Chest
Volume 135, Issue 4, April 2009, Pages 975-982
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Original Research
COPD
Cough and Sputum Production Are Associated With Frequent Exacerbations and Hospitalizations in COPD Subjects

https://doi.org/10.1378/chest.08-2062Get rights and content

Background

Epidemiologic studies indicate that chronic cough and sputum production are associated with increased mortality and disease progression in COPD subjects. Our objective was to identify features associated with chronic cough and sputum production in COPD subjects.

Methods

Cross-sectional analysis of data were obtained in a multicenter (17 university hospitals in France) cohort of COPD patients. The cohort comprised 433 COPD subjects (65 ± 11 years; FEV1, 50 ± 20% predicted). Subjects with (n = 321) and without (n = 112) chronic cough and sputum production were compared.

Results

No significant difference was observed between groups for age, FEV1, body mass index, and comorbidities. Subjects with chronic cough and sputum production had increased total mean numbers of exacerbations per patient per year (2.20 ± 2.20 vs 0.97 ± 1.19, respectively; p < 0.0001), moderate exacerbations (1.80 ± 2.07 vs 0.66 ± 0.85, respectively; p < 0.0001), and severe exacerbations requiring hospitalizations (0.43 ± 0.95 vs 0.22 ± 0.56, respectively; p < 0.02). The total number of exacerbations per patient per year was the only variable independently associated with chronic cough and sputum production. Frequent exacerbations (two or more per patient per year) occurred in 55% vs 22% of subjects, respectively, with and without chronic cough and sputum production (p < 0.0001). Chronic cough and sputum production and decreased FEV1 were independently associated with an increased risk of frequent exacerbations and frequent hospitalizations.

Conclusions

Chronic cough and sputum production are associated with frequent COPD exacerbations, including severe exacerbations requiring hospitalizations.

Section snippets

Study Design

A cross-sectional analysis of a cohort of COPD patients recruited between January 2005 and May 2007 was performed. The subjects were recruited from 17 pulmonary units in university hospitals located throughout France. Respiratory physicians prospectively recruited subjects with a secured diagnosis of COPD who were in stable condition (ie, no history of exacerbation requiring medical treatment for the previous 4 weeks). The diagnosis of COPD was based on the presence of a postbronchodilator FEV1

Description of the Study Cohort

Data were collected on 502 subjects; 23 subjects were excluded from the analyses because spirometry results showed a postbronchodilator FEV1/FVC > 70% (former GOLD stage 0). Additionally, 46 subjects were excluded from the analyses because the presence or absence of chronic cough and sputum production had not been recorded accurately. These 46 subjects were not statistically different from the other subjects for age, gender, smoking habits, FEV1, or exacerbations (data not shown). Thus, the

Discussion

Studying a large cohort of COPD subjects, we found that the number of exacerbations during the previous year was the only independent factor linked to chronic cough and sputum production. In addition, chronic cough and sputum production were associated with frequent exacerbations, including moderate and severe exacerbations. Importantly, the association between chronic cough and sputum production and frequent exacerbations was independent of other known risk factors for frequent exacerbations,14

Conclusions

Our data suggest that chronic cough and sputum production are closely associated with the occurrence of COPD exacerbations, including severe exacerbations. Interestingly, longitudinal studies16, 27 have shown that chronic cough and sputum production may not be a stable feature. Although current therapies are not known to affect chronic cough and sputum production, we suggest that therapeutic interventions targeting chronic cough and sputum production may be useful. Because frequent COPD

Appendix

The members of the Initiatives Bronchopneumopathie Chronique Obstructive (BPCO) Scientific Committee are as follows: Graziella Brinchault-Rabin (Rennes); Pierre-Régis Burgel (Paris, Cochin); Denis Caillaud (Clermont-Ferrand); Philippe Carré (Carcassonne); Pascal Chanez and Christophe Pinet (Marseille); Ari Chaouat (Vandoeuvre les Nancy); Isabelle Court-Fortune (Saint-Etienne); Antoine Cuvelier (Rouen); Roger Escamilla (Toulouse); Chantal Raherison (Bordeaux); Christophe Gut-Robert and

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    This work was funded by unrestricted grants from Boehringer Ingelheim France and Pfizer.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    A list of members of the Initiatives Bronchopneumopathie Chronique Obstructive (BPCO) Scientific Committee is located in the Appendix.

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