Cough frequency, reflex sensitivity and impact in progressive pulmonary fibrosis

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Introduction Chronic cough (CC, duration >8 weeks) is common in interstitial lung disease (ILD) but the burden and mechanism of cough are understudied. We investigated the impact of cough, objective cough frequency (CF) and cough reflex sensitivity (CRS) in idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). Methods Consecutive patients with IPF and PPF completed assessments: cough severity visual analogue scale (VAS, 0-100 mm), cough-specific health status Leicester Cough Questionnaire (LCQ, 3-21), 24hr CF (Leicester Cough Monitor), and CRS with capsaicin challenge (threshold to evoke >5 coughs; C5). Results A total of 30 participants were recruited; median (IQR) age 72 (67-79) years, 43% female, FVC% predicted 77 (64-90)% and 18 (60%) had IPF. Participants with CC (n=16, 53%) had median (IQR) VAS 30 (21-56) mm and LCQ score 14.3 (10.7-17.5), and geometric mean (SD) 24hr CF 12.4 (3.0) coughs.hr-1. Participants with CC had lower (more sensitive) C5 than those without; geometric mean (SD) 9.2 (3.5) vs 60.4 (6.2) mmol.L-1(p=0.02). In all participants, CF was associated with C5 (ρ=-0.43, and ρ=-0.84 in participants with CC; Fig 1), VAS (ρ=0.78) and LCQ (ρ=-0.66) (all p>0.04) but was not with age or sex (all p>0.39). Conclusion Chronic cough in progressive fibrosis is common and impactful, and may be mediated by cough reflex hypersensitivity. Further physiological study of cough in ILD may identify endotypes and enable targeted pharmacotherapy. erjor;12/suppl_20/TP131/F1 F1 F1 NEuroCOUGH CRC site

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