Article Figures & Data
Figures
- Figure 1
Flowchart of the study and participants.
- Figure 2
Prevalence of airway obstruction and bronchodilator responsiveness in patients consulting for acute cough, by diagnostic definition and age-group.
ERS = European Respiratory Society; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; GOLD = Global Initiative for Chronic Obstructive Lung Disease; LLN = lower limit of normal.
Note: obstruction GOLD = according to the GOLD defi nition: FEV1:FVC less than 0.70. Obstruction LLN = according to ERS: LLN of FEV1:FVC ratio for male patients: −0.18 × age + 87.21 − (1.64 × 7.17); for female patients: −0.19 × age + 89.10 − (1.64 × 6.51).
Tables
- Table 1 Characteristics of Adults Consulting for Acute Cough in Primary Care (N = 1,947) by Presence of Bronchodilator Responsiveness
Characteristic Acute Cough Responsiveness Airway Obstruction Responsiveness and Obstruction (GOLD or LLN) No Responsiveness or Obstruction Missing GOLDa LLNb History (day 1), No. (%) 1,947 (100) 240 (12) 193 (10) 126 (7%) 41 (2%)c 1,546 (79) 0 (0) Age, mean (SD), y 50 (16) 47 (17) 58 (16) 50 (17) 58 (16) 50 (16) 0 (0) Male, No. (%) 770 (40) 103 (43) 82 (43) 43 (34) 18 (44) 603 (39) 0 (0) Current smoking, No. (%) 496 (26) 78 (33) 61 (32) 48 (38) 12 (29) 366 (24) 1 (0) Pack-years of smoking, mean (SD), y 8 (14) 9 (17) 13 (20) 14 (21) 18 (27) 7 (13) 28 (1) History of cardiovascular disease, No. (%) 171 (9) 17 (7) 22 (11) 8 (6) 3 (7) 135 (9) 1 (0.1) Use of inhaled lung medication, No. (%) 50 (3) 14 (6) 6 (3) 3 (2) 3 (7) 33 (2) 1 (0.1) Asthma in parents or siblings, No. (%) 423 (22) 68 (28) 37 (21) 25 (22) 8 (20) 322 (21) 187 (10) Atopy or allergic disease, No. (%)d 732 (38) 116 (48) 71 (40) 52 (46) 6 (39) 552 (36) 186 (10) Cough before consultation, mean (SD), d 9 (7) 9 (7) 9 (7) 8 (7) 10 (7) 9 (7) 32 (2) Cough episodes last year, mean (SD), No. 2 (2) 3 (2) 2 (2) 2 (2) 2 (2) 1 (2) 232 (12) Spirometry (day 28) FEV1, mean (SD), L 3.0 (0.9) 3.2 (1.1) 2.1 (0.7) 2.0 (0.8) 2.1 (0.6) 3.0 (0.9) 0 (0) FVC, mean (SD), L 3.7 (1.1) 4.0 (1.3) 3.5 (1.1) 3.6 (1.1) 3.4 (1.0) 3.7 (1.0) 0 (0) FEV1:FVC ratio, mean (SD) 0.81 (0.11) 0.79 (0.12) 0.60 (0.11) 0.57 (0.12) 0.61 (0.08) 0.83 (0.08) 0 (0) -
RS = European Respiratory Society; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; GOLD = Global Initiative for Chronic Obstructive Lung Disease; LLN = lower limit of normal.
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↵a According to the GOLD definition: FEV1:FVC less than 0.70.4
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↵b According to ERS: LLN of FEV1:FVC ratio for males: −0.18 × age + 87.21 − (1.64 × 7.17), for females: −0.19 × age + 89.10 − (1.64 × 6.51).14
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↵c These 41 participants are also included in the categories bronchodilator responsiveness and airway obstruction.
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↵d Atopic symptoms or allergic disease = hay fever, eczema, urticaria, or history of allergic reaction.
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Supplemental Table & Figure
Supplemental Table 1. Missing or Incomplete Spirometry Results per Country; Supplemental Figure 1. Prevalence of airway obstruction and bronchodilator responsiveness in patients with acute cough (n = 3,105), per country (shown with mean age and proportion of current or past smokers).
Files in this Data Supplement:
- Supplemental data: Table 1 - PDF file, 1 page, 156 KB
- Supplemental data: Figure - PDF file, 1 page, 623 KB
The Article in Brief
Lidewij Broekhuizen , and colleagues
Background Cough is one of the most common conditions for which people seek health care. This study looks at adult patients with acute cough in primary care to determine the prevalence of abnormal lung function results that could suggest the risk of chronic obstructive pulmonary disease (COPD) or asthma.
What This Study Found In a 12-country study, approximately one-fifth of adult patients without an established diagnosis of asthma or COPD consulting their family physician for acute cough showed subsequent airway obstruction or bronchodilator responsiveness, both of which are suggestive of undiagnosed asthma or COPD. Analyzing data on 3,105 adult patients consulting for acute cough in primary care practices in 12 European countries, researchers found 240 patients (12%) showed bronchodilator responsiveness and 193 patients (10%) had obstructive spirometry according to the Global Initiative for Chronic Obstructive Lung Disease grading system.
Implications
- Because both asthma and COPD benefit from appropriate and timely interventions, including pharmacological and lifestyle modifications such as quitting smoking, clinicians should be aware and responsive to potential underdiagnosis.
- The authors note that detection of asthma and COPD may help reduce unnecessary use of antibiotics in patients with acute cough.
