Chronic cough is associated with increased reporting of autonomic symptoms

Rachel J Dockry; Carmen L Farrelly; Joanne Mitchell; Douglas R Corfield; Jaclyn A Smith

doi:10.1183/23120541.00105-2021

Chronic cough is associated with increased reporting of autonomic symptoms

ERJ Open Res. 2021 Jul 12;7(3):00105-2021. doi: 10.1183/23120541.00105-2021. eCollection 2021 Jul.

Authors

Rachel J Dockry¹, Carmen L Farrelly², Joanne Mitchell³, Douglas R Corfield⁴, Jaclyn A Smith^{1

3}

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
² Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK.
³ NIHR Manchester Clinical Research Facility at University Hospital of South Manchester, Manchester, UK.
⁴ Division of Medical Education, University of Manchester, Manchester, UK.

Abstract

Background: Patients with some neuronal hypersensitivity syndromes experience increased autonomic symptoms. Chronic cough is thought to be a neuronal hypersensitivity disorder and, therefore, may be associated with increased autonomic symptoms.

Methods: 96 chronic cough subjects were recruited from the tertiary cough clinic based at Wythenshawe Hospital, Manchester, UK; 76 healthy controls were also recruited. Subjects were aged >18 years. Those with significant respiratory disease, significant smoking history or taking medication known to affect cough or autonomic function were excluded. Subjects completed the Composite Autonomic Symptom Score (COMPASS) 31 autonomic symptom questionnaire, the Cough Quality of Life Questionnaire (CQLQ) and a cough severity visual analogue scale (VAS).

Results: 96 chronic cough subjects and 76 healthy volunteers were included in the final analysis. Mann-Whitney U-tests comparing COMPASS 31 scores in both groups showed that the total COMPASS 31 score was significantly higher in the patient group (median 18.4, interquartile range (IQR) 7.5-32.0) than the control group (median 3.6, IQR 1.1-9.5; p<0.001). The chronic cough subjects had significantly higher symptom scores than the healthy volunteer groups in all domains (p≤0.001) except vasomotor symptoms (p=0.770). There was a positive association between COMPASS 31 and CQLQ in the patient group (p<0.001, r=0.432) but not COMPASS 31 and VAS (p=0.227).

Interpretation: Chronic cough patients do indeed report more frequent and severe autonomic symptoms than healthy volunteers, indicating that this population may suffer from dysautonomia. At present, it remains unclear whether this occurs as a result of the cough or whether both the cough and dysfunction are part of some wider vagal pathology.