Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens

  • Raphael Weinberger
  • Marion Riffelmann
  • Nicole Kennerknecht
  • Christel Hülße
  • Martina Littmann
  • Judith O’Brien
  • Rüdiger von Kries
  • Carl Heinz Wirsing von König
Original Article


Studies of the incidence of pertussis in adults have shown that it accounts for only 5–15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan–Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4–11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.



Primarily, we thank all the patients who agreed to participate in this study. We would also like to thank all sentinel physicians:

Krefeld: Frau und Herr Dr Rieger, Praxis Dr Krausbauer und Frau Dr Möhrke, Herr Dr Dotzel, Herr Dr Frackenpohl, Praxis Dr Lüdemann und Herr Dr Schultz, Herr Dr Urban, Herr Dr Urlbauer, Herr Dr Baselt, Herr Dr Ridderskamp, Praxis Dr Hochbruck und Dr Hermann, Praxis Dr Kemmerich und Dr Thomaßen, Herr Dr Meißner, Herr Dr Seelhoff.

Rostock: Frau Dr Lusch, Herr Dr Rothe, Frau Dr Krüger, Herr Dr Th Hohlbein, Frau Dr Borchmann, Frau Dr Kähler, Frau Dr Bichowski, Frau Dr Lüder, Frau Dr Glaser, Frau Dr B Hohlbein, Frau Dr Vilbrandt, Herr Dr Anft, Frau Dr Burow, Frau Dr Olwig, Frau Dr Engelhardt, Frau Dr Lange, Herr Dr Langer, Frau Dr Evert, Frau Dr Michelsen, Frau Dr Frank, Frau Dr Morcan.

Authors’ contributions

RW, RvK and CHWvK wrote the manuscript. RW and RvK extracted and analyzed the data. CHWvK planned the study, and MR and CHWvK established and supervised the logistics in Krefeld, as CH and ML did in Rostock. NK supervised the laboratory work; JO’B collated the resource use data. All authors have read the manuscript, commented on it, and agreed to the final version.


The logistics of the sentinel were funded jointly by GlaxoSmithKline Pharma, Munich, Germany and Sanofi Pasteur, Leimen, Germany, to produce estimates of the incidence of adult pertussis. Both sponsors had no influence on any part of the study. All other laboratory tests, the data analysis, and the production of the manuscript were not funded externally.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest. For the sentinel physicians, products of pharmaceutical companies played no role; thus, all sentinel physicians declare that no conflicting interests were relevant in this study. Physicians received no remuneration in this study, doctor’s assistants received 25€ per patient for organizing the study logistics.

Ethical approval

This study was approved by the ethics committees of the Medical Boards in KR (Ethikkommission bei der Ärztekammer Nordrhein, Lfd. Nr.: 2,000,269) and HRO (Ethikkommission bei der Ärztekammer Mecklenburg-Vorpommern, Reg. Nr.: I42/01. Arzneimittelüberwachung MV: Lfd. Nr. AMÜSt 20a/610.1).

Informed consent

All adult patients included in this study were informed about the study goals and declared their consent to participate in the study by signing an appropriate form.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Raphael Weinberger
    • 1
  • Marion Riffelmann
    • 2
    • 3
  • Nicole Kennerknecht
    • 3
  • Christel Hülße
    • 4
  • Martina Littmann
    • 4
  • Judith O’Brien
    • 1
    • 2
    • 3
    • 4
  • Rüdiger von Kries
    • 1
  • Carl Heinz Wirsing von König
    • 2
  1. 1.Institut für Soziale PädiatrieLudwig-Maximilians-UniversitätMunichGermany
  2. 2.Labor: Medizin Krefeld MVZ GmbHKrefeldGermany
  3. 3.Institut für Hygiene und LabormedizinHELIOS Klinikum KrefeldKrefeldGermany
  4. 4.Landesamt für Gesundheit und Soziales des Landes Mecklenburg VorpommernRostockGermany

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