EC Pulmonology and Respiratory Medicine 10.5 (2021)

Long-Lasting Cough (L-LC): Prevalence and Impact in the Pre-COVID Era in Italy. A Multicentric Survey

Dal Negro Roberto W 1*, Turco Paola 2 and Zanasi Alessandro 3

1. Lung Unit of the National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy
2. Research and Clinica Government - R&CG, Verona, Italy
3. Lung Unit of the Italian Association for Studying Cough, AIST, Bologna, Italy

*Corresponding Author: Dal Negro Roberto W, Lung Unit of the National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy.

Citation: Dal Negro Roberto W., et al. “Long-Lasting Cough (L-LC): Prevalence and Impact in the Pre-COVID Era in Italy. A Multicentric Survey”. EC Pulmonology and Respiratory Medicine 10.5 (2021).

Received: March 30, 2021

Abstract

Introduction: Classification of cough is usually based on its duration even if it is frequently biased by patients’ poor accuracy. The comprehensive term of “long-lasting cough” (L-LC) was for the first time introduced in the aim of minimizing the critical role of this bias.

Aim: Aim was to measure the prevalence and the impact of L-LC among Italian adults from the general population, together to their beliefs.

Methods: A self-managed anonymous questionnaire was randomly distributed to a pre-calculate sample from general population. The questionnaire consisted in five blocks of questions on different domains: 1) basic beliefs; 2) general impact; 3) approach to cough; 4) therapeutic expectations and 5) willingness to pay out-of-pocket. Data were reported as frequencies. Statistical comparisons were calculated by means of Chi Square test and p < 0.05 was assumed as the minimum level of statistical significance.

Results: Regardless the job, the prevalence of L-LC was 38.9%, and was significantly higher in northern and central regions (both p< 0.001). L-LC was generally perceived as a disease per sé in 38.2%. L-LC was reported to affect Quality-of-life by 72.2% of respondents, but highly affecting by 27.3% of them. Lung physician was the most preferred (56.2%) first-line specialist to consult in these cases. COPD and lung cancer were slightly, but significantly more feared by active and former smokers of both genders (p < 0.02 and p < 0.01, respectively). A large proportion of respondents disagree the therapeutic first-line approach with antibiotics (54.8%) and steroids (42.1%) for curing their L-LC, because blindly decided in the majority of cases. Anti-tussive remedies are appreciated by 47.0% of respondents. The willingness to pay even more that 20 € out-of-pocket for receiving any effective reliever against their L-LC was reported by 27.7% of respondents.

Conclusion: The prevalence of L-LC is higher than presumed within the Italian general population. At present, L-LC is largely regarded as “a disease” and no longer as a spy symptom common to different diseases. This belief is curiously in agreement with the most recent scientific evidence on the Cough Hypersensitivity Syndrome. A great proportion of Italians have a proper and restrictive belief versus first-line blind prescriptions for treating L-LC. Anti-tussive agents are highly valued, even if people’s willingness to pay out-of-pocket for any reliever remedy is increasingly high. Beliefs on L-LC rapidly changed in the last decade and innovative therapeutic options are anxiously waited in the near future.

Keywords: Long-Lasting Cough; Persistent Cough; Chronic Cough; Cough Impact; General Population

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J Thorac Dis. 2020 Aug; 12(8): 4459–4468.

Authors: Nikolai Khaltaev, Umberto Solimene, Federico Vitale, and Alessandro Zanasi

WWJMRD 2021; 7(3): 00-00

Alterations in the Hydration Status Affect Coughing in Otherwise Normal School Children

Zanasi A., Mazzolini M., Fontana G.A, Bernacchi G., Fabbrizzi A. and Dal Negro R.W.

Abstract

Purpose – Compared with adults, children have a lower thirst sensitivity often leading to insufficient water intake. A negative water balance, termed dehydration, may result in neurological, cardiovascular and metabolic disturbances. An adequate water intake is important also in maintaining homeostasis of the airway epithelium and favouring mucociliary clearance. Little is known, however, on the possible association between dehydration and respiratory symptoms, including coughing. Aim - To investigate the relationship between dehydration and the prevalence, frequency and duration of cough episodes in children from a free-living general population. Methods – A questionnaire consisting of 32 questions designed to investigate the relationships between respiratory symptom, cough episodes, and daily water intake was distributed to the families of 400 students of primary and secondary school (6-16 years). From all participants, a urine sample was collected for osmolality measurements. Statistics. The Pearson Chi Square and the Fisher Exact Test were used for statistical comparisons; p<0.05 was taken as significant. Results – Valid data were obtained from 305/400 healthy students (mean±SD age 10.1±2.4; mean±SD osmolality 863.0± 223.0 mOsm/kg). The prevalence of cough was related to the level of osmolality (p<0.001). More specifically, in subjects with normal urine osmolality, the prevalence of cough was 54.2%; in mild dehydration it increased to 86.1%, and in severe dehydration cough prevalence rose to 93,9% (p<0.001). Conclusions – The results suggest a correlation between dehydration and the prevalence of cough in healthy children. In consequence, an adequate daily water intake may help to reduce the number of cough episodes in children.

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European Medical Journal, 2019 mar. 14.

Authors: Roberto Walter Dal Negro, Massimiliano Povero, Alessandro Zanasi, Paola Turco.

Abstract
Persistent cough is one of the most common conditions affecting quality of life. The aim of this study was to assess people’s beliefs regarding the impact of, and changes in the prevalence of, persistent cough in the Italian general population over a 10-year time period.

Methods: Two telephone surveys were conducted in 2006 and 2015, and the answers were compared. In 2015, the same questionnaire was also randomly distributed in paper form to another cohort. Sample sizes were precalculated for their representativeness and comparability (Chi-square test).

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