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Kim Y, Birring SS, McGarvey L, Morice AH, Song WJ. How Will a Treatable Traits Approach Reshape Clinical Practice in Chronic Cough? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2025; 17:304-316. [PMID: 40414808 PMCID: PMC12117485 DOI: 10.4168/aair.2025.17.3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Revised: 04/02/2025] [Accepted: 04/14/2025] [Indexed: 05/27/2025]
Abstract
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.
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Affiliation(s)
- Yeonhee Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Alyn H Morice
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, Castle Hill Hospital, University of Hull, Cottingham, East Yorkshire, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim MY, Won HK, Oh JY, Lee JH, Jo EJ, Kang SY, Lee JH, Lee SE, Kang N, Kim YC, Lee HY, An J, Yoo Y, Shim JS, Park SY, Park HK, Kim MH, Kim SH, Kim SH, Chang YS, Kim SH, Lee BJ, Birring SS, Song WJ. Could cough hypersensitivity symptom profile differentiate phenotypes of chronic cough? ERJ Open Res 2024; 10:00260-2024. [PMID: 39534772 PMCID: PMC11551855 DOI: 10.1183/23120541.00260-2024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 11/16/2024] Open
Abstract
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.
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Affiliation(s)
- Mi-Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Chan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hwa Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Youngsang Yoo
- Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han-Ki Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Surinder S. Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Jun H, Park JY, Oh JY, Won HK, Kang SY, Park SY, Kim BK, Kim MY, Kim YC, Lee HY, Jo EJ, Lee SE, Kim SH, Kim SH, Chang YS, Kim SH, Lee BJ, Chung KF, Song WJ. Exploring Traits Associated With Central Sensitization Features in Patients With Chronic Cough. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:690-700. [PMID: 39622692 PMCID: PMC11621473 DOI: 10.4168/aair.2024.16.6.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 12/08/2024]
Abstract
The concept of cough hypersensitivity suggests that central sensitization plays a role in the pathophysiology of chronic cough. However, it remains unclear which traits are associated with central sensitization features in patients with chronic cough. A cohort of 317 Korean patients with newly referred chronic cough underwent clinical evaluations. The Central Sensitization Inventory (CSI), a questionnaire originally developed as a screening tool to identify patients with Central Sensitization Syndrome, was also administered. Other patient-reported outcomes (PROs), such as the cough severity visual analogue scale, Leicester Cough Questionnaire (LCQ), Cough Hypersensitivity Questionnaire (CHQ), and the Center for Epidemiological Studies Depression (CES-D) scale, were also administered. Follow-up assessments were conducted one month later. At baseline, the presence of CSI scores of ≥ 40 was associated with being female (89.6% vs. 63.4%; P < 0.001), older age, concomitant symptoms, and cough-related complications. CSI scores correlated with PRO scores, including LCQ (r = -0.424, P < 0.001), CHQ (r = 0.373, P < 0.001), and CES-D (r = -0.660, P < 0.001). Their patterns of correlations were similar in the 1-month longitudinal follow-up data analysis. In conclusion, CSI scores in patients with chronic cough correlated with cough-specific and depression-related PROs, suggesting the potential relevance of central sensitization in certain phenotypes of chronic cough.
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Affiliation(s)
- Haesung Jun
- University of Ulsan College of Medicine, Seoul, Korea
| | | | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Chan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hwa Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Park JY, Jun H, Lee SE, Won HK, Kang SY, Kang N, Oh JY, Kim YC, Park SY, An J, Yoo Y, Kim MY, Lee HY, Shim JS, Kim MH, Kim SH, Kim SH, Chang YS, Kim SH, Lee BJ, Birring SS, Song WJ. Exploring the concept of disease control in chronic cough. ERJ Open Res 2024; 10:00320-2024. [PMID: 39351387 PMCID: PMC11440400 DOI: 10.1183/23120541.00320-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 10/04/2024] Open
Abstract
Background Disease control in chronic diseases is an overarching concept that reflects the degree to which the goals of therapy are met. However, to date, there is no consensus on the definition of disease control in chronic cough. This study aimed to provide a conceptual exploration of patient-reported cough control in chronic cough. Methods This research is comprised of two subanalyses. First, patients with chronic cough receiving care at referral clinics were evaluated. Correlation analyses were performed between patient-reported cough control (a 5-point Likert scale), cough-specific patient-reported outcomes (PROs) and generic health PRO scores. Second, a survey was conducted among patients with refractory chronic cough and physicians to identify factors pertinent to cough control. Results The analysis of 341 patients (mean age: 55.5±15.1 years; female: 66.6%) revealed that cough control rating was moderately correlated with cough severity visual analogue scale and Leicester Cough Questionnaire scores, while demonstrating weaker correlations with cough-associated throat symptoms, cough-related complications or general health-related quality of life (QoL). In the survey of patients and physicians, both groups considered certain factors, such as cough frequency, severity and impact on QoL, to be relevant to the concept of cough control. However, patients rated "need for cough rescue drug" notably higher than physicians. Conclusion Patient-reported cough control was associated with cough severity or impact on QoL; however, cough control may not be fully captured by conventional cough PRO measurement tools. Further studies are warranted to define the consensus and tools to measure disease control in chronic cough.
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Affiliation(s)
- Jin Young Park
- University of Ulsan College of Medicine, Seoul, South Korea
| | - Haesung Jun
- University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Allergy, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Young-Chan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, KyungHee University, Seoul, Korea
| | - Youngsang Yoo
- Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hwa Young Lee
- Division of Allergy, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Surinder S. Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Brister D, Khan S, Abraham T, Laventure S, Sahakian S, Juliá B, Satia I. Burden of Disease Associated with Refractory and Unexplained Chronic Cough in Canada: Results from a National Survey. Lung 2024; 202:415-424. [PMID: 38867086 DOI: 10.1007/s00408-024-00714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Chronic cough (persisting for ≥ 8 weeks) is a common disorder that includes refractory chronic cough (RCC; cough that persists despite treatment of underlying disease) and unexplained chronic cough (UCC; cough with no identifiable cause). We evaluated self-reported health-related quality of life (HR-QoL) and work/activity impairment associated with RCC/UCC in Canada. METHODS Our exploratory study included Canadians in the Leger Opinion Panel with RCC or UCC. Key entry criteria were ≥ 18 years of age, cough for ≥ 8 weeks, not currently smoking/quit ≥ 1 year ago, no serious respiratory disease or lung cancer, and not taking angiotensin-converting enzyme inhibitors. Respondents completed a 30-min online survey with general and cough-specific HR-QoL questionnaires, including the EuroQol (EQ) visual analogue scale (VAS), EQ-5-dimension 5-level (EQ-5D-5L), cough severity VAS, Leicester Cough Questionnaire (LCQ), and Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SPH). RESULTS Of 49,076 individuals who completed the chronic cough screening questionnaire (July 30-September 1, 2021), 1,620 (3.3%) met entry criteria for RCC/UCC and 1,046 (2.1%) completed the survey. The mean age of respondents was 45 years and 61% were female. Respondents reported impairments in global HR-QoL (EQ-VAS 73.8, 61% with anxiety/depression on the EQ-5D-5L) and cough-specific HR-QoL (mean cough severity VAS score 29.7, LCQ index 15.2). Work and non-work activities were reduced by 34% and 30%, respectively, on the WPAI-SPH. CONCLUSION RCC/UCC is prevalent in Canada and associated with impaired HR-QoL, particularly in mental health domains. Additional support and management options may be required to fully address this burden.
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Affiliation(s)
- Danica Brister
- Department of Medicine, McMaster University Medical Centre, 3U9, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada
| | - Sana Khan
- Department of Medicine, McMaster University Medical Centre, 3U9, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | | | | | | | - Imran Satia
- Department of Medicine, McMaster University Medical Centre, 3U9, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Lee JH, Kang SY, Yu I, Park KE, Oh JY, Lee JH, Park SY, Kim MH, Jo EJ, Moon JY, Kim SH, Kim SH, Lee BJ, Song WJ. Cough Response to High-Dose Inhaled Corticosteroids in Patients with Chronic Cough and Fractional Exhaled Nitric Oxide Levels ≥ 25 ppb: A Prospective Study. Lung 2024; 202:275-280. [PMID: 38733542 DOI: 10.1007/s00408-024-00698-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/10/2024] [Indexed: 05/13/2024]
Abstract
This study aimed to investigate the effects of high-dose inhaled corticosteroids (ICS) on chronic cough patients with elevated fractional exhaled nitric oxide (FeNO) levels. In a prospective study, adults with chronic cough and FeNO ≥ 25 ppb, without any other apparent etiology, received fluticasone furoate (200 mcg) for three weeks. Outcomes were evaluated using FeNO levels, cough severity, and Leicester Cough Questionnaire (LCQ) before and after treatment. Of the fifty participants (average age: 58.4 years; 58% female), the treatment responder rate (≥ 1.3-point increase in LCQ) was 68%, with a significant improvement in cough and LCQ scores and FeNO levels post-treatment. However, improvements in cough did not significantly correlate with changes in FeNO levels. These findings support the guideline recommendations for a short-term ICS trial in adults with chronic cough and elevated FeNO levels, but the lack of correlations between FeNO levels and cough raises questions about their direct mechanistic link.
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Affiliation(s)
- Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Iseul Yu
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Jung Song
- University of Ulsan College of Medicine, Seoul, Korea.
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Kim HS, Kim J, Kim JA. Mediating role of health literacy in relationship between frailty and health-related quality of life in community-dwelling older adults. PLoS One 2024; 19:e0303164. [PMID: 38814978 PMCID: PMC11139303 DOI: 10.1371/journal.pone.0303164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE The aim of this study was to investigate the mediating effects of health literacy on the relationship between frailty and health-related quality of life (HRQOL) among community-dwelling older adults. METHODS This study used the Korean Frailty and Aging Cohort Database (KFACD) for secondary data analysis. We selected data from 1,631 people without missing main variable values for analysis. Frailty was determined based on the modified Fried's phenotype [MFP], and HRQOL was measured using the Korean version of the 5-level EuroQol questionnaire (EQ-5D-5L). Health literacy was assessed using the questions on the Behavioral Risk Factor Surveillance System (BRFSS) used by the U.S. Center for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and HRQOL, Baron & Kenny's three-step mediating effect verification method was utilized. RESULTS The participants had a mean frailty score of 1.37±1.02, health literacy score of 8.56±2.59, and HRQOL score of 0.84±0.10. Frailty was negatively correlated with health literacy (r = -0.27, p < .001) and HRQOL (r = -0.32, p < .001), while health literacy was positively correlated with HRQOL (r = 0.34, p < .001). We observed that health literacy played a partial mediating role in the relationship between frailty and HRQOL. CONCLUSION To increase older adults' HRQOL, measures that directly prevent and manage frailty as well as interventions that target the enhancement of health literacy are needed.
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Affiliation(s)
- Hee-Sun Kim
- National Evidence-Based Collaborating Agency, Seoul, South Korea
| | - Jinhee Kim
- Department of Nursing, Chosun University Hospital, Gwangju, South Korea
| | - Ji-Ah Kim
- National Evidence-Based Collaborating Agency, Seoul, South Korea
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Jo EJ, Lee JH, Won HK, Kang N, Kang SY, Lee SE, Lee JH, Kim MY, Shim JS, An J, Yoo Y, Park SY, Kim BK, Moon JY, Park HK, Kim MH, Kwon HS, Kim SH, Kim SH, Chang YS, Kim SH, Birring SS, Lee BJ, Song WJ. Baseline Cohort Profile of the Korean Chronic Cough Registry: A Multicenter, Prospective, Observational Study. Lung 2023; 201:477-488. [PMID: 37658853 DOI: 10.1007/s00408-023-00644-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The Korean Chronic Cough Registry study was initiated to characterize patients with chronic cough (CC) and investigate their outcomes in real-world clinical practice. This report aims to describe the baseline cohort profile and study protocols. METHODS This multicenter, prospective observational cohort study included newly referred CC patients and those already being treated for refractory or unexplained chronic cough (RUCC). Cough status was assessed using a visual analog scale, the Leicester Cough Questionnaire (LCQ), and the Cough Hypersensitivity Questionnaire (CHQ). RESULTS A total of 610 patients (66.9% women; median age 59.0 years) were recruited from 18 centers, with 176 being RUCC patients (28.9%). The median age at CC onset was 50.1 years, and 94.4% had adult-onset CC (≥ 19 years). The median cough duration was 4 years. Compared to newly referred CC patients, RUCC patients had a longer cough duration (6.0 years vs. 3.0 years) but had fewer symptoms and signs suggesting asthma, rhinosinusitis, or gastroesophageal acid reflux disease. Subjects with RUCC had lower LCQ scores (10.3 ± 3.3 vs. 11.6 ± 3.6; P < 0.001) and higher CHQ scores (9.1 ± 3.9 vs. 8.4 ± 4.1; P = 0.024). There were no marked differences in the characteristics of cough between refractory chronic cough and unexplained chronic cough. CONCLUSIONS Chronic cough typically develops in adulthood, lasting for years. Cough severity and quality of life impairment indicate the presence of unmet clinical needs and insufficient cough control in real-world clinical practice. Longitudinal follow-up is warranted to investigate the natural history and treatment outcomes.
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Affiliation(s)
- Eun-Jung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Youngsang Yoo
- Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - So-Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Han-Ki Park
- Department of Allergy and Clinical Immunology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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9
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Lee JH, Oh JY, Kwon HS, Kim TB, Cho YS, Song WJ. Effects of bepotastine, a nonsedating H1-antihistamine, for the treatment of persistent cough and allergic rhinitis: a randomised, double-blind, placebo-controlled trial. ERJ Open Res 2023; 9:00448-2023. [PMID: 37868148 PMCID: PMC10588790 DOI: 10.1183/23120541.00448-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023] Open
Abstract
Background Empirical therapy with oral histamine-1 receptor antagonists (H1RAs) is often used for patients with suspected upper airway cough syndrome. No placebo-controlled trials with nonsedating H1RAs (nsH1RAs) have evaluated validated cough outcomes. The objective of the present study was to assess the effect of an nsH1RA, bepotastine, on cough outcomes in patients with allergic rhinitis and persistent cough. Methods A randomised, double-blind, placebo-controlled trial was conducted. Adult patients with persistent cough (>3 weeks in duration) and symptomatic allergic rhinitis were recruited and randomly assigned to receive either bepotastine or placebo at a 1:1 ratio. The primary outcome was cough-specific quality of life assessed using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included cough severity visual analogue scale (VAS), throat VAS, Cough Hypersensitivity Questionnaire, Sinonasal Outcome Test-22 score and drug adverse events. Results Between October 2021 and September 2022, 50 participants (43 females; mean age 46.28 years; median cough duration 3 months) were assigned to either the bepotastine 10 mg twice daily or placebo group in a 1:1 ratio. After 2 weeks of treatment, both bepotastine and placebo groups showed significant improvements in the LCQ scores, but there was no significant difference in the magnitude of change between the groups (3.45±2.10 versus 3.04±2.94, p=0.576). Secondary outcomes were also comparable. Conclusions Despite the relatively small sample size, our study clearly demonstrated that a 2-week treatment with bepotastine did not provide therapeutic benefits for cough outcomes. These findings suggest against the use of nsH1RAs with the intention of improving cough outcomes, even in patients with persistent cough and allergic rhinitis.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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