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Chronic cough in Vocal Cord Dysfunction: Description of a clinical entity - 27/05/20

Doi : 10.1016/j.rmed.2020.105990 
Anne E. Vertigan a, b, c, , Sarah L. Kapela a, Peter G. Gibson b, c, d
a Speech Pathology Department John Hunter Hospital, Newcastle, NSW, Australia 
b Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, Newcastle, NSW, Australia 
c School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia 
d Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia 

Corresponding author. John Hunter Hospital Locked Bag 1 Hunter Region Mail Centre NSW 2310, Australia.John Hunter Hospital Locked Bag 1 Hunter Region Mail Centre NSW 2310Australia

Abstract

Background and aim

Vocal Cord Dysfunction (VCD) and chronic cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of cough in VCD and whether patients with cough have coexisting VCD.

Method

Participants included 51 patients with VCD and a comparison group of 39 patients with chronic cough that was refractory to medical treatment. Participants underwent a comprehensive assessment including questionnaires, laryngoscopy, cough frequency monitoring and voice testing.

Results

Patients with VCD had significant cough morbidity with an increased cough frequency of 17.3 coughs/hour and reduced cough quality of life with mean Leicester Cough Questionnaire Score of 12.8. Breathing pattern abnormalities were also common in VCD and there was a strong correlation between the number of breathing pattern abnormalities and cough frequency (r = −0.827, p = 0.002). Cough measures were not significantly different between patients with VCD and those with CC. Moderate-severe PVFM was present in 69% of patients with CC. Abnormal vocal fold closure during phonation was also present in patients with chronic cough and was similar between the VCD (n = 40, 78.4%) and cough (n = 25, 64.1%) groups, p = 0.240.

Conclusion

Cough is an important symptom in VCD. Patients presenting with chronic cough may have underlying VCD as a cause of their cough. Since cough and VCD symptoms co-occur clinicians need to consider cough when are treating VCD and VCD when treating chronic cough.

Il testo completo di questo articolo è disponibile in PDF.

Highlights

Chronic cough and vocal cord dysfunction might not be discrete entities.
Vocal fold movement can be abnormal in chronic cough without respiratory symptoms.
Cough quality of life is equally severe in chronic cough and vocal cord dysfunction.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Cough, Vocal cord dysfunction, Inducible laryngeal obstruction, Cough hypersensitivity syndrome, Laryngeal dysfunction


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