Frequent productive cough: Symptom burden and future exacerbation risk among patients with asthma and/or COPD in the NOVELTY study

Abstract

Introduction: Persistent cough with sputum production is an important clinical trait in chronic obstructive pulmonary disease (COPD). We defined "frequent productive cough" based on 2 questions from the St George's Respiratory Questionnaire (SGRQ) and sought to determine its occurrence and associated outcomes in patients with physician-assigned asthma and/or COPD from the NOVELTY study.

Methods: Frequent productive cough was defined as cough and sputum production most or several days/week for the past 3 months (scoring ≥3 for both SGRQ questions). Relationships with baseline disease characteristics and exacerbations over 12 months' follow-up were examined using logistic regression.

Results: Baseline SGRQ data were available for 7125 patients, of whom 31.3% had frequent productive cough. It was more common in asthma+COPD (38.8%) and COPD (38.1%) than asthma (25.0%), increasing with physician-assessed severity, and in current versus former and never smokers. Patient-reported symptomatic worsening was more common in patients with versus without frequent productive cough. Reduced post-bronchodilator FEV1 (odds ratio [OR] per 10% decrement 1.14 [95% confidence interval 1.11-1.16]) and history of pollutant exposure at home/work (OR 1.50 [1.33-1.69]) were associated with frequent productive cough in all diagnoses. Patients with baseline frequent productive cough were more likely to have ≥1 exacerbation over the subsequent 12 months (OR 1.71 [1.52-1.93]), including exacerbations requiring hospital admission and those treated with oral corticosteroids.

Conclusions: Frequent productive cough represents an important indicator of adverse clinical outcomes across asthma and/or COPD. Research into the underlying pathologic mechanisms is required to support targeted therapy development.

Clinicaltrials: GOV: NCT02760329.

Keywords: Chronic bronchitis; Chronic mucus hypersecretion; Frequent productive cough; Obstructive lung diseases; Patient-reported outcome measures; Sputum.

Conflict of interest statement

Declaration of competing interest R.H., E.R., C.K., E.L.T., and H.M. are employees of AstraZeneca; C.J. has received personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, and Orion; B.J.M. has received CME personal fees from American College of Chest Physicians, Eastern Pulmonary Society, Integritas Communications, Medscape, National Jewish Health, Novartis, Mt Sinai, Projects in Knowledge, WebMD, and Wolters Kluwer Health; medical advisory board fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mylan, Novartis, Phillips, Third Pole, and Verona; personal fees for data safety and monitoring board from Quintiles and Spiration; grants from American Lung Association, AstraZeneca, GlaxoSmithKline; personal fees from AstraZeneca, GlaxoSmithKline, Optimum Patient Care Global Limited, Spiration, and Third Pole; funding from the NHLBI for the COPDGene study; P-R.B. has received personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Insmed, Pfizer, Vertex Pharmaceuticals, and Zambon; grants from Boehringer Ingelheim, GlaxoSmithKline and Vertex Pharmaceuticals; H.K.R. has participated in advisory boards for AstraZeneca, Chiesi, GlaxoSmithKline, Novartis, and Sanofi-Genzyme; and has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Sanofi, and Teva Pharmaceuticals for independent medical educational presentations; and independent research funding from AstraZeneca, GlaxoSmithKline and Novartis.

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