title: Frequent cough in unsatisfactory controlled asthma--results from the population-based West Sweden Asthma study.
abstract: BACKGROUND
  Asthma is a complex disease presenting with variable symptoms which are sometimes hard to control. The purpose of the study was to describe the prevalence of asthma symptoms, use of asthma medications and allergic sensitization in subjects with asthma. We also related those indices to the level of asthma control, lung function and in particular, cough.
  
  
  METHODS
  An extensive questionnaire was sent to randomly selected adults from the West Sweden region. Clinical examinations and interview were performed in a subset. Of the participants, 744 were defined as having an ongoing asthma - reported ever having asthma or physician diagnosed asthma and one of the following - use of asthma medications, recurrent wheeze or attacks of shortness of breath with or without wheeze in the last 12 months. A respiratory disease-free control group of 847 subjects was also described.
  
  
  RESULTS
  According to GINA guidelines, 40.6% of the asthmatics had partly controlled and 17.8% had uncontrolled asthma. Asthmatic subjects reported significantly more symptoms in the last 12 months than the control group - wheezing (79.4 vs 9.2%), shortness of breath (36.1 vs 2.5%), wheezing with shortness of breath (58.7 vs 1.3%). Important complaints were morning cough (42.5 vs 15.5%), cough with sputum production (36.1 vs 6.8%) and longstanding cough (32.5 vs 11.1%), which bothered two thirds of the uncontrolled and one third of partly controlled subjects. Asthma medications were used by 87.5% of the asthmatics, although around 30% of them who had insufficiently controlled disease used only short-acting beta-agonists. Asthmatics also had lower lung function, reacted to lower doses of methacholine that the controls and 13.6% of them had a FEV1/FVC ratio below 0.7. Allergic rhinitis was reported by 73.8% of the asthmatics and they were more frequently sensitized to several common allergens.
  
  
  CONCLUSIONS
  Approximately 60% of asthmatics from this population-based study had insufficiently controlled asthma and persistent complaints, despite a high use of asthma medications. These self-reported symptoms were supported by clinical examination data. Increased cough frequency is an indicator of a more severe and difficult to control disease and should be considered when asthma is characterized.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mincheva
authors.forename: Linda
authors.initials: L
authors.lastname: Ekerljung
authors.forename: Anders
authors.initials: A
authors.lastname: Bjerg
authors.forename: Malin
authors.initials: M
authors.lastname: Axelsson
authors.forename: Todor A
authors.initials: TA
authors.lastname: Popov
authors.forename: Bo
authors.initials: B
authors.lastname: Lundbäck
authors.affiliation: Krefting Research Centre, University of Gothenburg, SE 40530 Göteborg, Sweden. jan.lotvall@gu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Lötvall
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D003371:Cough / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011159:Population Surveillance / Q000379:methods; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology