2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Reprinted by permission of Chest. 2017; 152(3):563-573.

[ Original Research Signs and Symptoms of Chest Disease ]

Risk Factors for Chronic Cough Among 14,669 Individuals From the General Population

Yunus Çolak, MD, PhD; Børge G. Nordestgaard, MD, DMSc; Lars C. Laursen, MD, DMSc; Shoaib Afzal, MD, PhD; Peter Lange, MD, DMSc; and Morten Dahl, MD, DMSc, PhD

BACKGROUND: Risk factors for chronic cough in the general population have not been described systematically. We identi fi ed and ranked chronic cough risk factors at the individual and com- munity level using data from 14,669 individuals from the Copenhagen General Population Study. METHODS: Severity of chronic cough was assessed using the Leicester Cough Questionnaire (LCQ). We ranked chronic cough risk factors based on magnitude of age-adjusted ORs at the individual level and of the population attributable risks (PARs) at the community level. RESULTS: Prevalence of chronic cough in the general population was 4% overall and 3% in never smokers, 4% in former smokers, and 8% in current smokers. Median score of the LCQ was 5.8 (25th-75th percentile, 5.0-6.3) for physical domain, 5.6 (25th-75th percentile, 4.6-6.3) for psychologic domain, 6.3 (25th-75th percentile, 5.5-6.8) for social domain, and 17.3 (25th- 75th percentile, 15.4-18.9) in total. At the level of the individual, age-adjusted ORs for the three top-ranked risk factors were 5.0 (95% CI, 1.4-18) for bronchiectasis, 2.6 (95% CI, 1.7-3.9) for asthma and 2.3 (95% CI, 1.5-3.4) for gastroesophageal re fl ux disease in never smokers, 7.1 (95% CI, 2.6-20) for bronchiectasis, 3.1 (95% CI, 2.2-4.4) for asthma and 2.2 (95% CI, 1.5-3.2) for occupational exposure to dust/fumes in former smokers, and 1.9 (95% CI, 1.3-2.9) for air fl ow limitation in current smokers. At the level of the community, the three top-ranked risk factors were female sex (PAR, 19%), asthma (PAR, 10%), and gastroesophageal re fl ux disease (PAR, 8%) in never smokers; abdominal obesity (PAR, 20%), low income (PAR, 20%), and asthma (PAR, 13%) in former smokers; and air fl ow limitation (PAR, 23%) in current smokers. CONCLUSIONS: Risk factors for chronic cough differ at the level of the individual and community, and by smoking status. Strategies to prevent and treat modi fi able chronic cough risk factors should be tailored accordingly. CHEST 2017; 152(3):563-573

KEY WORDS: asthma; COPD; cough; epidemiology; smoking

Hospital, Hvidovre; and the Department of Clinical Biochemistry (Dr Dahl), Zealand University Hospital, Køge, Denmark. FUNDING/SUPPORT: This study was funded by the Danish Lung Association; the Danish Cancer Society; the Department of Clinical Biochemistry and Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital; and the Depart- ment of Public Health, University of Copenhagen, Denmark. CORRESPONDENCE TO: Morten Dahl, MD, DMSc, PhD, Department of Clinical Biochemistry, Zealand University Hospital Køge, Lykkebækvej 1, DK-4600, Køge, Denmark; e-mail: modah@regionsjaelland.dk Copyright 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2017.05.038

ABBREVIATIONS: PAR = population attributable risk AFFILIATIONS: From the Department of Internal Medicine (Drs Çolak and Laursen), Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev; the Department of Public Health (Drs Çolak and Lange), Section of Social Medicine, University of Copenhagen, Copenhagen; The Copenhagen General Population Study (Drs Çolak, Nordestgaard, Afzal, Lange, and Dahl), Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev; the Faculty of Health and Medical Sciences (Drs Çolak, Nordestgaard, Laursen, Afzal, Lange, and Dahl), University of Copenhagen, Copenhagen; the Department of Clinical Biochemistry (Drs Nordestgaard and Afzal), Herlev and Gentofte Hospital, Copen- hagen University Hospital, Herlev; the Medical Unit (Dr Lange), Respiratory Section, Hvidovre Hospital, Copenhagen University

chestjournal.org

84