Chest
Volume 142, Issue 5, November 2012, Pages 1237-1243
Journal home page for Chest

Original Research
Signs and Symptoms of Chest Disease
Four-Hour Cough Frequency Monitoring in Chronic Cough

https://doi.org/10.1378/chest.11-3309Get rights and content

Background

The recent development of automated cough monitors has enabled objective assessment of cough frequency. A study was undertaken to determine whether short-duration recordings (< 6 h) accurately reflect 24-h cough frequency and to investigate their responsiveness.

Methods

One hundred adults with chronic cough underwent 24-h cough frequency monitoring with the Leicester Cough Monitor and completed cough visual analog scales (VASs) and the Leicester Cough Questionnaire (LCQ). Cough recordings were analyzed using customized software to derive cough frequencies from 1 to 6 h and 24-h recordings. Responsiveness was assessed with repeat assessments following therapeutic trials.

Results

The median (interquartile range) 24-h cough frequency was 11.5 (5.8-26.6) coughs/h. Four hours was considered the shortest recording duration that represented 24-h cough frequency (ρ = 0.9, P ≤ .001). Median 4-h cough frequency was 16.6 (7.3-36.8) coughs/h. Both 4-h and 24-h cough frequency correlated moderately with cough VAS (ρ = 0.49, P ≤ .01 and ρ = 0.44, P ≤ .01) and LCQ (ρ = −0.48, P ≤ .01; ρ = −0.50, P ≤ .01). Four-hour cough frequency was responsive to improvements in cough severity following trials of therapy.

Conclusions

Four-hour cough frequency correlates highly with 24-h cough frequency recordings and relates equally well with subjective measures in chronic cough. Short-duration cough monitoring could be a practical tool to validate the presence of cough and assess response to trials of therapy in the clinic setting.

Section snippets

Subjects

One hundred consecutive patients with chronic cough were recruited from a general respiratory clinic that receives > 80% of its referrals from primary care. All patients presented with an isolated chronic cough. Chronic cough was defined as a cough lasting > 8 weeks duration. The cause of cough in all patients was ascertained from case note review when investigation and treatment trials were complete. All patients were assessed using a standardized diagnostic protocol.10 A diagnosis was

Results

One hundred patients with chronic cough were recruited. The primary causes of cough were asthma (n = 24), eosinophilic bronchitis (n = 7), rhinitis (n = 9), GERD (n = 3), idiopathic chronic cough (n = 29), postviral cough (n = 7), sarcoidosis (n = 6), interstitial lung disease (n = 8), obstructive sleep apnea (n = 2), bronchiectasis (n = 2), chronic bronchitis (n = 1), angiotensin-converting enzyme inhibitor-induced (n = 1), and postinfective (n = 1)). Baseline characteristics are shown in

Discussion

To our knowledge, this is the first study to investigate cough frequency measurement with short cough-monitor recordings in patients with chronic cough. There was good agreement between 4-h and 24-h cough recordings. Both CF4 and CF24 were associated with subjective measures of cough severity. Four-hour recordings were responsive, suggesting they could be used to assess the efficacy of therapeutic trials.

Cough monitors are usually set to record for 24 h. We hypothesized that short daytime

Acknowledgments

Author contributions: Dr Birring is guarantor of the manuscript.

Dr Lee: contributed to study concept and design; acquisition, analysis, and interpretation of data; and drafting of the manuscript for important intellectual content.

Dr Savani: contributed to acquisition of data and drafting of the manuscript for important intellectual content.

Dr Matos: contributed to analysis and interpretation of data and drafting of the manuscript for important intellectual content.

Dr Evans: contributed to

References (32)

  • K Brignall et al.

    Quality of life and psychosocial aspects of cough

    Lung

    (2008)
  • AB Chang et al.

    A new use for an old Holter monitor: an ambulatory cough meter

    Eur Respir J

    (1997)
  • SJ Barry et al.

    The automatic recognition and counting of cough

    Cough

    (2006)
  • IM Paul et al.

    Evaluation of a new self-contained, ambulatory, objective cough monitor

    Cough

    (2006)
  • JA Smith et al.

    Objective measurement of cough during pulmonary exacerbations in adults with cystic fibrosis

    Thorax

    (2006)
  • AH Morice et al.

    ERS guidelines on the assessment of cough

    Eur Respir J

    (2007)
  • Cited by (19)

    • Assessing the efficacy of interventions to control indoor SARS-Cov-2 transmission: An agent-based modeling approach

      2021, Epidemics
      Citation Excerpt :

      We make the assumption that the cough frequency for a symptomatic COVID-19 patient is equal to that of individuals with a chronic cough condition. Therefore, every minute our infectious individual had a 19% probability to expel droplets through coughing (Lee et al., 2012), and an 81% chance to expel droplets through an unspecified other activity (e.g., speaking, singing, etc.). Using the procedure described by Railsback and Grimm (2011), droplet travel distances for coughing and non-coughing expectoration events were randomly drawn from log-normal distributions with known means and standard deviations.

    • Efficacy of Speech-language Pathology Therapy in Chronic Cough: Systematic Review With Meta-analysis

      2021, Journal of Voice
      Citation Excerpt :

      The LCM is a validated instrument to assess the cough frequency. Currently, it is the best tool to objectively assess chronic cough in research and clinical practice.28 Traditional speech-language pathology therapy uses several ingredients for the management of chronic cough in order to break the cycle of reciprocal irritation of cough receptors.16

    • Tools for assessing outcomes in studies of chronic cough: CHEST Guideline Expert Panel report

      2015, Chest
      Citation Excerpt :

      The literature search was subsequently updated by two authors of the CER (R. R. C., D. C. M), who are also members of the subcommittee on assessment of cough, using the same selection criteria used for the original CER project. This updated literature search identified 27 eligible studies10–36 published between June 2012 and November 2013, inclusive, that were not included in the CER. The CER9 included an analytic framework constructed by using the general approach of specifying the population of interest, interventions, comparators, outcomes, timing of outcomes, and settings (PICOTS) to address the following key question: In adults and adolescents (≥ 14 years of age) and children (< 14 years of age), what is the comparative diagnostic accuracy, therapeutic efficacy, and patient outcome efficacy of instruments used to assess cough?

    View all citing articles on Scopus

    Funding/Support: This study was funded by the King's College Hospital NHS Foundation Trust.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text