Abstract
Deep inspiration-provoked cough (DIPC) is a form of allotussia. Allotussia is thought to be a manifestation of cough reflex arc hypersensitivity but objective evidence about this is lacking. 36 subjects with chronic cough and 25 healthy subjects underwent mannitol and citric acid cough provocation tests. DIPC was defined as two or more coughs after deep inhalation of an empty mannitol capsule. Citric acid was administered utilizing a dosimetric nebulizer during controlled tidal breathing. Nine subjects demonstrated DIPC, 8/36 subjects with chronic cough and 1/25 healthy subjects (p = 0.048). The concentration of citric acid to provoke five or more coughs (C5) was 23.4 (63.8) mM among subjects with DIPC and 750 (2941) mM among the subjects without it (p = 0.006). The number of deep inspiration-provoked coughs correlated with the citric acid C5 (Rs -0.38, p = 0.002). In conclusion, DIPC, a form of allotussia, is associated with cough reflex arc hypersensitivity.
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ClinicalTrials.gov database KUH5801136.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors thank Satu Nenonen, RN, for performing the cough provocation tests and the authors of the original publication, Anne Lätti, MD and John Brannan, PhD.
Funding
The study was supported by Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö foundations.
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Substantial contributions to the conception and design of the work: all authors. Acquisition, analysis, or interpretation of data for the work: all authors. Drafting the article or revising it critically for important intellectual content: all authors. Final approval of the version to be published: all authors. Agreement to be accountable for all aspects of the work, in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.
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Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö foundations, has been supported by AstraZeneca for attending a scientific meeting, and owns shares of a medical company Orion. Hanna M Nurmi has been supported by Boehringer-Ingelheim, Sanofi-Genzyme, and Chiesi for attending a scientific meeting and received payments for lectures from Boehringer-Ingelheim. Woo-Jung Song has received a research grant from MSD and consulting fees from MSD and AstraZeneca and received payment for lectures from MSD.
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The study was approved by the Ethics Committee of Kuopio University Hospital (289/2015).
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Koskela, H.O., Nurmi, H.M. & Song, WJ. Deep Inspiration-Provoked Cough: A Sign of Cough Reflex Arc Hypersensitivity. Lung 199, 501–505 (2021). https://doi.org/10.1007/s00408-021-00476-0
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DOI: https://doi.org/10.1007/s00408-021-00476-0