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Feasibility and clinical utility of ambulatory cough monitoring in an outpatient clinical setting: a real-world retrospective evaluation

Anne E. Vertigan, Sarah L. Kapela, Surinder S. Birring, Peter G. Gibson
ERJ Open Research 2021 7: 00319-2021; DOI: 10.1183/23120541.00319-2021
Anne E. Vertigan
1Speech Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
2Priority Centre for Healthy Lungs, The University of Newcastle Hunter Medical Research Institute, New Lambton, NSW, Australia
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  • For correspondence: anne.vertigan@health.nsw.gov.au
Sarah L. Kapela
1Speech Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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  • ORCID record for Sarah L. Kapela
Surinder S. Birring
3Respiratory Medicine, King's College Hospital, London, UK
4Dept of Respiratory Sciences, King's College London, London, UK
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Peter G. Gibson
2Priority Centre for Healthy Lungs, The University of Newcastle Hunter Medical Research Institute, New Lambton, NSW, Australia
5Centre of Excellence in Severe Asthma, The University of Newcastle Faculty of Health and Medicine, Callaghan, NSW, Australia
6Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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  • Article
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Figures

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  • FIGURE 1
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    FIGURE 1

    a) Photo of the Leicester Cough Monitor as worn by an individual. b) Photo of the Leicester Cough Monitor.

  • FIGURE 2
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    FIGURE 2

    An example of time distribution of cough events taken from a single 24-h recording of a participant.

  • FIGURE 3
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    FIGURE 3

    a) Scatterplot showing correlation between Laryngeal Hypersensitivity Questionnaire (LHQ) scores and cough frequency. Scores range between 3 and 21, and lower LHQ scores denote worse laryngeal hypersensitivity. b) Scatterplot showing correlation between Leicester Cough Questionnaire (LCQ) scores and cough frequency. Scores range between 3 and 21, and lower LCQ scores denote worse cough quality of life.

Tables

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  • TABLE 1

    Participant demographics

    Healthy controlsChronic coughInducible laryngeal obstructionSevere asthma
    Subjects151035021
    Age years51.69±12.7160.56±13.9558.3±12.3352.25±3.86
    Sex (% female)69707675
    FEV1 % predicted105.69±16.2286.4±15.6881.21±16.7067.63±18.17
    FVC % predicted106.85±15.4485.23±17.0885.79±23.8785.84±19.29
    FER %101.08±10.47100.07±12.2794.14±14.5572.17±16.27
    Duration of cough months0109±12583±16094±202
    Comorbid diagnoses
     Gastroesophageal reflux0572810
     Asthma0161520
     Rhinosinusitis0411615
     Obstructive sleep apnoea01282
    Smoking status
     Never-smoker13633510
     Ex-smoker033119
     Current smoker0101
    Asthma Control QuestionnaireNANANA2.4±1.2
    Beclomethasone equivalent doseNANANA1375±614

    Data are presented as n and mean±sd, unless otherwise indicated. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; FER: forced expiratory ratio; NA: not applicable.

    • TABLE 2

      Time required for cough monitoring analysis

      TaskEstimated timeFrequency
      Set-up equipment5–10 minPer patient visit
      Explaining use of cough monitor for patient5–10 minPer patient visit
      Save/download/rename5 minPer patient visit
      Analysis with input from clinician5–20 minPer patient visit
      Software processingUp to 55 minPer patient visit
      Maintaining records of cough monitor allocation2 minPer patient visit
      Processing and cleaning returned monitors5 minPer patient visit
      Chasing up lost/broken monitorsVariableVariable
      Problem solving for difficult to analyse recordingsVariableVariable
    • TABLE 3

      Data available from ambulatory cough monitoring for an individual patient

      MeasureExample/definition
      Cough countThe total number of coughs in a designated period of time
      Cough frequencyThe number of coughs per unit of time (usually hours)
      Cough patternsChanges in cough frequency per hour
    • TABLE 4

      Pre-treatment cough data

      Coughs per hourNumber of daytime coughsDaytime coughs per hNumber of overnight coughsOvernight coughs per h
      Chronic cough (n=97)11.7±1.1215.6±2.512.1±2.822.1±4.74.2±4.6
      ILO (n=46)7.5±2.7148.6±2.47.9±2.618.3±4.92.9±4.7
      Asthma (n=20)9.5±2.9167.0±2.910.7±2.924.4±3.24.6±2.9
      Healthy controls (n=13)2.4±2.0

      The participant numbers refer to the number of recordings available rather than the participant numbers. Data are expressed as GEM±GSD. GEM: geometric mean; GSD: geometric standard deviation; ILO: inducible laryngeal obstruction.

      • TABLE 5

        Comparison of pre- and post-treatment cough frequency and cough quality of life and laryngeal hypersensitivity

        Pre
        GEM±GSD#
        Post
        GEM±GSD#
        Change
        GEM (se)
        95% CIp-value¶ paired t-test
        Coughs per h10.5±3.1+4.0±3.42.6 (1.2)1.9 to 3.7<0.001
        LCQ12.5±3.316.4±3.53.9 (0.6)2.8 to 5.0<0.001
        LHQ14.5±3.116.8±3.22.3 (0.05)1.3 to 3.2<0.001

        GEM: geometric mean; GSD: geometric standard deviation; se: standard error; CI: confidence interval; LCQ: Leicester Cough Questionnaire; LHQ: Laryngeal Hypersensitivity Questionnaire. #: n=50; ¶: p-value was calculated using a paired sample t-test. +: the pre-treatment value in table 5 differs from the pre-treatment value reported in table 4 because not all patients had post-treatment cough frequency data.

        Supplementary Materials

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        • Supplementary Material

          Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

          FIGURE S1 Comparison of cough frequency pre- and post-speech pathology intervention. 00319-2021.figureS1

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        Feasibility and clinical utility of ambulatory cough monitoring in an outpatient clinical setting: a real-world retrospective evaluation
        Anne E. Vertigan, Sarah L. Kapela, Surinder S. Birring, Peter G. Gibson
        ERJ Open Research Oct 2021, 7 (4) 00319-2021; DOI: 10.1183/23120541.00319-2021

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        Feasibility and clinical utility of ambulatory cough monitoring in an outpatient clinical setting: a real-world retrospective evaluation
        Anne E. Vertigan, Sarah L. Kapela, Surinder S. Birring, Peter G. Gibson
        ERJ Open Research Oct 2021, 7 (4) 00319-2021; DOI: 10.1183/23120541.00319-2021
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