title: Cough and sputum production are associated with frequent exacerbations and hospitalizations in COPD subjects.
abstract: BACKGROUND
  Epidemiologic studies indicate that chronic cough and sputum production are associated with increased mortality and disease progression in COPD subjects. Our objective was to identify features associated with chronic cough and sputum production in COPD subjects.
  
  
  METHODS
  Cross-sectional analysis of data were obtained in a multicenter (17 university hospitals in France) cohort of COPD patients. The cohort comprised 433 COPD subjects (65 +/- 11 years; FEV(1), 50 +/- 20% predicted). Subjects with (n = 321) and without (n = 112) chronic cough and sputum production were compared.
  
  
  RESULTS
  No significant difference was observed between groups for age, FEV(1), body mass index, and comorbidities. Subjects with chronic cough and sputum production had increased total mean numbers of exacerbations per patient per year (2.20 +/- 2.20 vs 0.97 +/- 1.19, respectively; p < 0.0001), moderate exacerbations (1.80 +/- 2.07 vs 0.66 +/- 0.85, respectively; p < 0.0001), and severe exacerbations requiring hospitalizations (0.43 +/- 0.95 vs 0.22 +/- 0.56, respectively; p < 0.02). The total number of exacerbations per patient per year was the only variable independently associated with chronic cough and sputum production. Frequent exacerbations (two or more per patient per year) occurred in 55% vs 22% of subjects, respectively, with and without chronic cough and sputum production (p < 0.0001). Chronic cough and sputum production and decreased FEV(1) were independently associated with an increased risk of frequent exacerbations and frequent hospitalizations.
  
  
  CONCLUSIONS
  Chronic cough and sputum production are associated with frequent COPD exacerbations, including severe exacerbations requiring hospitalizations.
authors.affiliation: Service de Pneumologie, Hôpital Cochin, Paris, Descartes University, Paris, France. Electronic address: pierre-regis.burgel@cch.aphp.fr.
authors.forename: Pierre-Régis
authors.initials: PR
authors.lastname: Burgel
authors.affiliation: Service de Pneumologie, Hôpital de la Croix-Rousse, Lyon, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Nesme-Meyer
authors.affiliation: Département des Maladies Respiratoires, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Chanez
authors.affiliation: Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied, Service de Pneumologie, Clermont-Ferrand, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Caillaud
authors.affiliation: Service de Pneumologie, Hôpital Antoine Gayrard, Carcassonne, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Carré
authors.affiliation: Service d'Explorations Fonctionnelles Respiratoire, Hôpital Calmette, Lille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Perez
authors.affiliation: Service de Pneumologie, Hôpital de l'Hôtel Dieu, Paris Descartes University, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003371:Cough / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012008:Recurrence; D013183:Sputum