title: Objective measurement of cough during pulmonary exacerbations in adults with cystic fibrosis.
abstract: BACKGROUND
  Little is known about cough frequency in adults with cystic fibrosis (CF). This study aimed to determine (1) daytime and overnight cough rates in patients with CF at the beginning and end of a course of antibiotics for treatment of an exacerbation; (2) the relationship between cough frequencies and standard clinical measures of disease; and (3) the relationship between objective cough rates and the subjective assessment of cough.
  
  
  METHODS
  Nineteen adult patients admitted with a pulmonary exacerbation performed daytime and overnight sound recordings on admission; 13 had repeat recordings prior to discharge. Coughs were manually quantified in cough seconds (time spent coughing). Patients subjectively scored their cough using a visual analogue scale (VAS) and numerical score. Lung function, C-reactive protein (CRP) levels, and sputum weights were recorded.
  
  
  RESULTS
  Cough rates fell substantially with treatment; median fall in cough rate was 51.3% (IQR 32.3-77.5) (p<0.001) for daytime and 72.2% (28.6-90.1) (p = 0.049) for overnight. Multivariate regression analyses showed that forced expiratory volume in 1 second and CRP levels predicted overnight cough rates on admission. On discharge, sputum volume predicted daytime cough rates. Only the change in overnight VAS correlated with the change in objective cough rates.
  
  
  CONCLUSIONS
  The cough rate significantly decreases with treatment of a pulmonary exacerbation in adults with CF. Lung function, sputum volume, and CRP influences the cough rate, with the effects differing from day to night and between admission and discharge. Subjective reporting of a nocturnal cough may indicate a pulmonary exacerbation of CF in adults.
authors.affiliation: North West Lung Centre, South Manchester University Hospitals Trust, UK. Jacky.Smith@manchester.co.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Smith
authors.forename: E C
authors.initials: EC
authors.lastname: Owen
authors.forename: A M
authors.initials: AM
authors.lastname: Jones
authors.forename: M E
authors.initials: ME
authors.lastname: Dodd
authors.forename: A K
authors.initials: AK
authors.lastname: Webb
authors.forename: A
authors.initials: A
authors.lastname: Woodcock
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D003371:Cough / Q000209:etiology*; D003550:Cystic Fibrosis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D011379:Prognosis; D013997:Time Factors; D014797:Vital Capacity / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein