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      Prevalence and incidence of, and risk factors for chronic cough in the adult population: the Rotterdam Study

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          Abstract

          Chronic cough is a common complaint in the general population but there are no precise data on the incidence of, and prospectively examined risk factors for chronic cough in a population-based setting. Therefore, we investigated the period prevalence, incidence and risk factors for chronic cough in adult subjects.

          In a prospective population-based cohort study among subjects aged ≥45 years, data on chronic cough were collected on two separate occasions using a standardised questionnaire. Chronic cough was defined as daily coughing for at least 3 months duration during the preceding 2 years. Potential risk factors were gathered by interview, physical examination and several investigations.

          Of the 9824 participants in this study, 1073 (10.9%) subjects had chronic cough at baseline. The prevalence of chronic cough increased with age and peaked in the eighth decade. In subjects aged <70 years, chronic cough was more common in women. During an average follow-up of 6 years, 439 incident cases of chronic cough occurred with an overall incidence rate of 11.6 per 1000 person-years (95% CI 10.6–12.8). In current smokers, the incidence of chronic cough was higher in men. In the multivariable analysis, current smoking, gastro-oesophageal reflux disease (GORD), asthma and COPD were identified as risk factors for chronic cough.

          Chronic cough is common among adults and highly prevalent in the older population. Current smoking, GORD, asthma and COPD are independent risk factors for chronic cough. Individuals at risk of developing chronic cough may benefit from smoking cessation and control of the underlying disease.

          Abstract

          Smokers and individuals with gastro-oesophageal reflux disease, asthma or COPD have an independent risk of developing chronic cough http://bit.ly/31RKk7t

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          Most cited references32

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          ERS guidelines on the diagnosis and treatment of chronic cough in adults and children

          These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
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            The Rotterdam Study: 2018 update on objectives, design and main results

            The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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              The global epidemiology of chronic cough in adults: a systematic review and meta-analysis.

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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                April 2020
                19 April 2020
                : 6
                : 2
                : 00300-2019
                Affiliations
                [1 ]Dept of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
                [2 ]Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
                [3 ]Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
                [4 ]Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
                Author notes
                Guy G. Brusselle. Dept of Respiratory Medicine, Ghent University Hospital, C. Heymanslaan 10, B-9000, Gent, Blegium. E-mail: guy.brusselle@ 123456uzgent.be
                Author information
                https://orcid.org/0000-0002-4981-6823
                https://orcid.org/0000-0003-1683-7211
                https://orcid.org/0000-0002-1746-3314
                https://orcid.org/0000-0001-8162-4904
                https://orcid.org/0000-0003-3713-9762
                https://orcid.org/0000-0001-7021-8505
                Article
                00300-2019
                10.1183/23120541.00300-2019
                7167208
                32337212
                25879bf2-4cd7-4d42-a186-ad076543961c
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 1 November 2019
                : 6 February 2020
                Categories
                Original Articles
                Cough

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