Defining chronic cough: A systematic review of the epidemiological literature

Woo Jung Song, Yoon Seok Chang, Shoaib Faruqi, Min Koo Kang, Ju Young Kim, Min Gyu Kang, Sujeong Kim, Eun Jung Jo, Seung Eun Lee, Min Hye Kim, Jana Plevkova, Heung Woo Park, Sang Heon Cho, Alyn H. Morice

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods: A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results: A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I2=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions: This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.

Original languageEnglish
Pages (from-to)146-155
Number of pages10
JournalAllergy, Asthma and Immunology Research
Volume8
Issue number2
DOIs
StatePublished - 1 Jan 2016

Fingerprint

Cough
Meta-Analysis
Epidemiologic Studies
PubMed
Population
Language
Odds Ratio
Guidelines
Confidence Intervals

Keywords

  • Cough
  • Definition
  • Epidemiology

Cite this

Song, Woo Jung ; Chang, Yoon Seok ; Faruqi, Shoaib ; Kang, Min Koo ; Kim, Ju Young ; Kang, Min Gyu ; Kim, Sujeong ; Jo, Eun Jung ; Lee, Seung Eun ; Kim, Min Hye ; Plevkova, Jana ; Park, Heung Woo ; Cho, Sang Heon ; Morice, Alyn H. / Defining chronic cough : A systematic review of the epidemiological literature. In: Allergy, Asthma and Immunology Research. 2016 ; Vol. 8, No. 2. pp. 146-155.
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abstract = "Purpose: Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods: A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results: A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95{\%} confidence interval 0.92-1.73) with significant heterogeneity (I2=96{\%}, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions: This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.",
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author = "Song, {Woo Jung} and Chang, {Yoon Seok} and Shoaib Faruqi and Kang, {Min Koo} and Kim, {Ju Young} and Kang, {Min Gyu} and Sujeong Kim and Jo, {Eun Jung} and Lee, {Seung Eun} and Kim, {Min Hye} and Jana Plevkova and Park, {Heung Woo} and Cho, {Sang Heon} and Morice, {Alyn H.}",
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Song, WJ, Chang, YS, Faruqi, S, Kang, MK, Kim, JY, Kang, MG, Kim, S, Jo, EJ, Lee, SE, Kim, MH, Plevkova, J, Park, HW, Cho, SH & Morice, AH 2016, 'Defining chronic cough: A systematic review of the epidemiological literature', Allergy, Asthma and Immunology Research, vol. 8, no. 2, pp. 146-155. https://doi.org/10.4168/aair.2016.8.2.146

Defining chronic cough : A systematic review of the epidemiological literature. / Song, Woo Jung; Chang, Yoon Seok; Faruqi, Shoaib; Kang, Min Koo; Kim, Ju Young; Kang, Min Gyu; Kim, Sujeong; Jo, Eun Jung; Lee, Seung Eun; Kim, Min Hye; Plevkova, Jana; Park, Heung Woo; Cho, Sang Heon; Morice, Alyn H.

In: Allergy, Asthma and Immunology Research, Vol. 8, No. 2, 01.01.2016, p. 146-155.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Defining chronic cough

T2 - A systematic review of the epidemiological literature

AU - Song, Woo Jung

AU - Chang, Yoon Seok

AU - Faruqi, Shoaib

AU - Kang, Min Koo

AU - Kim, Ju Young

AU - Kang, Min Gyu

AU - Kim, Sujeong

AU - Jo, Eun Jung

AU - Lee, Seung Eun

AU - Kim, Min Hye

AU - Plevkova, Jana

AU - Park, Heung Woo

AU - Cho, Sang Heon

AU - Morice, Alyn H.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Purpose: Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods: A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results: A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I2=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions: This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.

AB - Purpose: Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods: A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results: A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I2=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions: This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.

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KW - Definition

KW - Epidemiology

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