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Prevalence and burden of chronic cough in China: a national cross-sectional study

Kewu Huang, Xiaoying Gu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, Pixin Ran, Huahao Shen, Fuqiang Wen, Yahong Chen, Tieying Sun, Guangliang Shan, Yingxiang Lin, Sinan Wu, Ruiying Wang, Zhihong Shi, Yongjian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, Chun Wan, Wanzhen Yao, Yanfei Guo, Fei Xiao, Yong Lu, Xiaoxia Peng, Dan Xiao, Xiaoning Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Zhixin Cao, Qingyuan Zhan, Yuanhua Yang, Lirong Liang, Huaping Dai, Bin Cao, Jiang He, Kian Fan Chung, Chen Wang for the China Pulmonary Health (CPH) Study Group
ERJ Open Research 2022 8: 00075-2022; DOI: 10.1183/23120541.00075-2022
Kewu Huang
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Xiaoying Gu
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Ting Yang
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
6Dept of Respiratory Medicine, Capital Medical University, Beijing, China
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Jianying Xu
7Dept of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Taiyuan, China
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Lan Yang
8Dept of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Jianping Zhao
9Dept of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xiangyan Zhang
10Dept of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
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Chunxue Bai
11Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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  • ORCID record for Chunxue Bai
Jian Kang
12Dept of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
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Pixin Ran
13State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Huahao Shen
14Dept of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Fuqiang Wen
15State Key Laboratory of Biotherapy of China and Dept of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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Yahong Chen
16Dept of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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Tieying Sun
17Dept of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China
18National Center of Gerontology, Beijing Hospital, Beijing, China
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Guangliang Shan
19Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China
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Yingxiang Lin
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Sinan Wu
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Ruiying Wang
7Dept of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Taiyuan, China
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Zhihong Shi
8Dept of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Yongjian Xu
9Dept of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xianwei Ye
10Dept of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
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Yuanlin Song
11Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Qiuyue Wang
12Dept of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
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Yumin Zhou
13State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Wen Li
14Dept of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Liren Ding
14Dept of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Chun Wan
15State Key Laboratory of Biotherapy of China and Dept of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
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Wanzhen Yao
16Dept of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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Yanfei Guo
17Dept of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China
18National Center of Gerontology, Beijing Hospital, Beijing, China
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Fei Xiao
18National Center of Gerontology, Beijing Hospital, Beijing, China
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Yong Lu
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Xiaoxia Peng
20Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Dan Xiao
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
21WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
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Xiaoning Bu
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Hong Zhang
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Xiaolei Zhang
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Li An
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Shu Zhang
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Zhixin Cao
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Qingyuan Zhan
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
6Dept of Respiratory Medicine, Capital Medical University, Beijing, China
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Yuanhua Yang
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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  • ORCID record for Yuanhua Yang
Lirong Liang
1Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Dept of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
2Beijing Institute of Respiratory Medicine, Beijing, China
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Huaping Dai
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
6Dept of Respiratory Medicine, Capital Medical University, Beijing, China
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Bin Cao
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
6Dept of Respiratory Medicine, Capital Medical University, Beijing, China
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Jiang He
22Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Kian Fan Chung
23National Heart & Lung Institute, Imperial College London, and Royal Brompton & Harefield NHS Trust, London, UK
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Chen Wang
3National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China
4Dept of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
5Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
6Dept of Respiratory Medicine, Capital Medical University, Beijing, China
21WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
24Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • For correspondence: wangchen@pumc.edu.cn
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  • FIGURE 1
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    FIGURE 1

    The prevalence of chronic cough in different regions of China.

  • FIGURE 2
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    FIGURE 2

    Association of chronic cough with quality of life and respiratory exacerbations: a) physical component summary (PCS) score; b) mental component summary (MCS) score; c) emergency; and d) hospital admission. Adjusted for age, sex, urbanisation, body mass index, cigarette smoking, biomass, annual mean particulate matter with a diameter <2.5 μm (PM2.5), education, occupational exposure, visible mould spots in the current residence, history of pneumonia or bronchitis during childhood, parental history of respiratory diseases and allergic rhinitis. The subgroup variables were not adjusted in the corresponding subgroup analysis for themselves, except that age was still adjusted as continuous variable for the subgroup analysis conducted among those aged 20–49 and ≥50 years. SAD: small airway dysfunction.

Tables

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  • Supplementary Materials
  • TABLE 1

    Demographics and risk factors by diagnosis of chronic cough in the general Chinese adult population

    VariablesNo chronic coughChronic coughp-value
    Subjects n49 0061985
    Men20 255 (50.0)1191 (64.0)0.0031
    Age years43.5±0.852.0±1.5<0.0001
    Urban residents31 637 (51.6)1242 (52.1)0.9135
    Education level0.0359
     Primary school or less12 090 (22.2)665 (33.0)
     Middle and high school28 113 (52.5)1057 (46.8)
     College and higher8803 (25.3)263 (20.2)
    Cigarette smoking0.0001
     Never-smoker35 466 (69.4)963 (45.9)
     Ever-smoker#13 540 (30.6)1022 (54.1)
    Passive smoking at home¶17 130 (47.8)470 (52.9)0.2546
    Biomass use12 967 (25.8)661 (32.4)0.0747
    Annual mean PM2.5 exposure µg·m−370.7±2.972.3±3.60.3203
    Occupational exposure11 608 (24.5)719 (37.3)0.0017
    Visible mould spots in the current residence0.2377
     Rarely36 152 (69.1)1319 (62.3)
     Sometimes10 098 (24.2)487 (28.7)
     Often2265 (6.7)170 (9.0)
    History of pneumonia or bronchitis during childhood2227 (4.9)217 (11.3)0.0033
    Parental history of respiratory diseases8070 (16.5)539 (24.4)0.0006
    Body mass index kg·m−223.6±0.123.9±0.20.1855
    Allergic rhinitis4676 (10.6)407 (25.0)0.0006

    Values are weighted and shown as n (%) or mean±se unless otherwise indicated. p-values are weighted, taking into account the multistage cluster sampling design and based on χ2 test for categorical variables or t-test for continuous variables. PM2.5: particulate matter with a diameter <2.5 µm. #: ever-smoker was defined as having smoked equal to or >100 cigarettes in the lifetime; ¶: demographics of passive smoking at home were shown for never-smokers.

    • TABLE 2

      Age-specific and age-standardised prevalence of chronic cough in the general adult population

      VariablesTotalMenWomenp-value
      Total3.6 (3.1–4.1)4.6 (3.9–5.4)2.6 (2.1–3.3)0.0005
      Age years
       20–492.4 (1.9–3.1)3.0 (2.2–4.2)1.7 (1.1–2.7)0.0433
       ≥506.0 (5.3–6.8)7.7 (6.7–8.8)4.3 (3.6–5.0)<0.0001
       p-value for difference<0.0001<0.0001<0.0001
      COPD#
       No3.2 (2.7–3.7)4.1 (3.4–5.0)2.3 (1.8–3.0)0.0006
       Yes6.0 (3.5–10.0)5.2 (4.0–6.7)6.9 (2.5–18.1)0.5777
       p-value for difference0.08450.11550.1846
      SAD¶
       No2.8 (2.3–3.5)3.7 (3.0–4.5)2.0 (1.5–2.8)0.0010
       Yes4.4 (3.7–5.2)5.4 (4.2–6.9)3.2 (2.4–4.2)0.0101
       p-value for difference0.00390.02290.0233

      Values are represented as percentage (95% confidence interval). p-value for difference is for the comparison of binary variables. All the calculations of p-values are weighted, taking into account the multistage cluster sampling design and based on χ2 test. SAD: small airway dysfunction. #: COPD was defined as those individuals with post-bronchodilator FEV1/FVC <70%. ¶: SAD was diagnosed on the basis of at least two of the following three indicators of lung function being <65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50% and FEF 75% after bronchodilator inhalation.

      • TABLE 3

        Multiple adjusted odds ratios of chronic cough in the general Chinese adult population

        VariablesOR (95% CI)p-value
        Male0.93 (0.63–1.37)0.7045
        Age (10 years)1.43 (1.26–1.61)<0.0001
        Rural resident0.84 (0.59–1.19)0.3094
        Smoking status
         Never-smoker1.00 (Reference)
         Ever-smoker#2.61 (2.10–3.25)<0.0001
        Biomass use1.04 (0.86–1.26)0.6621
        Annual mean PM2.5 µg·m−3
         <501.00 (Reference)-
         50–750.96 (0.59–1.57)0.8784
         ≥751.05 (0.62–1.79)0.8471
        Education level
         Primary school and lower1.00 (Reference)-
         Middle and high school0.80 (0.61–1.05)0.1083
         College and higher0.97 (0.68–1.39)0.8770
        Occupational exposure1.41 (1.10–1.80)0.0086
        Visible mould spots in the current residence
         Rarely1.00 (Reference)-
         Sometimes1.31 (0.91–1.90)0.1414
         Often1.19 (0.73–1.93)0.4652
        History of pneumonia or bronchitis during childhood2.23 (1.49–3.34)0.0006
        Parental history of respiratory diseases1.23 (0.95–1.59)0.1165
        Body mass index kg·m−2
         <18.51.45 (0.97–2.16)0.0662
         18.5–24.91.00 (Reference)-
         ≥251.23 (0.94–1.61)0.1197
        Allergic rhinitis2.84 (1.98–4.09)<0.0001

        The variables listed in the table are all included in the model. The logistic regression analyses are weighted, taking into account the multistage cluster sampling design. OR: odds ratio; 95% CI: 95% confidence interval; PM2.5: particulate matter with a diameter <2.5 µm. #: ever-smoker was defined as having smoked equal to or >100 cigarettes in the lifetime.

        • TABLE 4

          Clinical characteristics and use of healthcare resources by diagnosis of chronic cough

          VariablesNo chronic coughChronic coughp-value
          Subjects n49 0061985
          Lung function#
           FEV1/FVC %82.0±0.475.2±1.2<0.0001
           FEV1 % pred99.8±0.994.5±2.50.0155
           FEV1/FVC <70%4420 (8.1)488 (22.8)0.0010
           MMEF % pred76.0±1.062.6±2.8<0.0001
           FEF 50% pred88.4±1.074.4±3.4<0.0001
           FEF 75% pred77.2±1.362.7±2.6<0.0001
           SAD¶15 991 (28.3)988 (48.0)0.0017
           Positive bronchodilator reversibility+3059 (6.1)222 (13.0)0.0315
          Short form (SF)-12 scores
           PCS scores52.6±0.248.7±0.6<0.0001
           MCS scores54.1±0.353.1±0.60.0656
          Comorbidities
           Hypertension3846 (6.4)309 (13.1)0.0116
           Coronary heart disease698 (1.9)87 (3.2)0.3501
           Diabetes1203 (2.6)96 (3.9)0.2589
          Acute exacerbation of respiratory symptoms in the last 12 months
           Emergency174 (0.5)89 (3.5)0.0042
           Hospital admission167 (0.4)119 (5.5)0.0002

          Values are weighted and shown as n (%) or mean±se. All the calculations of p-value are weighted, taking into account the multistage cluster sampling design and based on χ2 test for categorical variables or t-test for continuous variables. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; MMEF: maximal mid-expiratory flow; FEF50%: forced expiratory flow at 50% of the FVC; FEF 75%: forced expiratory flow at 75% of the FVC; SAD: small airway dysfunction; PCS: physical component summary; MCS: mental component summary. #: the parameters were measured at 20 min after inhalation of 400 µg of salbutamol; ¶: SAD was diagnosed on the basis of at least two of the following three indicators of lung function being <65% of predicted – maximal mid-expiratory flow, forced expiratory flow (FEF) 50% and FEF 75% after bronchodilator inhalation. +: a positive bronchodilator reversibility test was defined as an increase in post-bronchodilator forced expiratory volume in 1 s of >12% and >200 mL from baseline, 20 min after inhalation of 400 µg of salbutamol.

          • TABLE 5

            Associations of chronic cough with lung function after bronchodilator inhalation

            VariablesOR or β (95% CI)p-value
            FEV1/FVC−3.30 (−4.93– −1.66)0.0005
            FEV1 %pred−4.42 (−8.89–0.05)0.0522
            FEV1/FVC <70%1.59 (1.13–2.23)0.0106
            MMEF % pred−5.73 (−9.06– −2.40)0.0020
            FEF 50% pred−7.64 (−12.16– −3.11)0.0023
            FEF 75% pred−6.51 (−10.29– −2.74)0.0019
            SAD#1.47 (1.14–1.89)0.0049
            Positive bronchodilator reversibility¶1.87 (1.01–3.47)0.0472

            Adjusted for age, sex, urbanisation, body mass index, cigarette smoking, biomass, annual mean PM2.5, education, occupational exposure, visible mould spots in the current residence, history of pneumonia or bronchitis during childhood, parental history of respiratory diseases and allergic rhinitis. The logistic or linear regression analyses are weighted, taking into account the multistage cluster sampling design. FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; MMEF: maximal mid-expiratory flow; FEF 50%: forced expiratory flow at 50% of the FVC; FEF 75%: forced expiratory flow at 50% of the FVC; SAD: small airway dysfunction. #: SAD was diagnosed on the basis of at least two of the following three indicators of lung function being <65% of predicted – MMEF, FEF 50% and FEF 75% after bronchodilator inhalation; ¶: a positive bronchodilator reversibility test was defined as an increase in post-bronchodilator forced expiratory volume in 1 s of >12% and >200 mL from baseline, 20 min after inhalation of 400 µg of salbutamol.

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              Supplementary material 00075-2022.SUPPLEMENT

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            Prevalence and burden of chronic cough in China: a national cross-sectional study
            Kewu Huang, Xiaoying Gu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, Pixin Ran, Huahao Shen, Fuqiang Wen, Yahong Chen, Tieying Sun, Guangliang Shan, Yingxiang Lin, Sinan Wu, Ruiying Wang, Zhihong Shi, Yongjian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, Chun Wan, Wanzhen Yao, Yanfei Guo, Fei Xiao, Yong Lu, Xiaoxia Peng, Dan Xiao, Xiaoning Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Zhixin Cao, Qingyuan Zhan, Yuanhua Yang, Lirong Liang, Huaping Dai, Bin Cao, Jiang He, Kian Fan Chung, Chen Wang
            ERJ Open Research Jul 2022, 8 (3) 00075-2022; DOI: 10.1183/23120541.00075-2022

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            Prevalence and burden of chronic cough in China: a national cross-sectional study
            Kewu Huang, Xiaoying Gu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, Pixin Ran, Huahao Shen, Fuqiang Wen, Yahong Chen, Tieying Sun, Guangliang Shan, Yingxiang Lin, Sinan Wu, Ruiying Wang, Zhihong Shi, Yongjian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, Chun Wan, Wanzhen Yao, Yanfei Guo, Fei Xiao, Yong Lu, Xiaoxia Peng, Dan Xiao, Xiaoning Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Zhixin Cao, Qingyuan Zhan, Yuanhua Yang, Lirong Liang, Huaping Dai, Bin Cao, Jiang He, Kian Fan Chung, Chen Wang
            ERJ Open Research Jul 2022, 8 (3) 00075-2022; DOI: 10.1183/23120541.00075-2022
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