Abstract
Chronic cough is one of the most common complaints for which patients in China seek medical attention. However, there are no nationwide data on the prevalence and socioeconomic burden of chronic cough. Although approximately 50% of Chinese men smoke, the vast majority of patients presenting for evaluation of chronic cough are never smokers. An equal sex distribution and a middle-aged predominance have been observed in the Chinese chronic cough population, despite demonstration of a higher cough reflex sensitivity in females and older patients. The role of air pollution in the distinct age and sex distribution requires further study. In terms of the etiologies of chronic cough in China, cough-variant asthma, upper airway cough syndrome, nonasthmatic eosinophilic bronchitis, and atopic cough are the most common causes, comprising 75.2% to 87.6% of cases across different regions. Chinese Guidelines for Diagnosis and Treatment of Cough were initially published in 2005, and updated in 2009 and 2016. In addition, the China Cough Coalition was established in 2016. Great progress has been made in both cough-related clinical practice and research in recent years, however, there are still challenges ahead. To facilitate optimal management of chronic cough in China, efforts promoting the dissemination and application of published guidelines will be essential, especially in community-based healthcare and in rural regions. As chronic refractory cough has been identified as a huge challenge to clinicians worldwide, continued international cooperation will be essential in optimizing evaluation and management of chronic cough.
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References
Li B, Lai K, Wang F, Zhong N (2011) Quality-of-life questionnaire in patients with chronic cough. Int J Respir 31:326–328
Lai K, Li B, Wang F, Chen R, Liu X, Zhong N (2011) Survey on the diagnosis and management of the patients with chronic cough. Int J Respir 31:645–647
Morice AH, Millqvist E, Bieksiene K et al (2019) ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. https://doi.org/10.1183/13993003.01136-2019
McGarvey LP (2005) Idiopathic chronic cough: a real disease or a failure of diagnosis? Cough 1:9
Irwin RS, French CL, Chang AB, Altman KW, Panel* CEC (2018) Classification of cough as a symptom in adults and management algorithms: chest guideline and expert panel report. Chest 153:196–209
Moscato G, Pala G, Cullinan P et al (2014) EAACI position paper on assessment of cough in the workplace. Allergy 69:292–304
Morice AH, Fontana GA, Belvisi MG et al (2007) ERS guidelines on the assessment of cough. Eur Respir J 29:1256–1276
Gibson PG, Chang AB, Glasgow NJ, et al. CICADA: cough in children and adults: diagnosis and assessment. Australian cough guidelines summary statement. Med J Aust 2010;192:265–271.
Kardos P, Dinh QT, Fuchs KH et al (2019) Guidelines of the german respiratory society for diagnosis and treatment of adults suffering from acute, subacute and chronic cough. Pneumologie 73:143–180
Song DJ, Song WJ, Kwon JW et al (2018) KAAACI evidence-based clinical practice guidelines for chronic cough in adults and children in Korea. Allergy Asthma Immunol Res 10:591–613
Committee for the Japanese Respiratory Society Guidelines for Management, Kohno S, Ishida T, et al (2006) The Japanese Respiratory Society guidelines for management of cough. Respirology 11(Suppl 4):S135–S186
Morice AH, McGarvey L, Pavord I (2006) British Thoracic Society cough guideline. Recommendations for the management of cough in adults. Thorax 61(Suppl 1):i1–i24
Lai K, Shen H, Zhou X et al (2018) Clinical practice guidelines for diagnosis and management of cough-Chinese Thoracic Society (CTS) asthma consortium. J Thorac Dis 10:6314–6351
Song WJ, Chang YS, Faruqi S et al (2015) The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J 45:1479–1481
Wilson D, Takahashi K, Pan G et al (2008) Respiratory symptoms among residents of a heavy-industry province in China: prevalence and risk factors. Respir Med 102:1536–1544
Chen R, Lai K, Liu C, Luo W, Zhong N (2006) An epidemiologic study of cough in young college students in Guangzhou. Chin J Epidemiol 27:123–126
Lai K, Long L, Yi F et al (2019) Age and sex distribution of chinese chronic cough patients and their relationship with capsaicin cough sensitivity. Allergy Asthma Immunol Res 11:871–884
Wang J, Li S, Wang S, Shang K (2015) Effects of long-term dust exposure on human respiratory system health in Minqin County, China. Arch Environ Occup Health 70:225–231
Lai K, Chen R, Lin J et al (2013) A prospective, multicenter survey on causes of chronic cough in China. Chest 143:613–620
El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880
Liu W, Yu Q, Yue H et al (2016) The distribution characteristics of etiology of chronic cough in Lanzhou. Chin J Tuberc Respir Dis 39:362–367
Deng HY, Luo W, Zhang M, Xie JX, Fang ZY, Lai KF (2016) Initial empirical treatment based on clinical feature of chronic cough. Clin Respir J 10:622–630
Dong R, Xu X, Yu L et al (2019) Randomised clinical trial: gabapentin vs baclofen in the treatment of suspected refractory gastro-oesophageal reflux-induced chronic cough. Aliment Pharmacol Ther 49:714–722
Tan VP, Wong BC, Wong WM et al (2016) Gastroesophageal reflux disease: cross-sectional study demonstrating rising prevalence in a Chinese population. J Clin Gastroenterol 50:e1–7
Takeda N, Takemura M, Kanemitsu Y et al (2019) Effect of anti-reflux treatment on gastroesophageal reflux-associated chronic cough: implications of neurogenic and neutrophilic inflammation. J Asthma. https://doi.org/10.1080/02770903.2019.1641204
Niimi A (2017) Cough associated with gastro-oesophageal reflux disease (GORD): Japanese experience. Pulm Pharmacol Ther 47:59–65
Morice AH, Jakes AD, Faruqi S et al (2014) A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response. Eur Respir J 44:1149–1155
He M, Ichinose T, Song Y et al (2016) Desert dust induces TLR signaling to trigger Th2-dominant lung allergic inflammation via a MyD88-dependent signaling pathway. Toxicol Appl Pharmacol 296:61–72
He M, Ichinose T, Yoshida S, Nishikawa M, Sun G, Shibamoto T (2019) Role of iron and oxidative stress in the exacerbation of allergic inflammation in murine lungs caused by urban particulate matter %3c 25 mum and desert dust. J Appl Toxicol 39:855–867
Fang Z, Huang C, Zhang JJ et al (2019) Traffic-related air pollution induces non-allergic eosinophilic airway inflammation and cough hypersensitivity in guinea-pigs. Clin Exp Allergy 49:366–377
Niimi A, Ohbayashi H, Sagara H et al (2013) Cough variant and cough-predominant asthma are major causes of persistent cough: a multicenter study in Japan. J Asthma 50:932–937
Kang SY, Won HK, Lee SM et al (2019) Impact of cough and unmet needs in chronic cough: a survey of patients in Korea. Lung 197:635–639
Bao W, Zhang X, Lv C et al (2018) The value of fractional exhaled nitric oxide and forced mid-expiratory flow as predictive markers of bronchial hyperresponsiveness in adults with chronic cough. J Allergy Clin Immunol Pract 6:1313–1320
Yi F, Chen R, Luo W et al (2016) Validity of fractional exhaled nitric oxide in diagnosis of corticosteroid-responsive cough. Chest 149:1042–1051
Lin J, Wang H, Yan F et al (2018) Effects of occupational exposure to noise and dust on blood pressure in Chinese industrial workers. Clin Exp Hypertens 40:257–261
Tang YX, Bloom MS, Qian ZM et al (2019) Association between ambient air pollution and hyperuricemia in traffic police officers in China: a cohort study. Int J Environ Health Res. https://doi.org/10.1080/09603123.2019.1628926
Feng Z, Zhan J, Wang C, Ma C, Huang Z (2018) The association between musculoskeletal disorders and driver behaviors among professional drivers in China. Int J Occup Saf Ergon. https://doi.org/10.1080/10803548.2018.1482088
Wu X, Zhang H, Xiao W, Ning P, Schwebel DC, Hu G (2019) Are bus company regulations associated with crash risk? Findings from a retrospective survey in four Chinese cities. Int J Environ Res Public Health 16(8):1342
Bennett WD, Zeman KL, Kim C (1996) Variability of fine particle deposition in healthy adults: effect of age and gender. Am J Respir Crit Care Med 153:1641–1647
Colak Y, Nordestgaard BG, Laursen LC, Afzal S, Lange P, Dahl M (2017) Risk factors for chronic cough among 14,669 individuals from the general population. Chest 152:563–573
Zhang LX, Enarson DA, He GX, Li B, Chan-Yeung M (2002) Occupational and environmental risk factors for respiratory symptoms in rural Beijing, China. Eur Respir J 20:1525–1531
Ouyang Y (2017) The respiratory landscape in China: a focus on air pollution. Lancet Respir Med 5:16–17
Wang C, Xu J, Yang L et al (2018) Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet 391:1706–1717
Zhang H, Dong L, Kang YK et al (2018) Epidemiology of chronic airway disease: results from a cross-sectional survey in Beijing, China. J Thorac Dis 10:6168–6175
Dicpinigaitis PV (2012) Thoughts on one thousand chronic cough patients. Lung 190:593–596
Dicpinigaitis PV (2017) Effect of tobacco and electronic cigarette use on cough reflex sensitivity. Pulm Pharmacol Ther 47:45–48
Kanezaki M, Ebihara S, Gui P, Ebihara T, Kohzuki M (2012) Effect of cigarette smoking on cough reflex induced by TRPV1 and TRPA1 stimulations. Respir Med 106:406–412
Ando A, Mazzone SB, Farrell MJ (2019) Altered neural activity in brain cough suppression networks in cigarette smokers. Eur Respir J. https://doi.org/10.1183/13993003.00362-2019
Jorm LR, Shepherd LC, Rogers KD, Blyth FM (2012) Smoking and use of primary care services: findings from a population-based cohort study linked with administrative claims data. BMC Health Serv Res 12:263
Doherty MJ, Mister R, Pearson MG, Calverley PM (2000) Capsaicin responsiveness and cough in asthma and chronic obstructive pulmonary disease. Thorax 55:643–649
Molassiotis A, Smith JA, Mazzone P, Blackhall F, Irwin RS, Panel CEC (2017) Symptomatic treatment of cough among adult patients with lung cancer: chest guideline and expert panel report. Chest 151:861–874
Sumner H, Woodcock A, Kolsum U et al (2013) Predictors of objective cough frequency in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 187:943–949
Lee LY, Gu Q, Lin YS (2010) Effect of smoking on cough reflex sensitivity: basic and preclinical studies. Lung 188(Suppl 1):S23–S27
Hu ZW, Zhao YN, Cheng Y et al (2016) Living near a major road in Beijing: association with lower lung function, airway acidification, and chronic cough. Chin Med J 129:2184–2190
Belvisi MG, Dubuis E, Birrell MA (2011) Transient receptor potential A1 channels: insights into cough and airway inflammatory disease. Chest 140:1040–1047
Deering-Rice CE, Shapiro D, Romero EG et al (2015) Activation of transient receptor potential ankyrin-1 by insoluble particulate material and association with asthma. Am J Respir Cell Mol Biol 53:893–901
Sato R, Gui P, Ito K, Kohzuki M, Ebihara S (2016) Effect of short-term exposure to high particulate levels on cough reflex sensitivity in healthy tourists: a pilot study. Open Respir Med J 10:96–104
Sinharay R, Gong J, Barratt B et al (2018) Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study. Lancet 391:339–349
Dauchet L, Hulo S, Cherot-Kornobis N et al (2018) Short-term exposure to air pollution: associations with lung function and inflammatory markers in non-smoking, healthy adults. Environ Int 121:610–619
Yang Q, Ge MQ, Kokalari B et al (2016) Group 2 innate lymphoid cells mediate ozone-induced airway inflammation and hyperresponsiveness in mice. J Allergy Clin Immunol 137:571–578
Mazzone SB, Chung KF, McGarvey L (2018) The heterogeneity of chronic cough: a case for endotypes of cough hypersensitivity. Lancet Respir Med 6:636–646
Long L, Yao H, Tian J et al (2019) Heterogeneity of cough hypersensitivity mediated by TRPV1 and TRPA1 in patients with chronic refractory cough. Respir Res 20:112
Belvisi MG, Birrell MA, Khalid S et al (2016) Neurophenotypes in airway diseases. Insights from translational cough studies. Am J Respir Crit Care Med 193:1364–1372
Turner RD, Birring SS (2019) Chronic cough: ATP, afferent pathways and hypersensitivity. Eur Respir J. https://doi.org/10.1183/13993003.00889-2019
Fowles HE, Rowland T, Wright C, Morice A (2017) Tussive challenge with ATP and AMP: does it reveal cough hypersensitivity? Eur Respir J. https://doi.org/10.1183/13993003.01452-2016
Abdulqawi R, Dockry R, Holt K et al (2015) P2X3 receptor antagonist (AF-219) in refractory chronic cough: a randomised, double-blind, placebo-controlled phase 2 study. Lancet 385:1198–1205
Morice AH, Kitt MM, Ford AP et al (2019) The effect of gefapixant, a P2X3 antagonist, on cough reflex sensitivity: a randomised placebo-controlled study. Eur Respir J. https://doi.org/10.1183/13993003.00439-2019
Bonvini SJ, Birrell MA, Grace MS et al (2016) Transient receptor potential cation channel, subfamily V, member 4 and airway sensory afferent activation: role of adenosine triphosphate. J Allergy Clin Immunol 138:249–261
Smith J, Allman D, Badri H et al (2019) The neurokinin-1 receptor antagonist orvepitant is a novel antitussive therapy for chronic refractory cough: results from a phase 2 pilot study (VOLCANO-1). Chest 19:31451–31455. https://doi.org/10.1016/j.chest.2019.08.001
Deng Z, Zhou W, Sun J, Li C, Zhong B, Lai K (2018) IFN-gamma enhances the cough reflex sensitivity via calcium influx in vagal sensory neurons. Am J Respir Crit Care Med 198:868–879
Ando A, Smallwood D, McMahon M, Irving L, Mazzone SB, Farrell MJ (2016) Neural correlates of cough hypersensitivity in humans: evidence for central sensitisation and dysfunctional inhibitory control. Thorax 71:323–329
Cho PSP, Fletcher HV, Turner RD, Jolley CJ, Birring SS (2019) Impaired cough suppression in chronic refractory cough. Eur Respir J 53(5):1802203
Kelsall A, Decalmer S, McGuinness K, Woodcock A, Smith JA (2009) Sex differences and predictors of objective cough frequency in chronic cough. Thorax 64:393–398
Faruqi S, Thompson R, Wright C, Sheedy W, Morice AH (2011) Quantifying chronic cough: objective versus subjective measurements. Respirology 16:314–320
Lai K, Liu B, Xu D et al (2015) Will nonasthmatic eosinophilic bronchitis develop into chronic airway obstruction? a prospective, observational study. Chest 148:887–894
Chinese Thoracic Society (CTS) Asthma Consortium (2005) Chinese guidelines for diagnosis and treatment of cough (draft). Chin J Tuberc Respir Dis 28:738–744
Chinese Thoracic Society (CTS) Asthma Consortium (2009) Chinese guidelines for diagnosis and treatment of cough (2009). Chin J Tuberc Respir Dis 32:407–413
Chinese Thoracic Society (CTS) Asthma Consortium (2015) Chinese guidelines for diagnosis and treatment of cough. Chin J Tuberc Respir Dis 2016(39):323–354
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This work was supported by the National Natural Science Foundation of China (Award No. 81270151), Incubative Project for Innovation Team of GMU (2017-159) and Guangzhou Municipal Science and Technology Key Project (2002Z2-E0091).
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Lai, K., Long, L. Current Status and Future Directions of Chronic Cough in China. Lung 198, 23–29 (2020). https://doi.org/10.1007/s00408-019-00319-z
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DOI: https://doi.org/10.1007/s00408-019-00319-z