Cough Hypersensitivity and Suppression in Chronic Obstructive Pulmonary Disease.

Cough reflex hypersensitivity (CRH) and impaired cough suppression are features of chronic refractory cough (CRC). Little is known about cough suppression and CRH in cough associated with chronic obstructive pulmonary disease (COPD). This study investigated the ability of participants with COPD to suppress cough during a cough challenge test in comparison to participants with CRC and healthy subjects. This study also investigated whether CRH is associated with chronic cough in COPD.Participants with COPD (n=27), CRC (n=11), and healthy subjects (n=13) underwent capsaicin challenge test with and without attempts to self-suppress cough in a randomised order over 2 visits, 5 days apart. For participants with COPD, the presence of self-reported chronic cough was documented, and objective 24-h cough frequency was measured.Amongst participants with COPD, those with chronic cough (n=16) demonstrated heightened cough reflex sensitivity (CRS) compared to those without chronic cough (n=11); geometric mean (sd) capsaicin dose thresholds for 5 coughs (C5) 3.36 (6.88) versus 44.50 (5.90) µmol·L-1 respectively (p=0.003). Participants with CRC also had heightened CRS compared to healthy participants; geometric mean (sd) C5 3.86 (5.13) versus 45.89 (3.95) µmol·L-1 respectively (p<0.001). Participants with COPD were able to suppress capsaicin-evoked cough, regardless of the presence or absence of chronic cough; geometric mean (sd) capsaicin dose thresholds for 5 coughs without self-suppression attempts (C5) and with (CS5) were 3.36 (6.88) versus 12.80 (8.33) µmol·L-1 (p<0.001) and 44.50 (5.90) versus 183.2 (6.37) µmol·L-1 (p=0.006) respectively. This was also the case for healthy participants (C5 versus CS5: 45.89 (3.95) versus 254.40 (3.78) µmol·L-1, p=0.033), but not those with CRC, who were unable to suppress capsaicin-evoked cough (C5 versus CS5: 3.86 (5.13) versus 3.34 (5.04) µmol·L-1, p=0.922). C5 and CS5 were associated with objective 24-h cough frequency in participants with COPD; ρ=-0.430, p=0.036 and ρ=-0.420, p=0.041 respectively.Participants with COPD-chronic cough and CRC both have heightened cough reflex sensitivity but in contrast, only participants with CRC were unable to suppress capsaicin evoked cough. This suggests differing mechanisms of cough between participants with COPD and CRC, and the need for disease specific approaches to its management.