scores that were 3.1 points higher on day 4, 3.5 points higher on day 7, and 2.0 points higher on day 14 compared with symptomatic treatment (P <0.001 for all). Our results demonstrated that early administration of ensitrelvir may be effective as a treatment for cough due to the COVID-19 Omicron variant.

Clinical manifestations of COVID-19 Omicron variants in medical healthcare workers: Focusing on the cough

INTRODUCTION

Important points in cough management are that it is necessary to be familiar with the characteristic medical history for each disease, such as infection and cough variant asthma. To clarify whether cough due to SARS-CoV-2 has any characteristics or not, we investigated the clinical manifestations of COVID-19 Omicron variant focused especially on infectious cough.

METHODS

We enrolled adult patients consecutively diagnosed with mild COVID-19 who were medical healthcare workers in our five hospitals. A total of 2449 patients were analyzed: 300 patients with BA.1 subvariant, 202 patients with BA.2 subvariant, 1030 patients with BA.5 subvariant, 413 patients with XBB lineage, 103 patients with BA.2.86, and 401 patients with JN.1 subvariant.

RESULTS

Among the clinical symptoms, cough was most frequent symptom in all Omicron subvariants groups and all age groups. The most frequent pattern of symptoms was cough appearing after pharyngeal symptoms in 38 % of patients, with cough appearing after fever observed in 25.1 % of patients. The pattern in which cough and pharyngeal symptoms were the initial symptoms was observed in 19.6 % of cases, and where cough and fever were the initial symptoms was observed in 14.9 % of cases.

CONCLUSIONS

Cough was the most frequent symptom in patients with COVID-19 Omicron variant and cough was the initial symptom in 1/3 of cases, and 2/3 of cases were preceded by symptoms other than cough. There were few cases of cough only or paroxysmal cough. However, it is considered difficult to differentiate between sources of infectious cough based on symptoms alone.

Clinical characteristics of the early responders in the treatment of chronic cough

Background

Chronic cough (CC) is defined by cough more than 8 weeks. Common causes of CC are upper airway cough syndrome (UACS), asthma, eosinophilic bronchitis (EB), and gastroesophageal reflux diseases (GERD). However, we do not know the characteristics of responding to treatment early. We conducted this study to evaluate the characteristics of the early responder group of CC.

Methods

This study was conducted as multi-center, retrospective observational study. Patients were collected in 15 university hospitals. The severity and quality of life (QOL) of CC were measured by cough numeric rating scale (NRS) and Cough Assessment Test (COAT) scores three times (baseline, 2 weeks, and 4 weeks after treatment). The early responder group was defined by improvement of minimal important difference in both cough NRS and COAT.

Results

Early responder group was more diagnosed as UACS compared to non-early responder group (65.7% vs. 49.2%, P=0.006). They also had higher baseline cough NRS (5.5±1.2 vs. 4.9±1.3, P<0.001). After adjusting confounding factors such as sex, age, cough duration, baseline cough severity and QOL, and diagnoses of UACS, asthma/EB, or GERD, higher cough NRS [odds ratio (OR) 1.44; 95% confidence interval (CI): 1.06-1.97; P=0.02] and diagnosis of UACS (OR 1.76; 95% CI: 1.02-3.02; P=0.04) were associated with being early responder group in the multivariate logistic regression analyses.

Conclusions

We demonstrated the characteristics of early responders of CC treatment. UACS group and higher baseline cough severity group showed earlier response to treatment than other groups.

Cough in pulmonary rehabilitation: a retrospective analysis of responders and nonresponders

Background

Pulmonary rehabilitation (PR) is essential for people with chronic respiratory diseases (CRDs), yet its impact on cough-related quality of life (CR-QoL) remains unexplored. We assessed the effects of PR on CR-QoL, described the characteristics of responders and nonresponders to PR, and explored determinants of responsiveness in this health domain in individuals with CRDs.

Methods

A retrospective study was conducted. We assessed CR-QoL using the Leicester Cough Questionnaire (LCQ) and the impact of the disease with the COPD Assessment Test (CAT), before and after PR. Cut-offs of <17.05 in LCQ total score and ≥10 in CAT were used to detect low CR-QoL and medium impact of the disease. Responders were defined as achieving a minimal clinically important difference (MCID) of ≥1.3 on the LCQ total score. Pre- versus post-PR analysis involved the t-test, Wilcoxon test or McNemar test and comparisons between groups included the independent t-test, Mann-Whitney U-test or Fisher's exact test. Logistic regression was employed to investigate factors influencing MCID achievement.

Results

135 participants with CRDs (39% females; age 68±10 years; 61% COPD; forced expiratory volume in 1 s (FEV1) % pred 62.6±23.0%) were included. After PR, significant improvements were observed in all LCQ domains and CAT. 31% of participants were identified as responders in the LCQ (36% females; age 66±10 years; 62% COPD; FEV1 % pred 60.0±22.3%), showcasing significant differences in the LCQ and CAT compared to nonresponders. People with low CR-QoL and medium/high impact of the disease at baseline were 11 and 4 times more likely to respond to PR in CR-QoL, respectively.

Conclusion

PR enhances CR-QoL. Identification of CR-QoL and disease impact traits at baseline offers insights to optimise this outcome responsiveness to PR.

Protocol for a double-blind crossover randomised controlled trial to investigate inhalation challenge to assess inducible laryngeal obstruction: CH-ILO

Introduction

Inducible laryngeal obstruction (ILO) remains a poorly understood condition in part due to lack of understanding about the underlying neuronal mechanisms. Many suffer delayed confirmed diagnosis as no standardised assessment exists. Based on previous work, we propose citric acid (CA) is the most appropriate inhalation agent for inducing upper airway reflex responses, with a view to developing an inhalation challenge test for ILO.

Methods and analysis

This is a single-centre, double-blind crossover study. The primary objective is to identify if CA inhalation challenge provokes laryngeal obstruction in patients with confirmed ILO. We will recruit 10 participants with ILO, 10 with refractory chronic cough (RCC) and 10 healthy controls. Each participant will undergo two inhalation challenges during laryngoscopy, with ascending concentrations of CA or saline control; they will be randomised sequentially by a computer-generated schedule to determine order of delivery. Follow-up is a telephone consultation. Randomisation and preparation of challenge agents will be by an unblinded study team member not involved in data analysis. Challenge agents will only be unblinded on study completion. Log10 concentration of CA evoking ILO will be compared between patient groups using a one-way ANOVA, comparing participants with ILO and participants with RCC to healthy controls.

Conclusion

This will be the first randomised controlled trial to investigate the role of inhalation challenge as an assessment tool to evoke laryngeal obstruction in patients with confirmed ILO. If results prove CA inhalation challenge agent provokes ILO, it will provide new insights into neuronal mechanisms and support development of a standardised diagnostic test.

WAO - ARIA consensus on chronic cough: Executive summary

Acute cough is a highly prevalent symptom in clinical practice. Chronic cough is a complex disease with significant impact on quality of life. The mechanistic pathways of chronic cough in cough-comorbid clinical phenotypes are elusive. Mounting evidence suggests presence of a hypersensitive cough reflex and implication of transient receptor potential channels and P2X receptors in cough neuronal pathways. Previously, the World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough published updated experimental and clinical data on chronic cough, in addition to a multidisciplinary care pathway approach to its management. The goal of this manuscript is to provide clinicians with a succinct summary of chronic cough pathophysiology, clinical phenotypes, and management strategies in both primary and cough specialty care. This executive summary is a primer for clinicians on chronic cough. Increasing awareness on the topic among primary care physicians will improve the outcome of management of patients with chronic cough.

Comparison of Early Functional Recovery Following Triportal Robot-Assisted and Uniportal Video-Assisted Segmentectomy in Patients With Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

BACKGROUND

Robot-assisted thoracoscopic surgery (RATS) is more precise and flexible than video-assisted thoracoscopic surgery (VATS) for early-stage non-small cell lung cancer (NSCLC) treatment. This study compared the early postoperative functional recovery of patients who underwent triportal RATS with that of patients who underwent uniportal video-assisted thoracic surgery (UVATS) for segmentectomy.

METHODS

This observational, prospective study included 172 patients with clinical stage I or II peripheral NSCLC who underwent RATS or UVATS segmentectomy. Propensity score matching (PSM) was used to balance differences between groups. The functional recovery data were collected during the first 4 weeks after discharge via portable devices and questionnaires (EORTC QLQ-C30, Christensen Fatigue Scale, MD Anderson Symptom Inventory, and Leicester Cough Questionnaire).

RESULTS

After PSM, the baseline characteristics were consistent between the groups. RATS was associated with shorter operation time and lower total drainage volume compared to UVATS. However, RATS was associated with more cases of severe postoperative pain. Despite this, patients who underwent RATS recovered well, showed good short-term outcomes in fatigue and physical function, and experienced few postoperative adverse events. The differences in average daily step count and sleep duration were not significant. In terms of global health status (GHS), RATS was slightly but nonsignificantly advantageous.

CONCLUSIONS

In the enhanced recovery after surgery (ERAS) pathway, triportal RATS has potential benefits in terms of perioperative and early postoperative functional recovery after segmentectomy.

TRIAL REGISTRATION

Biomedical Research Ethics Committee of Shandong Province: 2022-580; Chinese Clinical Trial Registry: ChiCTR2300067977.

The Clinical Approach to Chronic Cough

Chronic cough remains a significant clinical challenge, affecting approximately 10% of the population and leading to significant impairment in psychological, social, and physical quality of life. In recent years, efforts have intensified to elucidate the mechanisms underlying chronic cough and to focus on investigating and treating refractory chronic cough (RCC). A "treatable trait" approach, which focuses on identifying and addressing the specific associated causes of chronic cough, has gained traction. In some patients, RCC is likely driven by a neuropathic mechanism due to dysregulation of the neuronal pathways involved in the cough reflex, often clinically described as cough hypersensitivity syndrome. Although the initial treatment of underlying conditions remains central to managing treatable traits, the therapeutic options for RCC have expanded to include targeting cough hypersensitivity. First-line treatments now include neuromodulators and speech therapy with one P2X3 receptor antagonist (gefapixant) recently licensed in the European Union, United Kingdom, and Japan. Despite these advances, patient responses remain variable, underscoring the ongoing need for research into the pathophysiology and treatment of RCC. This article reviews current investigations and management options in treating chronic cough and RCC.

Patient-centered assessment of treatment for alpha-1 antitrypsin deficiency: literature review to identify concepts and measures for people with alpha1-antitrypsin deficiency

BACKGROUND

Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that can result in a range of illnesses, with chronic obstructive pulmonary disease (COPD) being one of the most common. Although some people obtain genetic testing that identifies AATD, many people are unaware that they have AATD until they develop COPD, often at a younger age than is typical. Treatment for AATD consists primarily of augmentation with AAT, requiring weekly infusions of blood products for most patients. This treatment can slow disease progression and improve symptoms, but is burdensome; thus, people with AATD could benefit from additional or alternate treatments. However, to guide the development of new treatments, researchers need to identify which outcomes matter to people with AATD.

METHODS

We conducted a scoping literature review to better understand patient experiences with AATD and its treatment and identify patient-reported outcome measures (PROMs) used to assess symptoms and impacts in studies of people with AATD.

RESULTS

The review identified 44 concepts related to symptoms and disease burden, grouped into six domains (symptoms, physical function, cognitive function, emotional function, psychosocial function, and treatment burden) and 24 PROMs that have been used in research on AATD. None of the identified measures were developed specifically for people with AATD. Research on patient-focused outcomes was limited, suggesting a significant gap in knowledge.

CONCLUSIONS

People with AATD experience a variety of disease-related burdens, but this study showed there is a lack of published, in-depth studies to support selection and evaluation of patient-centered outcomes among populations of people with AATD. A limited number of PROMs have been used in research on AATD or in clinical trials of treatment, including COPD-specific measures that assess symptoms and quality of life and measures of mood, sleep, and general physical and psychosocial functioning. The current study documented the available evidence and compiled a list of potential concepts of interest, but further qualitative and quantitative studies will be needed to understand the outcomes that matter to people with AATD and to evaluate the alignment between these outcomes and available measures.

The effectiveness and risks of Treating people with Idiopathic Pulmonary fibrosis with the Addition of Lansoprazole (TIPAL): study protocol for a randomised placebo-controlled multicentre clinical trial

INTRODUCTION

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic lung disease frequently complicated by gastro-oesophageal reflux disease. Although several observational studies and a pilot study have investigated the role of proton pump inhibitors (PPIs) in IPF, their efficacy is unknown and there is much debate in international IPF guidelines on their use. We aim to undertake an adequately powered double-blind placebo-controlled randomised multicentre clinical trial to assess the change in forced vital capacity (FVC), cough and other important patient-reported outcomes, following 12-month therapy with PPIs in people with IPF.

METHODS AND ANALYSIS

A total of 298 patients with IPF diagnosed by a multidisciplinary team according to international guidelines who are not receiving PPIs will be enrolled. Patients are randomised equally to receive two capsules of lansoprazole or two placebo capsules, two times per day for 12 months. The primary outcome for the trial is change in FVC, measured at home, between the first week and last week of the study period. Secondary assessments include cough frequency (in a subgroup) measured using the VitaloJAK cough monitor, the King's Brief Interstitial Lung Disease questionnaire, the Raghu Scale for Pulmonary Fibrosis, Medical Research Council dyspnoea score, EQ-5D-5L, Leicester Cough Questionnaire, modified DeMeester reflux symptoms questionnaire and opportunistically captured routine lung function measurements. High-resolution CT scoring will be undertaken in a subgroup. The trial is designed to determine whether treating people with IPF with lansoprazole will reduce the reduction in FVC over a year. The COVID-19 pandemic required the study to be undertaken as a remote trial.

ETHICS AND DISSEMINATION

This study received ethical approval from the East of England Cambridgeshire and Hertfordshire Research Ethics Committee (reference 20/EE/0043; integrated research application system number 269050). Trial results will be published in a peer-reviewed journal upon completion.

TRIAL REGISTRATION NUMBER

ISRCTN13526307; ClinicalTrials.gov NCT04965298.

The Newcastle Laryngeal Hypersensitivity Questionnaire: Translation and Cross-Cultural Adaptation to the Arabic Language

OBJECTIVES

This study aims to validate and assess the reliability of the Arabic version of the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) as a self-reported questionnaire for patients with laryngeal hypersensitivity syndrome (LHS).

STUDY DESIGN

A prospective, observational, cross-sectional study was conducted in the ear, nose and throat Department of Kafr Elsheikh University Hospitals.

METHODS

The preliminary Arabic version of the LHQ (LHQ-Ar) was created using a rigorous forward and backward translation method. Native Arabic-speaking patients visiting outpatient pulmonology, speech pathology, and ear, nose and throat clinics in this tertiary referral center were invited to participate. Participants were divided into two groups: group 1, comprising patients with LHS, and group 2, consisting of healthy controls. All participants completed the LHQ-Ar questionnaire twice, with a two-week interval, to assess test-retest reliability. Additionally, LHS patients completed the Arabic Voice Handicap Index-10 to examine correlations with LHQ-Ar scores. The LHQ-Ar underwent rigorous testing for internal consistency, reliability, validity, sensitivity, and specificity to establish it as a validated patient questionnaire.

RESULTS

The KMO test (KMO = 0.955) and Bartlett's test (P < 0.001) confirmed the sample's adequacy. The analysis identified only one factor with an eigenvalue greater than one, which explained 63.4% of the total variance. Items 13 (0.372) and 14 (0.306), which had commonalities below 0.5, were excluded. The final model, consisting of 12 items, accounted for 68.7% of the variance. Cronbach's alpha coefficients ranged from 0.933 to 0.988 for individual items and 0.995 for the total score, indicating excellent internal consistency.

CONCLUSION

The Arabic version of the Newcastle LHQ (LHQ-Ar) proves to be a reliable and valid tool for assessing LHS in Arabic-speaking populations. The LHQ-Ar shows strong internal consistency, test-retest reliability, and good sensitivity and specificity in predicting LHS, thus making it a valuable instrument for clinical use and research in Arabic-speaking patients.

The McMaster Cough Severity Questionnaire (MCSQ): a cough severity instrument for patients with refractory chronic cough

BACKGROUND

Cough severity represents an important end-point to assess the impact of therapies for patients with refractory chronic cough (RCC). Our objective was to develop a new patient-reported outcome measure addressing cough severity in patients with RCC.

METHODS

Phase 1 (item generation): a systematic survey, focus groups and expert consultation generated 51 items. Phase 2 (item reduction): from a list of 51 items, 100 patients identified those they had experienced in the previous year and rated their importance on a 5-point scale. The McMaster Cough Severity Questionnaire (MCSQ) included items reported to occur most frequently and that had the highest importance scores. Patient feedback on the MCSQ led to elimination of redundant items. Another 100 patients completed the MCSQ, from which we performed an exploratory factor analysis and a Rasch analysis to further refine items on the MCSQ.

RESULTS

Previous publications report on the details of Phase 1. Phase 2 led to selection of 15 items from the initial 51. Patient feedback on the 15 items led to elimination of five redundant items. An exploratory factor analysis of the 10-item MCSQ led to the selection of two domains, and the elimination of one item that demonstrated cross-loading and another that had high inter-item correlations. A Rasch analysis of the 8-item MCSQ confirmed that the response options functioned in a logically progressive manner and that no items exhibited differential item functioning. The final 8-item MCSQ has a 1-week recall period and includes two domains (intensity and frequency). The 8-item MCSQ had high internal consistency (Cronbach's α=0.89), proved able to distinguish different levels of cough severity (person separation index 0.89) and demonstrated high cross-sectional convergent validity (Pearson's correlation 0.76, 95% CI 0.66-0.83) with the 100-mm cough severity visual analogue scale.

CONCLUSIONS

Initial evidence supports the validity of the MCSQ, an 8-item instrument measuring cough severity in patients with RCC. Future studies should evaluate its properties in measuring change over time.

Examining Cough's Role and Relief Strategies in Interstitial Lung Disease

Chronic cough is a distressing and prevalent symptom in interstitial lung disease (ILD), significantly impairing quality of life (QoL) and contributing to disease progression, particularly in idiopathic pulmonary fibrosis (IPF). It is associated with physical discomfort, psychological distress, and social isolation and is often refractory to conventional therapies. The pathophysiology of cough in ILD is complex and multifactorial, involving neural hypersensitivity, structural lung changes, inflammatory processes, and comorbid conditions such as gastroesophageal reflux disease (GERD). Evaluating cough in ILD relies on subjective and objective tools to measure its severity, frequency, and impact on daily life, although standardization of these measures remains challenging. Management strategies span pharmacological interventions, including neuromodulators such as opiates, antifibrotic agents, pharmacologic and surgical GERD treatments, and non-pharmacological approaches like behavioral therapies, cough suppression techniques, and pulmonary rehabilitation and physiotherapy. Emerging treatments, such as P2X3 receptor antagonists and airway hydration therapies, offer promising avenues but require further investigation through robust clinical trials. This review aims to demonstrate the importance of addressing cough in ILD as a significant symptom and present objective and subjective methods of quantifying coughs, while providing insights into effective and emerging therapeutic options. By highlighting these potential therapies, we hope to guide healthcare practitioners in considering them through a thorough evaluation of benefits and risks on a case-by-case basis, with relevance both in the U.S. and internationally.

Living with chronic cough: experiences, burden and management in interstitial lung disease - a mixed methods study

People living with interstitial lung disease and chronic cough have unique experiences in their cough characteristics, triggers, management strategies and overall impact on quality of life https://bit.ly/4e8vNZl.

Interactive 3D visualisation technique used in pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled study evaluating quality of life, compliance and use of health care

Introduction

A pulmonary rehabilitation (PR) programme, including exercise training, education, and behaviour change, is highly recommended in treatment guidelines for chronic obstructive pulmonary disease (COPD). A new PR educational material for PR using an interactive three-dimensional (3D) visualisation technique was developed. There is little known regarding using 3D in this setting. The aim was to evaluate, within a PR programme setting, differences between outcomes of education through interactive 3D compared with education by means of 2D visualisation in patients with COPD regarding health-related quality of life (HRQL), physical capacity, exercise self-efficacy, compliance to exercise training, compliance to medication, and the use of health care and to describe learning styles.

Methods

Patients were cluster randomised to PR at the University Hospital clinic, including exercise training, for 10 weeks with education by 3D (n = 27) or education by traditional 2D technique (n = 17). At follow-ups, HRQL, physical capacity, self-efficacy, handgrip strength, compliance to exercise training, compliance to medication and health care utilisation were assessed.

Results

No significant differences were observed in HRQL in relation to COPD between the groups after 10 weeks. Differences were found in handgrip strength at baseline and at 10 weeks (p < 0.01). The 3D group had improved scores in HRQL assessed with the Leicester Cough Questionnaire (LCQ-S) psychological domain (p = 0.022). In the 2D group, the LCQ-S social domain (p = 0.028), psychological domain (p = 0.021) and the St George's Respiratory Questionnaire total (p = 0.050) were increased. The most common learning mode and learning style in both groups was reflective observation and divergent style.

Conclusion

An interactive education in 3D technique used in a PR programme for patients with COPD yielded no significant differences compared to conventional techniques. Three-dimensional techniques can be used in PR for COPD as an alternative to conventional techniques. ClinicalTrials.gov (identifier:NCT02802618).

Repeat expansions in RFC1 gene in refractory chronic cough

Introduction

Refractory chronic cough (RCC), persisting despite addressing contributory diagnoses, is likely underpinned by neurally mediated cough hypersensitivity. RFC1 disorders are genetic neurodegenerative conditions caused by biallelic RFC1 repeat expansion sequences, commonly presenting with cough, followed by neurological features including cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). The prevalence and identifying clinical characteristics of RFC1 repeat-expansion disorders in patients with RCC are unknown.

Methods

Consecutive patients with RCC underwent RFC1 genotyping, cough severity visual analogue scale (VAS) and cough-specific health status assessment (Leicester Cough Questionnaire (LCQ)). Participants with biallelic RFC1 repeat expansions (RFC1++) also underwent nerve conduction studies, brain imaging (MRI) and cough reflex sensitivity testing.

Results

51 participants with RCC were recruited; 36 (71%) female, median (IQR) age 65 (56-70) years, duration of cough 12.8 (6.9-20.0) years. Four (8%) were RFC1++, five (10%) monoallelic carriers (RFC1+-) and 42 (82%) of wild-type genotype (RFC1--). No difference was observed in age, sex, cough duration, spirometry, VAS or LCQ scores between RFC1++ and RFC1-- subjects (p>0.05). The symptom of pins and needles was more frequent in RFC1++ (n=4, 100%) compared to RFC1-- (n=12, 33%) (p=0.01). RFC1++ participants had impaired sensory action potentials, and one had cerebellar atrophy. RFC1++ participants had heightened cough reflex sensitivity to capsaicin, similar to previous CANVAS and RCC studies.

Conclusion

Biallelic RFC1 repeat expansions (RFC1++) were present in 8% of RCC patients. RFC1++ participants demonstrated features of cough reflex hypersensitivity. RFC1++ chronic cough had few identifying features, although symptoms of pins and needles were more common.

Efficacy of Chinese Medicine on Postoperative Rehabilitation of Non-small Cell Lung Cancer (NSCLC), a Randomized Controlled Study

BACKGROUND

With an increasing number of non-small cell lung cancer (NSCLC) patients being offered surgical treatment, postoperative rehabilitation is also being increasingly emphasized. Traditional Chinese medicine (TCM) holds promise for enhancing postoperative recovery, with treatment methods still in refinement. This study aims to evaluate the efficacy of Chinese herbal decoction and Liuzijue exercises in NSCLC patients during the rapid postoperative recovery period.

METHODS

A randomized, parallel-group clinical trial assigned 50 patients to receive Chinese herbal medicine and Liuzijue exercise plus symptomatic treatment, and 49 to symptomatic treatment alone. Treatment continued until postoperative complications resolved, chest tubes were removed, and no abnormal examination findings were reported. The primary outcome was Quality of Life Questionnare-Core 30 (QLQ-C30) score. Secondary outcomes included MOS item short form 36-Item Short Form Health Survey (SF-36) score, rate of complications, six-minute walk test (6MWT) distance, Leicester Cough Questionnaire (LCQ) score, numerical rating scale (NRS) score, and functional activity score (FAS).

RESULTS

Significant improvements in role (MD: 12.15, 95%CI: 2.99-21.32, P < .05) and social functioning (MD: 10.25, 95%CI: 1.72-18.78, P < .05) were observed in the intervention group vs. controls, as measured by QLQ-C30. The intervention group showed better post-treatment SF-36 scores in Role-Physical (RP), Social Function (SF), Role-Emotional (RE), and Mental Health Summary (MCS) (P < .05). The complication rate was lower in the intervention (20.00%) than the control group (44.44%) (P < .05). The intervention group also had a significant increase in FAS scores (P < .05) and covered a better 6MWT distance (P < .05).

CONCLUSION

Chinese herbal decoction and Liuzijue exercises during the rapid recovery period after lung cancer surgery enhanced patients' QoL and physical endurance, and mitigated complications.Trial registration: This tial was registered with chictr.org.cn (Registration number:ChiCTR2100044776).

Chronic Cough Patient Perspective: questionnaire validation and symptom impact

Background

Chronic cough (CC) is underevaluated and underreported. The introduction of a tool that is easy to complete, score and interpret and with the psychometric properties requested for use in individual patients could improve clinical practice.

Objective

This cross-sectional study aimed to validate the Chronic Cough Patient Perspective (CCPP) for assessing CC in daily practice.

Methods

A provisional CCPP was created by iteratively reducing the Chronic Cough Impact Questionnaire (CCIQ). Its psychometric properties were tested in CC patients at baseline (visit 1) and after 1 month (visit 2).

Results

The reduction process yielded an 8-item provisional version, subsequently validated in 150 patients (36.33% males, mean age 50±16.9 years). Exploratory factor analysis revealed a one-dimensional structure, with one item being deleted as it did not align with the extracted dimension. The 7-item version of the CCPP showed a strong correlation with the CCIQ (r=0.902 at visit 1, r=0.932 at visit 2) and internal consistency (Cronbach's alpha values: 0.85 at visit 1, 0.93 at visit 2); discriminant and convergent validity were satisfactory. The reliability, assessed in 21 patients with no change in CC (Global Rating Scale=0), was high (concordance correlation coefficient=0.815; interclass coefficient=0.823). A score ≤5 indicates optimal health-related quality of life (HRQoL) attainment, with a minimum important difference of 3. The mean CCPP score was 20.5±6.24 at enrolment, and only 37.33% of the participants achieved an optimal HRQoL at visit 2.

Conclusion

The CCPP exhibited good psychometric properties suitable for clinical use, providing a valid, reliable and standardised assessment of CC's impact on HRQoL.

Pregabalin for chronic cough due to lung cancer: randomized, double-blind, placebo-controlled trial

BACKGROUND

Developing effective therapies for cough in lung cancer is an unmet need Neuromodulators like pregabalin may act centrally as cough suppressants.

METHODS

Randomized double-blind placebo-controlled study in patients with locally advanced/metastatic lung cancer and at least 2 weeks of moderate or severe cough. Randomization was 1:1 to pregabalin 300 mg orally daily or matching placebo, both administered for 9 weeks. Primary endpoint was the change in cough severity as measured by the difference in VAS scores.

RESULTS

Between Jul 2022 and Dec 2023, we enrolled 166 patients: 83 to each arm. Baseline cough severity was grade 2 in 128 (77.1%) and grade 3 in 38 (22.9%) patients; median cough duration was 12 weeks (IQR, 6-20). Systemic cancer-directed therapy was started in 78 (94.0%) and 72 (86.7%) patients in the pregabalin and placebo arms, respectively; P = 0.187. The mean (SD) VAS score (in mm) decreased from 71.58 (14.99) at baseline, to 45.54 (26.60) on day 7, and 22.27 (24.20) by week 9 in the pregabalin arm; and 71.75 (17.58), 46.35 (25.00), and 23.08 (22.42), respectively in the placebo arm; P = 0.877.

CONCLUSION

Pregabalin does not significantly decrease cough in patients with lung cancer. Systemic cancer-directed therapy is the most effective antitussive.

CLINICAL TRIAL REGISTRATION

Name of the registry: Clinical Trials Registry India Registration number: CTRI/2020/11/029275 Website: www.ctri.nic.in.

Treatable traits in interstitial lung disease: a narrative review

The interstitial lung diseases (ILDs) are a heterogeneous and complex group of diseases. The treatable trait (TT) model represents a shift in ILD management, away from traditional diagnostic labels towards a more individualised, trait-focused approach. This review explores the application of the TT paradigm to ILD, identifying key traits across the aetiological, pulmonary, extrapulmonary and behavioural domains. By addressing these traits, the TT model offers a framework to improve outcomes in ILD through multidisciplinary management with a precision medicine focus. Further research is necessary to evaluate the overall impact of this TT model on ILD care.

Interpretation of Change in Novel Digital Measures: A Statistical Review and Tutorial

Background

Novel clinical measures assessed by a digital health technology tool require thresholds to interpret change over time, such as the minimal clinically important difference. Establishing such thresholds is a key component of clinical validation, facilitating understanding of relevant treatment effects.

Summary

Many of the approaches to derive interpretative thresholds for patient-reported outcomes can be applied to digital clinical measures. We present theoretical background to the use of interpretative thresholds, including the distinction between thresholds based on perceived importance versus measurement error, and thresholds for group- versus individual-level interpretations. We then review methods to estimate such thresholds, including anchor-based approaches. We illustrate the methods using data on cough frequency counts as measured by a wearable device in a clinical trial.

Key Messages

This paper provides an overview of statistical methodologies to estimate thresholds for the interpretation of change.

Increased Resistance of the Peripheral Airways in Patients with Unexplained Chronic Cough

INTRODUCTION

Troublesome coughing that persists for more than 8 weeks without evident aetiology or effective therapy is termed unexplained chronic cough (UCC). Using impulse oscillometry (IOS) and spirometry, we assessed the functionalities of the large and small airways, respectively, in patients with UCC and in healthy control subjects.

METHODS

On a single occasion, 50 patients with UCC (mean age, 61 years; 82% women) and 23 subjectively healthy controls (mean age, 58.9 years; 95.7% women) underwent IOS and spirometry. Patients with UCC were also subjected to fractional exhaled nitric oxide (FeNO) measurement, and they answered a local questionnaire, a visual analogue scale (VAS) for cough and cough-related symptoms, and a health-related quality of life questionnaire.

RESULTS

Forty-nine (98%) patients with UCC reported cough symptoms from exposure to chemicals, 39 (78%) had problems with cold air, and 38 (76%) had cough symptoms following exercise. The mean VAS cough score was 62 mm in the patient group. FeNO was measured in 25 patients, showing a mean value of 16.6 ppb. Women with UCC had significantly greater airway resistance and reactance than men with UCC. The UCC group showed significantly increased peripheral airway resistance and reactance, and lower FEV1% predicted values (albeit within the normal range), as compared with the healthy control group.

CONCLUSION

Patients with UCC show increased peripheral airway resistance and significantly lower FEV1% predicted values compared with healthy control subjects. Routine measurements of lung function with both IOS and spirometry could have added value to the diagnosis of UCC.

The Relationship Between Self-Reported Nocturnal Cough Symptoms and Acoustic Cough Monitoring

OBJECTIVE

This pilot investigation explored the relationship between self-reported clinical cough symptoms and objective acoustic cough data in individuals with nocturnal chronic cough.

METHODS

Ten participants diagnosed with chronic cough with a nocturnal component underwent two study sessions, approximately 1 week apart. Participants completed questionnaires regarding cough severity and their perceptions of using a smartphone application (app) to audio record cough. Between sessions, participants utilized the continuous audio recorder while sleeping. The relationship between the number of coughs captured at night and the self-reported impact of cough awakening during sleep were analyzed.

RESULTS

We found strong correlations (ρ = -0.78, -0.87) between formalized Leicester Cough Questionnaire scores and acoustically determined cough frequency. However, there were large differences between the average number of self-reported cough awakening events (0-3) and the number of acoustically recorded coughs (0-639). While users expressed comfort with recording and sharing acoustic data (4.8/5 Likert rating), concerns over confidentiality in daytime use were noted (4.1/5).

CONCLUSION

Formalized cough questionnaires provide insight into chronic cough at night but may fall short in quantifying the shear frequency of coughs patients are experiencing. Although continuous audio recordings via smartphone emerged as a comfortable means for patients to supply quantifiable data regarding the impact of chronic cough during sleep, future endeavors in cough acoustic monitoring should prioritize privacy considerations for daytime use and work to share information with health care providers.

Preoperative fractional exhaled nitric oxide is a risk and predictive factor of postoperative cough for early-stage non-small cell lung cancer patients: a longitudinal study

BACKGROUND

To determine whether preoperative fractional exhaled nitric oxide (FENO) level is a risk and predictive factor of postoperative cough by using the Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC).

METHODS

292 early-stage non-small cell lung cancer (NSCLC) patients without preoperative cough were enrolled. 138 patients (47.2%) developed postoperative cough, univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of postoperative cough. For an exploratory analysis, patients with cough were divided into low and high- FENO [≥ 31 parts per billion (ppb)] groups. The LCQ-CM was used to evaluate changes and recovery trajectory of postoperative cough over time between the two groups for 12 months after surgery.

RESULTS

The independent factors of postoperative cough included preoperative FENO level [odds ratio (OR) 1.106, 95% confidence interval (CI): 1.076-1.137, p < 0.001] and duration of anesthesia (OR 1.008, 95% CI: 1.002-1.013, p = 0.004). The low-FENO group reported significantly higher LCQ-MC scores at 1 month after surgery and returned to preoperative physical (28 vs. 91 days), psychological (28 vs. 60 days), social (28 vs. 80 days) and total (28 vs. 91 days) scores faster than the high-FENO group (all p < 0.05).

CONCLUSION

Higher preoperative FENO level and longer duration of anesthesia were independent risk factors related to postoperative cough. Additionally, patients with high preoperative FENO level had worse cough-related quality of life and slower recovery from postoperative cough.

TRIAL REGISTRATION

This study was approved by the Chinese Clinical Trial Registry (Clinicaltrials.gov number: ChiCTR1900023419) on 26 May 2019 and the first patient was enrolled after pre-registration.

The precision medicine strategy to treat COPD pulmonary traits in clinical practice: The role of N-acetylcysteine

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition and a leading cause of physical decline and death. COPD prevalence is expected to increase steadily in the coming years, and as a result, the healthcare and social burden of this condition will intensify. In this scenario, a patient-centric approach, the treatable trait (TT) strategy, based on the identification of traits that are clinically relevant, identifiable, monitorable and treatable, has emerged. The TT strategy, which considers behavioral/risk factors, as well as pulmonary and extrapulmonary traits, has shown to be a promising strategy in COPD management. This work reviews the TT strategy in COPD, giving special attention to the most relevant pulmonary traits, such as frequent productive cough, chronic bronchitis, type 2 inflammation, neutrophilic inflammation, lung hyperinflation, bronchiectasis, exacerbations and non-reversible airflow limitation. N-acetylcysteine (NAC), a widely used mucolytic agent, might be a major player in this strategy. Indeed, through a thorough review of the literature, it has been possible to highlight that, besides being essential in the treatment of frequent productive cough, NAC could bring benefits in case of airflow limitations, airways inflammation, exacerbations and bronchiectasis. A clinical case in which the TT strategy was able to reduce symptoms and improve lung function and quality of life, minimizing unnecessary medication and side effects, is also presented. The identification of TTs and their proper treatment through personalized medicine remarkably ameliorates COPD management. Of note, the mucolytic, antioxidant, and anti-inflammatory activities of NAC might have beneficial effects on several TTs.

Quality of life in sarcoidosis

Having sarcoidosis often has a major impact on quality of life of patients and their families. Improving quality of life is prioritized as most important treatment aim by many patients with sarcoidosis, but current evidence and treatment options are limited. In this narrative review, we describe the impact of sarcoidosis on various aspects of daily life, evaluate determinants of health-related quality of life (HRQoL), and provide an overview of the different patient-reported outcome measures to assess HRQoL in sarcoidosis. Moreover, we review the current evidence for pharmacological and non-pharmacological interventions to improve quality of life for people with sarcoidosis.

A Study on the Association between Cough Sensitivity and Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVE

To investigate the relationship between cough sensitivity and acute exacerbation in stable chronic obstructive pulmonary disease (COPD) patients.

METHODS

Stable COPD patients who visited our department from July 2022 to June 2023 were included. They were subjected to cough sensitivity test, spirometry, induced sputum cytology examination, questionnaire assessment such as cough symptom score, etc. They were followed up for 12 months, and were divided into the acute exacerbation (AE) group and the stable group according to whether acute exacerbation occurred during the follow-up period. We compared the differences in cough sensitivity, pulmonary function, and questionnaires between the two groups, analyzed the relationship between cough sensitivity and acute exacerbation, and screened the risk factors for AECOPD.

RESULTS

A total of 145 patients with stable COPD were included. AE group (n = 94) had lower FEV1/FVC (50.08 ± 11.11 versus 54.28 ± 11.58, p = 0.03) and cough sensitivity lgC5 [-0.01(0.90) versus 0.59(0.90), p < 0.01] than those in the stable group (n = 51) patients, the daytime cough symptom score [2(2) versus 1(2), p = 0.02] and VAS score [50(40) versus 30(50), p < 0.01] were higher than stable group. Multivariate logistic regression analysis showed lgC5 (OR = 0.34, 95% CI = 0.16-0.71, p < 0.01) was an independent risk factor for AECOPD. When lgC5 was used to predict acute exacerbation in stable COPD patients, the AUC was 0.69, the sensitivity was 59.57%, and the specificity was 72.55%.

CONCLUSION

Although causality is not necessarily demonstrated, baseline cough sensitivity lgC5 in stable COPD patients is an independent risk factor for AECOPD, and it has some predictive value for future acute exacerbations.

Laryngeal Vibrotactile Stimulation Is Feasible, Acceptable To People With Unexplained Chronic Cough

OBJECTIVES

Unexplained chronic cough (UCC) is common and has significant impacts on quality of life. Ongoing cough can sensitize the larynx, increasing the urge to cough and perpetuating the cycle of chronic cough. Vibrotactile stimulation (VTS) of the larynx is a noninvasive stimulation technique that can modulate laryngeal somatosensory and motor activity. Study objectives were to assess feasibility and acceptability of VTS use by people with UCC. Secondarily, changes in cough-related quality of life measures were assessed.

METHODS

Adults with UCC recorded cough measures at baseline and after completing 2 weeks of daily VTS. Feasibility and acceptability were assessed through participant-reported device use and structured feedback. Cough-related quality of life measures were the Leicester Cough Questionnaire (LCQ) and the Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ).

RESULTS

Nineteen adults participated, with mean age 67 years and cough duration 130 months. Notably, 93% of planned VTS sessions were logged, 94% of participants found the device comfortable to wear, 89% found it easy to operate and 79% would recommend it to others. Pre-post LCQ change achieved a minimal important difference (MID) (mean 1.3 [SD 2.4, p = 0.015]). NLHQ scores improved, but did not reach an MID.

CONCLUSIONS

Laryngeal VTS use was feasible and acceptable for use by patients with UCC and was associated with a meaningful improvement in cough-related quality of life. Future studies will include VTS dose refinement and the inclusion of a comparison arm to further assess the potential for laryngeal VTS as a novel treatment modality for UCC.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:5010-5014, 2024.

Protocol and research program of the European registry and biobank for interstitial lung diseases (eurILDreg)

BACKGROUND AND AIMS

Interstitial lung diseases (ILDs), encompassing both pediatric and adult cases, present a diverse spectrum of chronic conditions with variable prognosis. Despite limited therapeutic options beyond antifibrotic drugs and immunosuppressants, accurate diagnosis is challenging, often necessitating invasive procedures that may not be feasible for certain patients. Drawn against this background, experts across pediatric and adult ILD fields have joined forces in the RARE-ILD initiative to pioneer novel non-invasive diagnostic algorithms and biomarkers. Collaborating with the RARE-ILD consortium, the eurILDreg aims to comprehensively describe different ILDs, analyze genetically defined forms across age groups, create innovative diagnostic and therapeutic biomarkers, and employ artificial intelligence for data analysis.

METHODS

The foundation of eurILDreg is built on a comprehensive parameter list developed and adopted by clinical experts, encompassing over 1,800 distinct parameters related to patient history, clinical examinations, diagnosis, lung function and biospecimen collection. This robust dataset is further enriched with daily assessments captured through the patientMpower app, including handheld spirometry and exercise tests, conducted on approximately 350 patients over the course of a year. This approach involves app-based daily assessments of quality of life, symptom tracking, handheld spirometry, saturation measurement, and the 1-min sit-to-stand test (1-STST). Additionally, pediatric data from the ChILD-EU registry will be integrated into the RARE-ILD Data Warehouse, with the ultimate goal of including a total of 4.000 ILD patients and over 100.000 biospecimen.

DISCUSSION

The collaborative efforts within the consortium are poised to streamline research endeavors significantly, promising to advance patient-centered care, foster innovation, and shape the future landscape of interstitial lung disease research and healthcare practices.

TRIAL REGISTRATION

EurILDreg is registered in the German Clinical Trials Register (DRKS 00028968, 26.07.2022), and eurIPFreg is registered in ClinicalTrials.gov (NCT02951416).

Reclassification of items in the Leicester Cough Questionnaire: Correlation analysis

BACKGROUND

The Leicester Cough Questionnaire (LCQ) is a validated tool for assessing cough that has three domains (physical, psychological, and social), with eight, seven, and four items, respectively. However, the assigned domain may not accurately reflect the characteristics of an item. This study aimed to reclassify the items in the Korean version of the LCQ (K-LCQ) to improve the coherence in each domain.

METHODS

Data of patients with chronic cough from 16 centers who completed the K-LCQ were retrospectively analyzed. Spearman's rank correlation analysis was used to assess the correlations between items and their domains. Principal component analysis was performed to recategorize the K-LCQ items.

RESULTS

The correlation analysis of the data from 255 patients demonstrated that certain items such as tiredness, embarrassment, and interference with daily work or overall life enjoyment showed strong or very strong correlations with all three domains. Cough bout frequency showed the weakest correlation with the physical domain, despite being included in that domain, and had stronger correlations with the psychological and social domain. The principal component analysis led to the reclassification of six items: one from the physical to psychological, two from the social to psychological, and three from the psychological to social domain. The within-domain correlation coherence was higher in the new classification than in the original. Validation using an independent cohort of 203 patients yielded similar results.

CONCLUSIONS

The new classification of the K-LCQ items showed improved within-domain correlation coherence.

Could cough hypersensitivity symptom profile differentiate phenotypes of chronic cough?

Background

Recently, cough reflex hypersensitivity has been proposed as a common underlying feature of chronic cough in adults. However, symptoms and clinical characteristics of cough hypersensitivity have not been studied amongst phenotypes of chronic cough. This study aimed to compare symptom features, such as cough triggers and associated throat sensations, of cough hypersensitivity in patients with asthmatic chronic cough and those with refractory chronic cough (RCC).

Methods

Patients with chronic cough from the Korean Chronic Cough Registry were prospectively evaluated over 6 months. Physicians determined the aetiological diagnosis based on clinical evaluations and responses to treatment at the 6-month follow-up visit. Symptoms of cough hypersensitivity and cough-specific quality of life were assessed using the Cough Hypersensitivity Questionnaire (CHQ) and the Leicester Cough Questionnaire (LCQ), respectively.

Results

The analysis included 280 patients who completed the follow-up: 79 with asthmatic cough (cough variant asthma or eosinophilic bronchitis) and 201 with RCC. Baseline CHQ scores were similar between the groups (8.3±3.7 in asthmatic cough versus 8.9±3.9 in RCC; p=0.215, adjusted for age, sex and LCQ score). There were no significant between-group differences in the LCQ and cough severity Visual Analog Scale scores. Both groups showed a similar negative correlation with LCQ scores (asthmatic cough: r=-0.427, p<0.001; RCC: r=-0.306, p<0.001).

Conclusions

The symptoms of cough hypersensitivity may not distinguish between asthmatic cough and RCC. This suggests that chronic cough is the primary diagnosis in both phenotypes. It indicates a shared mechanism in their cough pathogenesis, despite having potentially different treatable traits.

Abnormal breathing pattern features in chronic refractory cough

Background

Chronic refractory cough (CRC) is a challenging condition that responds to speech pathology intervention. Clinical observation suggests abnormal breathing patterns occur in CRC and may be indirectly addressed as part of behavioural treatment, yet breathing pattern changes in CRC are poorly understood. The aims of this study were to 1) describe breathing patterns in patients with CRC, 2) compare breathing pattern features between patients with CRC and inducible laryngeal obstruction (ILO), and 3) estimate the effect of breathing pattern features on clinical measures of laryngeal sensory and motor dysfunction.

Methods

This retrospective cross-sectional observational study included 634 patients with CRC or ILO. A file audit of speech pathology assessment data was undertaken. Analysis of self-reported laryngeal symptoms (via questionnaires) and clinical assessment of voice and breathing of those with CRC and ILO was conducted.

Results

Most participants with CRC (73%) demonstrated at least one abnormal breathing pattern feature. The most common feature was thoracic breathing (69%) followed by oral breathing (33%). The type and prevalence of abnormal breathing patterns were similar between CRC and ILO. Abnormal breathing patterns were associated with reduced maximum phonation time (MPT); however, there was no association between these features and Newcastle Laryngeal Hypersensitivity Questionnaire scores.

Conclusions

Abnormal breathing features are common in patients with CRC and are not significantly different from those occurring in ILO. There is some association between abnormal breathing features and MPT, suggesting impairment of laryngeal motor function. Conversely, there is no association between abnormal breathing features and laryngeal hypersensitivity.

Assessment of health-related quality of life in patients with nontuberculous mycobacterial pulmonary disease: A comprehensive review

The global incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing. The primary aim of pharmacotherapeutic treatment for NTM-PD is to achieve negative bacterial conversion, but this goal is challenging, especially in cases with poor prognosis factors. Moreover, recurrence frequently occurs following successful treatment. Consequently, patient-reported outcomes (PROs) have attracted an increasing amount of attention due to their potential to elucidate the pathophysiology of NTM-PD. The current review article aimed to describe the current understanding of PROs related to health-related quality of life (HRQoL). HRQoL is influenced by a variety of factors; notably, those factors associated with the prognosis of NTM-PD significantly impair HRQoL. In patients with refractory NTM-PD, HRQoL tends to worsen over time. Assessing HRQoL through PROs involves short-term or long-term evaluation tools, which are selected based on their relevance to the patient's condition and the clinician's goals. Understanding the nuances of PROs can be helpful for delivering empathetic care tailored to patients in even the most complex treatment scenarios.

Cough severity visual analog scale scores and quality of life in patients with refractory or unexplained chronic cough

BACKGROUND

Refractory chronic cough (RCC) and unexplained chronic cough (UCC) adversely affect patients' quality of life (QoL). This multicenter, non-interventional study evaluates the relationship between cough severity and QoL and other patient-reported outcomes (PROs) in Spanish outpatients.

METHODS

RCC/UCC patients self-administered a printed survey comprising the cough-severity visual analog scale (VAS), adapted Cough Severity Diary (CSD), and Leicester Cough Questionnaire (LCQ), plus purpose-designed items regarding the physical and everyday-life impact of cough. Patients were stratified into VAS score tertiles. The impact of cough on QoL and other PROs in each tertile, and relationships between LCQ scores and the tertiles, were assessed.

RESULTS

The VAS was completed by 189 patients, and VAS score tertiles were identified as 0-50, 60-70, and 80-100 mm. The only between-tertile difference in demographic or cough characteristics was cough duration. VAS score tertiles were linearly associated with mean LCQ domain and total scores, as well as the proportion of patients with the highest scores on all adapted CSD items, and almost all physical and everyday-life impact items. In multiple linear-regression models, an increase of one tertile in the VAS score was associated with a decrease of 2.23 points in the LCQ total score, indicating poorer cough-related QoL.

CONCLUSION

As self-assessed in patients with RCC/UCC, cough-severity VAS scores were strongly associated with the impact of cough on QoL and everyday life. Patients with VAS scores of 60-100 mm reported the greatest impact and thus may benefit the most from targeted cough therapies.

Efficacy and safety of gefapixant in women with chronic cough and cough-induced stress urinary incontinence: a phase 3b, randomised, multicentre, double-blind, placebo-controlled trial

BACKGROUND

Approximately two-thirds of women with chronic cough have cough-induced stress urinary incontinence (CSUI). We aimed to evaluate the efficacy and safety of gefapixant in reducing CSUI episodes in women with refractory or unexplained chronic cough.

METHODS

This phase 3b, double-blind, randomised, placebo-controlled trial done at 90 sites in 12 countries enrolled women aged 18 years or older who had chronic cough for at least 1 year, a diagnosis of refractory or unexplained chronic cough, a cough severity visual analogue scale score of 40 mm or more (100 mm maximum), and CSUI for 3 months or more. Participants were randomised 1:1 to oral gefapixant or placebo for 12 weeks. The primary outcome was percentage change from baseline in daily CSUI episodes (7-day average) at week 12. This study is registered with ClinicalTrials.gov (NCT04193176).

FINDINGS

From May 10, 2020, to Sept 2, 2022, 375 participants were randomised to and treated with gefapixant 45 mg twice daily (n=185) or placebo (n=190). Mean age was 56·4 years (SD 11·4), with mean chronic cough duration of 5·2 years (SD 6·6) and SUI duration of 4·0 years (SD 5·9). Least-squares mean percentage change from baseline in daily CSUI episodes was -52·8% (95% CI -58·4 to -47·1%) for gefapixant and -41·1% (-46·7 to -35·4%) for placebo (estimated treatment difference: -11·7% [95% CI -19·7 to -3·7]; p=0·004). 129 (70%) of 185 participants who received gefapixant and 71 (37%) of 190 participants who received placebo had at least one adverse event. Safety and tolerability were consistent with previous trials of gefapixant; the most frequent adverse events were taste related.

INTERPRETATION

Gefapixant 45 mg twice daily is the first treatment to show efficacy versus placebo in reducing CSUI episodes in participants with refractory or unexplained chronic cough.

FUNDING

Merck Sharp & Dohme, a subsidiary of Merck & Co.