key: cord-0758099-i7tw482t
authors: Lai, Kefang; Zhan, Wenzhi; Li, Hu; Yi, Fang; Peng, Wen; Zhou, Jianmeng; Tang, Jiaman; Zhang, Liting; Long, Li; Chen, Ruchong; Luo, Wei; Chen, Qiaoli; MeiJiang,; Zhong, Nanshan
title: The predicative clinical features associated with chronic cough that has a single underlying cause
date: 2020-07-18
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.06.066
sha: c44eef8f9a861369f95bc3444d55fa6abcdb5233
doc_id: 758099
cord_uid: i7tw482t

Abstract Background Few studies have investigated the usefulness of the clinical characteristics of cough in the diagnosis of chronic cough. Objective To evaluate the diagnostic value of clinical characteristics and concomitant symptoms of chronic cough in predicting its cause． Methods We recruited adult patients with chronic cough as a primary presenting symptom and identified those with a single underlying cause. Clinical features of cough were recorded with a custom-designed questionnaire and its relationship with cause of cough were analyzed. Results A total of 1162 patients with a single underlying cause were enrolled. Nocturnal cough alone was a predictor of cough variant asthma [odds ratio (OR) 2.037, 95% CI 1.003-4.139] with high specificity (97.6%) and low sensitivity (8.1%). Heartburn (OR 2.671, 95% CI 1.544-4.620), belching (OR 2.536, 95% CI 1.620-3.971), acid regurgitation (OR 2.043, 95% CI 1.299-3.212) indicated gastroesophageal reflux-related cough with high specificity (85.5%-94.9%) and low sensitivity (22.8%-40.7%). Cough after meals had a high specificity (91.2%) and a low sensitivity (24.8%) for gastroesophageal reflux-related cough. Postnasal dripping (OR 2.317, 95% CI 1.425-3.767) and history of sinusitis (OR 4.137, 95% CI 2.483-6.892) were indicators for upper airway cough syndrome with high specificity (80.8% and 90.2% respectively). Rhinitis/sinusitis-related symptoms showed moderate sensitivity (72.9%), however, they showed mild specificity (46.1%) for upper airway cough syndrome. Conclusion Cough timing, several concomitant symptoms associated with gastroesophageal reflux or rhinitis/sinusitis, and medical history are useful to indicate common causes of chronic cough.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the 25 manuscript. 26 27

The authors declare that they have no competing interests. high specificity (97.6%) and low sensitivity (8.1%). Heartburn (OR 2.671, 95% CI 1.544-4.620), 50 belching (OR 2.536, 95% CI 1.620-3.971), acid regurgitation (OR 2.043, 95% CI 1.299-3.212) 51 indicated gastroesophageal reflux-related cough with high specificity (85.5%-94.9%) and low 52 sensitivity (22.8%-40.7%). Cough after meals had a high specificity (91.2%) and a low sensitivity 53 (24.8%) for gastroesophageal reflux-related cough. Postnasal dripping (OR 2.317, 95% CI 54 1.425-3.767) and history of sinusitis (OR 4.137, 95% CI 2.483-6.892) were indicators for upper 55 airway cough syndrome with high specificity (80.8% and 90.2% respectively). 56 Rhinitis/sinusitis-related symptoms showed moderate sensitivity (72.9%), however, they showed 57 mild specificity (46.1%) for upper airway cough syndrome. What is already known about this topic? 62 It is important for successful therapy to identify causes of chronic cough. Few studies have 63 investigated the usefulness of the clinical characteristics of cough, concomitant symptoms in the 64 diagnosis of chronic cough.

Chronic cough is one of the most common complains for patients who seek medical attention in 99 primary care and respiratory specialist clinics. Persistent chronic cough not only leads to significant 100 physiological morbidity but also brings a huge psychological burden (1) (2) (3) Table E1 . The proportion of total nocturnal cough (66.2%) was significantly higher in patients with CVA when 195 compared with other patients (Table 1 ). There was no significant difference among different causes 

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CVA: cough variant asthma; EB: eosinophilic bronchitis

UACS: upper airway cough syndrome; OC: other causes; Each subscript letter denotes a subset of different causes of chronic cough categories whose column data do not differ significantly

P-values for post-hoc test was adjusted with Bonferroni method