Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens

Raphael Weinberger, Marion Riffelmann, Nicole Kennerknecht, Christel Hülße, Martina Littmann, Judith O'Brien, Rüdiger von Kries, Carl Heinz Wirsing von König, Raphael Weinberger, Marion Riffelmann, Nicole Kennerknecht, Christel Hülße, Martina Littmann, Judith O'Brien, Rüdiger von Kries, Carl Heinz Wirsing von König

Abstract

Studies of the incidence of pertussis in adults have shown that it accounts for only 5-15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan-Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4-11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.

Conflict of interest statement

The authors declare that they have no conflicts of interest. For the sentinel physicians, products of pharmaceutical companies played no role; thus, all sentinel physicians declare that no conflicting interests were relevant in this study. Physicians received no remuneration in this study, doctor’s assistants received 25€ per patient for organizing the study logistics.

Figures

Fig. 1
Fig. 1
Algorithm according to Strebel et al. [6] extrapolating the number of patients in sentinels to overall estimates of population-based incidences of longer lasting coughs in German adults
Fig. 2
Fig. 2
Kaplan–Meier survival plots comparing the duration of coughing in weeks in smoking and nonsmoking German adults with longer lasting coughs
Fig. 3
Fig. 3
Kaplan–Meier survival plots comparing the duration of symptoms in weeks as related to diagnostic tests in 596 German adult patients with complete information on the duration of coughing. Agents with n < 10 (human metapneumovirus, n = 3; rhinovirus, n = 7; and parainfluenza, n = 5) are not shown in the figure

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Source: PubMed

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