Department of Respiratory Medicine, University Hospital Centre of Toulouse, Toulouse, France.
Centre for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France.
Lung. 2020 Jun;198(3):441-448. doi: 10.1007/s00408-020-00359-w. Epub 2020 Apr 30.
Chronic cough management is challenging as this condition is often associated with multiple comorbidities, requiring a multidisciplinary diagnostic approach. Little is known about the characteristics of obese patients with chronic cough. This study aims to describe treatable traits of chronic cough and the response to pump proton inhibitor (PPI) therapy in this sub-group of patients.
A retrospective, observational study was performed in patients with chronic cough in a French University Hospital. Characteristics of chronic cough were analyzed for obese (N = 112) and non-obese (N = 355) patients. Refractory cough was estimated at 6 and 12 months.
The 3 main treatable traits associated with chronic cough in obese patients and non-obese patients were gastroesophageal reflux disease (GERD), asthma, and upper airway cough syndrome (UACS). A noticeable difference was the higher frequency of GERD (47.3% vs 34.6%, p = 0.0188) and obstructive sleep apnea (OSA) (9.8% vs 3.1%, p = 0.0080) in obese patients compared to non-obese patients. Pump proton inhibitor (PPI) treatment had a significantly higher success rate in obese patients (32.5% vs 17.0%, p < 0.05) and refractory cough at 12 months was less frequently reported in obese patients (22.3% vs 34.1%, p < 0.05).
In a context of chronic cough, a higher prevalence of GERD was noted in obese patients compared to non-obese patients and obese patients were more responsive to PPI treatment. Moreover, OSA was reported more frequently as a treatable trait in obese patients and should be considered early in the diagnostic evaluation. Prospective clinical studies that evaluate the contribution of obesity to chronic cough are further needed.
慢性咳嗽的管理具有挑战性，因为这种情况通常与多种合并症相关，需要多学科的诊断方法。对于肥胖的慢性咳嗽患者的特征，人们知之甚少。本研究旨在描述慢性咳嗽患者的可治疗特征以及此类患者对泵质子抑制剂（PPI）治疗的反应。
在法国一所大学医院进行了一项回顾性、观察性研究，纳入慢性咳嗽患者。分析肥胖（N=112）和非肥胖（N=355）患者慢性咳嗽的特征。在 6 个月和 12 个月时评估难治性咳嗽。
肥胖患者和非肥胖患者慢性咳嗽的 3 个主要可治疗特征是胃食管反流病（GERD）、哮喘和上气道咳嗽综合征（UACS）。值得注意的是，与非肥胖患者相比，肥胖患者 GERD（47.3% vs 34.6%，p=0.0188）和阻塞性睡眠呼吸暂停（OSA）（9.8% vs 3.1%，p=0.0080）的发生率更高。与非肥胖患者相比，肥胖患者泵质子抑制剂（PPI）治疗的成功率更高（32.5% vs 17.0%，p<0.05），12 个月时难治性咳嗽的报告频率较低（22.3% vs 34.1%，p<0.05）。
在慢性咳嗽的背景下，与非肥胖患者相比，肥胖患者的 GERD 患病率更高，并且肥胖患者对 PPI 治疗的反应更好。此外，在肥胖患者中，OSA 被更多地报道为可治疗的特征，应在诊断评估早期考虑。需要进一步开展评估肥胖对慢性咳嗽的影响的前瞻性临床研究。
