Asia Pac Allergy.  2016 Oct;6(4):198-206. 10.5415/apallergy.2016.6.4.198.

Chronic cough in Korean adults: a literature review on common comorbidity

• Kang SY
• Kim GW
• Song WJ
• Chang YS
• Cho SH

• KMID: 2397015
• DOI: http://doi.org/10.5415/apallergy.2016.6.4.198

Abstract

Chronic cough is a significant medical condition with high prevalence and a strong negative impact on the quality of life. Cough hypersensitivity is thought to underlie chronic cough, with several environmental and host factors interacting to cause neuronal sensitization and chronicity. Comorbid conditions affecting cough reflex pathways, such as upper airway diseases, asthma, and gastroesophageal reflux, play important roles in chronic cough. However, their prevalence may vary in patients living in different geographical regions or with different ethnicities. We conducted a literature review to examine common comorbidities in Korean adult patients with chronic cough, their clinical implications, and the issues that still need to be addressed in the development of clinical evidence of chronic cough in Korean adult patients.

Keyword

Asthma; Chronic cough; Epidemiology; Korea; Rhinitis

MeSH Terms

Adult*
Asthma
Comorbidity*
Cough*
Epidemiology
Gastroesophageal Reflux
Humans
Hypersensitivity
Korea
Neurons
Prevalence
Quality of Life
Reflex
Rhinitis

Figure

• 

  Fig. 1 Common comorbid conditions in Korean adult patients with chronic cough.

Reference

1. Brooks SM. Perspective on the human cough reflex. Cough. 2011; 7:10.

2. Morice AH. Epidemiology of cough. Pulm Pharmacol Ther. 2002; 15:253–259.

3. Vertigan AE, Gibson PG. Chronic refractory cough as a sensory neuropathy: evidence from a reinterpretation of cough triggers. J Voice. 2011; 25:596–601.

4. Matsumoto H, Tabuena RP, Niimi A, Inoue H, Ito I, Yamaguchi M, Otsuka K, Takeda T, Oguma T, Nakaji H, Tajiri T, Iwata T, Nagasaki T, Jinnai M, Matsuoka H, Mishima M. Cough triggers and their pathophysiology in patients with prolonged or chronic cough. Allergol Int. 2012; 61:123–132.

5. Song WJ, Kim JY, Jo EJ, Lee SE, Kim MH, Yang MS, Kang HR, Park HW, Chang YS, Min KU, Cho SH. Capsaicin cough sensitivity is related to the older female predominant feature in chronic cough patients. Allergy Asthma Immunol Res. 2014; 6:401–408.

6. Hilton E, Marsden P, Thurston A, Kennedy S, Decalmer S, Smith JA. Clinical features of the urge-to-cough in patients with chronic cough. Respir Med. 2015; 109:701–707.

7. Morice AH, Lowry R, Brown MJ, Higenbottam T. Angiotensin-converting enzyme and the cough reflex. Lancet. 1987; 2:1116–1118.

8. Millqvist E, Bende M, Löwhagen O. Sensory hyperreactivity: a possible mechanism underlying cough and asthma-like symptoms. Allergy. 1998; 53:1208–1212.

9. Morice AH, Millqvist E, Belvisi MG, Bieksiene K, Birring SS, Chung KF, Dal Negro RW, Dicpinigaitis P, Kantar A, McGarvey LP, Pacheco A, Sakalauskas R, Smith JA. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J. 2014; 44:1132–1148.

10. Chung KF, McGarvey L, Mazzone SB. Chronic cough as a neuropathic disorder. Lancet Respir Med. 2013; 1:414–422.

11. Morice AH, Jakes AD, Faruqi S, Birring SS, McGarvey L, Canning B, Smith JA, Parker SM, Chung KF, Lai K, Pavord ID, van den Berg J, Song WJ, Millqvist E, Farrell MJ, Mazzone SB, Dicpinigaitis P. Chronic Cough Registry. A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response. Eur Respir J. 2014; 44:1149–1155.

12. Atkinson SK, Sadofsky LR, Morice AH. How does rhinovirus cause the common cold cough? BMJ Open Respir Res. 2016; 3:e000118.

13. Abdullah H, Heaney LG, Cosby SL, McGarvey LP. Rhinovirus upregulates transient receptor potential channels in a human neuronal cell line: implications for respiratory virus-induced cough reflex sensitivity. Thorax. 2014; 69:46–54.

14. Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC. Causes and clinical features of subacute cough. Chest. 2006; 129:1142–1147.

15. Song WJ, Chang YS, Morice AH. Changing the paradigm for cough: does 'cough hypersensitivity' aid our understanding? Asia Pac Allergy. 2014; 4:3–13.

16. Undem BJ, Taylor-Clark T. Mechanisms underlying the neuronal-based symptoms of allergy. J Allergy Clin Immunol. 2014; 133:1521–1534.

17. Gibson PG, Dolovich J, Denburg J, Ramsdale EH, Hargreave FE. Chronic cough: eosinophilic bronchitis without asthma. Lancet. 1989; 1:1346–1348.

18. Plevkova J, Song WJ. Chronic cough in subjects with upper airway diseases: analysis of mechanisms and clinical applications. Asia Pac Allergy. 2013; 3:127–135.

19. Song WJ, Chang YS. Cough hypersensitivity as a neuro-immune interaction. Clin Transl Allergy. 2015; 5:24.

20. Houghton LA, Lee AS, Badri H, DeVault KR, Smith JA. Respiratory disease and the oesophagus: reflux, reflexes and microaspiration. Nat Rev Gastroenterol Hepatol. 2016; 13:445–460.

21. Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, O'Connell F, Geppetti P, Gronke L, De Jongste J, Belvisi M, Dicpinigaitis P, Fischer A, McGarvey L, Fokkens WJ, Kastelik J. ERS Task Force. The diagnosis and management of chronic cough. Eur Respir J. 2004; 24:481–492.

22. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM. American College of Chest Physicians (ACCP). Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129:1 Suppl. 1S–23S.

23. Niimi A. Geography and cough aetiology. Pulm Pharmacol Ther. 2007; 20:383–387.

24. Song WJ, Faruqi S, Klaewsongkram J, Lee SE, Chang YS. Chronic cough: an Asian perspective. Part 1: Epidemiology. Asia Pac Allergy. 2015; 5:136–144.

25. Shin C, Lee S, Abbott RD, Kim JH, Lee SY, In KH, Kimm K. Respiratory symptoms and undiagnosed airflow obstruction in middle-aged adults: the Korean Health and Genome Study. Chest. 2004; 126:1234–1240.

26. Song WJ, Morice AH, Kim MH, Lee SE, Jo EJ, Lee SM, Han JW, Kim TH, Kim SH, Jang HC, Kim KW, Cho SH, Min KU, Chang YS. Cough in the elderly population: relationships with multiple comorbidity. PLoS One. 2013; 8:e78081.

27. Kim SH, Kim SH, Song WJ, Kwon JW, Kim MH, Kim KM, Jeong JW, Kim SH, Ahn Y, Jo EJ, Lee SE, Lee JY, Lee JY, Kim CW, Kwon HS, Kim TB, Moon JY, Shin JW, Lee BJ. Work Group for Chronic Cough, the Korean Academy of Asthma, Allergy and Clinical Immunology. Allergists' Perceptions and Practices on the Management of Chronic Cough in Korea: A Questionnaire Survey. Korean J Asthma Allergy Clin Immunol. 2012; 32:239–253.

28. Jee YK, Oh HT, Lee KY, Kim KY, Cho SH, Min KU, Kim YY. A prospective study for spectrum and frequency of chronic cough in patients visiting out-patient clinic. J Asthma Allergy Clin Immunol. 1998; 18:222–231.

29. Joo JH, Park J, Park SJ, Seo MJ, Kim DJ, Uh ST, Kim YH, Park CS. Clinical features of eosinophilic bronchitis. Korean J Med. 2001; 60:77–84.

30. Kwon NH, Lee BJ, Choi DC. Chronic cough of unknown causes and gastroesophageal reflux disease: the incidence and treatment response. Korean J Med. 2005; 69:528–535.

31. Yoo B, Choi SW, Moon HB. Airway responsiveness in patients with chronic cough. Allergy. 1995; 15:223–229.

32. Cho YJ. Metacholine induced bronchial hyperreativity and atopic state in patients with chronic cough. Ewha Med J. 1997; 20:131–136.

33. Kim KH, Lee GT, Park SW, Oh JH, Ki SY, Moon SH, Jeong SH, Kim HT, Uh ST, Kim YH, Park CS, Jin BW. Airway hyperresponsiveness and etiology in patients with chronic cough. Tuberc Respir Dis. 1997; 44:146–153.

34. Oh YB, Mon CH, Kim HY, Lee SM. The diagnostic value of sputum eosinophil counts in patients with chronic cough. Korean J Allergy. 1997; 17:180–185.

35. Cho JH, Ryu JS, Lee HL. Chronic cough: the spectrum and the frequency of etiologies. Tuberc Respir Dis. 1999; 46:555–563.

36. Cho YS, Lee CK, Yoo B, Moon HB. Cough sensitivity and extrathoracic airway responsiveness to inhaled capsaicin in chronic cough patients. J Korean Med Sci. 2002; 17:616–620.

37. Jeon G, Jang SH, Song HG, Ha JW, Eom KS, Bahn JW, Kim DG, Shin TR, Park SM, Park YB, Kim CH, Hyun IG, Jung KS. Diagnostic performance of routine objective tests and cost-effective approach for chronic cough. Tuberc Respir Dis. 2004; 57:535–542.

38. Lee BJ, Min TH, Choi DC. Ever wheeze as a predictor of cough variant asthma. J Asthma Allergy Clin Immunol. 2004; 24:94–102.

39. Lee KH, Jang SH, Lee JH, Eom KS, Bahn JW, Kim DG, Shin TR, Park SM, Lee MG, Kim CH, Hyun IG, Jung KS. The role of inhaled corticosteroid in the management of chronic cough. Tuberc Respir Dis. 2006; 60:221–227.

40. Lee J, Kim M, Kim JH, Lee YR, Kim S, Kim Y. A cheaper, faster way to resolve chronic cough. J Fam Pract. 2007; 56:641–646.

41. Shin JY, Lee JE, Park JW, Jung SY, Yoo SJ, Yoon JH, Park HS, Kim SY, Kim JO. Validation of a modified ECRHS questionnaire for diagnosing asthma in patients with chronic cough. Korean J Med. 2009; 77:734–740.

42. Chun SY, Park KO, Park YB, Choi JH, Lee JY, Mo EK, Park SH, Kim CH, Lee CY, Hwang YI, Jang SH, Shin TR, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS. Infection rate of chlamydia pneumoniae in patients with chronic cough. Tuberc Respir Dis. 2010; 69:426–433.

43. Kim YJ, Callaway Z, Kim HB, Kim CK. The efficacy of eosinophilic degranulation proteins for diagnosing asthma in chronic cough patients. Korean J Asthma Allergy Clin Immunol. 2010; 30:293–298.

44. Kim JY, Kang MG, Lee SE, Lee SY, Kim MH, Yang MS, Song WJ, Kang HR, Park HW, Cho SH, Min KU. Capsaicin cough hypersensitivity among adult patients with chronic cough. Seoul: Korean Academy of Asthma Allergy and Clinical Immunology Annual Congress;2012.

45. Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006; 129:1 Suppl. 63S–71S.

46. O'Hara J, Jones NS. "Post-nasal drip syndrome": most patients with purulent nasal secretions do not complain of chronic cough. Rhinology. 2006; 44:270–273.

47. Morice AH. Post-nasal drip syndrome--a symptom to be sniffed at? Pulm Pharmacol Ther. 2004; 17:343–345.

48. Janson C, Chinn S, Jarvis D, Burney P. Determinants of cough in young adults participating in the European Community Respiratory Health Survey. Eur Respir J. 2001; 18:647–654.

49. Guerra S, Sherrill DL, Baldacci S, Carrozzi L, Pistelli F, Di Pede F, Viegi G. Rhinitis is an independent risk factor for developing cough apart from colds among adults. Allergy. 2005; 60:343–349.

50. Bende M, Millqvist E. Prevalence of chronic cough in relation to upper and lower airway symptoms; the Skövde population-based study. Front Physiol. 2012; 3:251.

51. Gibson PG, Hargreave FE, Girgis-Gabardo A, Morris M, Denburg JA, Dolovich J. Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroid. Clin Exp Allergy. 1995; 25:127–132.

52. Ayik SO, Başoğlu OK, Erdínç M, Bor S, Veral A, Bílgen C. Eosinophilic bronchitis as a cause of chronic cough. Respir Med. 2003; 97:695–701.

53. Birring SS, Parker D, Brightling CE, Bradding P, Wardlaw AJ, Pavord ID. Induced sputum inflammatory mediator concentrations in chronic cough. Am J Respir Crit Care Med. 2004; 169:15–19.

54. Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999; 160:406–410.

55. Carney IK, Gibson PG, Murree-Allen K, Saltos N, Olson LG, Hensley MJ. A systematic evaluation of mechanisms in chronic cough. Am J Respir Crit Care Med. 1997; 156:211–216.

56. McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M, Shepherd DR, MacMahon J. Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax. 1998; 53:738–743.

57. O'Connell F, Thomas VE, Pride NB, Fuller RW. Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med. 1994; 150:374–380.

58. Lai K, Chen R, Lin J, Huang K, Shen H, Kong L, Zhou X, Luo Z, Yang L, Wen F, Zhong N. A prospective, multicenter survey on causes of chronic cough in China. Chest. 2013; 143:613–620.

59. Sohn SW, Yang MS, Lee SH, Song WJ, Lee SM, Kwon HS, Kim DI, Park CH, Park HW, Chang YS, Kim SS, Cho SH, Min KU, Kim YY. Evaluation of the causes of chronic cough with sputum eosinophilia. Korean J Asthma Allergy Clin Immunol. 2007; 27:125–130.

60. Song WJ, Kwon JW, Kim EJ, Lee SM, Kim SH, Lee SY, Kim SH, Park HW, Chang YS, Kim WK, Shim JY, Seo JH, Kim BJ, Kim HB, Song DJ, Jang GC, Jang AS, Park JW, Yoon HJ, Lee JS, Cho SH, Hong SJ. Clinical application of exhaled nitric oxide measurements in a korean population. Allergy Asthma Immunol Res. 2015; 7:3–13.

61. Chatkin JM, Ansarin K, Silkoff PE, McClean P, Gutierrez C, Zamel N, Chapman KR. Exhaled nitric oxide as a noninvasive assessment of chronic cough. Am J Respir Crit Care Med. 1999; 159:1810–1813.

62. Oh MJ, Lee JY, Lee BJ, Choi DC. Exhaled nitric oxide measurement is useful for the exclusion of nonasthmatic eosinophilic bronchitis in patients with chronic cough. Chest. 2008; 134:990–995.

63. Song WJ, Won HK, Moon SD, Chung SJ, Kang SY, Sohn KH, Kim JY, Kim BK, Lim KH, Kim MY, Yang MS, Park HW, Chang YS, Lee BJ, Morice AH, Cho SH. Could fractional exhaled nitric oxide test be useful in predicting inhaled corticosteroid responsiveness in chronic cough? A systematic review. J Allergy Clin Immunol Pract. 2016; 10. 01. [Epub]. DOI: 10.1016/j.jaip.2016.07.017.

64. Fujimura M, Abo M, Ogawa H, Nishi K, Kibe Y, Hirose T, Nakatsumi Y, Iwasa K. Importance of atopic cough, cough variant asthma and sinobronchial syndrome as causes of chronic cough in the Hokuriku area of Japan. Respirology. 2005; 10:201–207.

65. Song WJ, Kim SH, Lim S, Park YJ, Kim MH, Lee SM, Lee SB, Kim KW, Jang HC, Cho SH, Min KU, Chang YS. Association between obesity and asthma in the elderly population: potential roles of abdominal subcutaneous adiposity and sarcopenia. Ann Allergy Asthma Immunol. 2012; 109:243–248.

66. Ford AC, Forman D, Moayyedi P, Morice AH. Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms. Thorax. 2006; 61:975–979.

67. Kim KM, Cho YK, Bae SJ, Kim DS, Shim KN, Kim JH, Jung SW, Kim N. Prevalence of gastroesophageal reflux disease in Korea and associated health-care utilization: a national population-based study. J Gastroenterol Hepatol. 2012; 27:741–745.

68. Park WB, Park SW, Kim HB, Kim EC, Oh M, Choe KW. Pertussis in adults with persistent cough in South Korea. Eur J Clin Microbiol Infect Dis. 2005; 24:156–158.

69. Park S, Lee MG, Lee KH, Park YB, Yoo KH, Park JW, Kim C, Lee YC, Park JS, Kwon YS, Seo KH, Kim HJ, Kwak SM, Kim JO, Lim SY, Sung HY, Jung SO, Jung KS. A Multicenter study of pertussis infection in adults with coughing in Korea: PCR-based study. Tuberc Respir Dis (Seoul). 2012; 73:266–272.

70. Lee SY, Han SB, Kang JH, Kim JS. Pertussis prevalence in korean adolescents and adults with persistent cough. J Korean Med Sci. 2015; 30:988–990.

71. Kim WJ, Lee HY, Lee ME, Lee SJ. Serology of Chlamydia pneumoniae in patients with chronic cough. Respirology. 2006; 11:805–808.

72. Jeon K, Koh WJ, Kim H, Kwon OJ, Kim TS, Lee KS, Han J. Clinical features of recently diagnosed pulmonary paragonimiasis in Korea. Chest. 2005; 128:1423–1430.

73. Birrell MA, Belvisi MG, Grace M, Sadofsky L, Faruqi S, Hele DJ, Maher SA, Freund-Michel V, Morice AH. TRPA1 agonists evoke coughing in guinea pig and human volunteers. Am J Respir Crit Care Med. 2009; 180:1042–1047.

74. Belvisi MG, Birrell MA, Khalid S, Wortley MA, Dockry R, Coote J, Holt K, Dubuis E, Kelsall A, Maher SA, Bonvini S, Woodcock A, Smith JA. Neurophenotypes in airway diseases: insights from translational cough studies. Am J Respir Crit Care Med. 2016; 193:1364–1372.

75. 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. Defining chronic cough: a systematic review of the epidemiological literature. Allergy Asthma Immunol Res. 2016; 8:146–155.

76. Pisinger C, Godtfredsen NS, Jørgensen T. Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study. Clin Respir J. 2008; 2:41–46.

77. Kang MG, Song WJ, Chang YS, Kim SS, Kim MK, Chang SI, Min KU, Cho SH. Epidemiology of chronic cough in Korea: a nationwide database analysis (2010-2012). In : 34th European Academy of Allergy and Clinical Immunology (EAACI) Congress 2015; 2015 Jun 6-10; Barcelona, Spain. Meeting Abstract No. 1625.