title: Clinical features of the urge-to-cough in patients with chronic cough.
abstract: BACKGROUND
  The urge-to-cough is a consciously perceived compulsion, previously investigated in healthy volunteers inhaling irritants. We aimed to characterise the urge-to-cough and associated sensations in a group of chronic cough patients attending a specialist clinic.
  
  
  METHODS
  100 patients with chronic cough [mean age 60 yrs (±11.89), 71 female, median cough duration 7 yrs (IQR 11.13) completed an investigator-led survey describing aggravating and relieving factors for urge-to-cough, associated somatic sensations (quality, location, intensity) and emotions. Subjects rated each using a 5-point Likert scale (strongly disagree to strongly agree) or visual analogue scale (VAS). Cluster analysis identified groups of patients with similar patterns of responses.
  
  
  RESULTS
  Subjects rated the severity of urge-to-cough highly (84.5 mm on VAS). The majority always cough in response to the urge-to-cough (91%), but fewer (69%) always experienced an urge-to-cough before coughing. The somatic sensations associated with the urge-to-cough were described as an irritation (86%) or tickle (73%), localised in the neck (75%). The urge-to-cough was triggered by various stimuli including smoky atmospheres (79%), talking (72%), cold temperatures (67%) and dry atmospheres (66%) and relieved by coughing (63%), and drinking (61%); in 42% nothing provided relief. Cluster analysis suggested two distinct patient groups, differing in the factors precipitating the urge-to-cough rather than quality or location of associated sensations.
  
  
  CONCLUSIONS
  The unifying characteristics of patients with chronic cough are a severe urge-to-cough associated with throat irritation, consistent with sensory neuronal dysfunction of vagal afferents. Precipitants of the urge-to-cough vary though, and can be used to classify sub-groups of patients who may share similar underlying pathophysiology.
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester, UK; University Hospital of South Manchester NHS Foundation Trust and Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Hilton
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester, UK; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Marsden
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester, UK; University Hospital of South Manchester NHS Foundation Trust and Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thurston
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust and Manchester Academic Health Sciences Centre, Manchester, UK; Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kennedy
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester, UK; Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Decalmer
authors.affiliation: Centre for Respiratory Medicine and Allergy, The University of Manchester, Manchester, UK; University Hospital of South Manchester NHS Foundation Trust and Manchester Academic Health Sciences Centre, Manchester, UK. Electronic address: jacky.smith@manchester.ac.uk.
authors.forename: Jaclyn A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003371:Cough / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007509:Irritants; D008297:Male; D008875:Middle Aged; D010465:Perception / Q000502:physiology; D010614:Pharynx / Q000473:pathology; D011788:Quality of Life; D012018:Reflex / Q000502:physiology; D012677:Sensation / Q000502:physiology; D011984:Sensory Receptor Cells / Q000473:pathology; D011795:Surveys and Questionnaires
chemical_list: D007509:Irritants
keywords: Chronic cough; Cluster analysis; Urge-to-cough