Breathing pattern characteristics in refractory chronic cough patients

Chamberlain S, 1,2,3 Bellas H, 4 Clark L,2 Douiri A,5 Birring SS,2,3 Garrod R 3

¹ Keele University, School of Health and Rehabilitation, McKay Building, Keele University, UK

2 King’s College Hospital, London, United Kingdom

3 King’s College London, London, United Kingdom

4 Sutton and Merton Community Respiratory Service

5 NIHR Biomedical Research Centre, London, United Kingdom

Background• Chronic cough is defined as a cough present for > 8weeks

duration1

• High prevalence of chronic cough in Europe (11-13%) 2-7

• Main causes in people with a normal chest x-ray are1:

Asthma RhinitisGastroesophageal

reflux

Background• Chronic cough is defined as a cough present for > 8weeks

duration1

• High prevalence of chronic cough in Europe (11-13%) 2-7

• Main causes in people with a normal chest x-ray are1:

Asthma RhinitisGastroesophageal

reflux

10-42% cases 8-10

Background• Cough suppression therapy (CST) has been found to be an effective

treatment in reducing cough symptoms for refractory chronic cough10-12

Background• Cough suppression therapy (CST) has been found to be an effective

treatment in reducing cough symptoms for refractory chronic cough10-12

• CST consists of a package of treatment: 10-13

Education

Cough suppression techniques and breathing pattern retraining exercises

Vocal Hygiene and hydration techniques

Psycho-educational counselling

Background• Cough suppression therapy (CST) has been found to be an effective

treatment in reducing cough symptoms for refractory chronic cough10-12

• CST consists of a package of treatment: 10-13

Education

Cough suppression techniques and breathing pattern retraining exercises

Vocal Hygiene and hydration techniques

Psycho-educational counselling

• Despite breathing pattern retraining exercises being included in CST little is known about the breathing pattern characteristics of people with refractory chronic cough

Methods• This study was completed as part of a larger multi-centred RCT

“Efficacy of a Physiotherapy, Speech and Language Therapy Intervention (PSALTI) for patients with chronic cough: a randomised controlled trial”

Inclusion Criteria Exclusion Criteria

Cough >8 weeks, normal chest x-ray Vocal cord malignancies, and active aspiration

Minimal sputum production (<10ml a day)

Upper respiratory tract in past 4 weeks

Negative investigations and/or failed treatment trials for asthma, rhinitis and reflux

Current smokers

Known Respiratory disease: lung cancer, pneumonia, pulmonary fibrosis, sarcoidosis, pleural effusion, bronchiectasis

Methods

• Breathing pattern was assessed in sitting, over 1 minute by one trained respiratory physiotherapist.

• Normal RR was defined as 12-16 bpm14.

• Route and region of most movement during breathing was also recorded.

Results - Demographics

Demographics

N 49

Male: Female 18 : 31

Age Mean(SD) years 56 (13)

Median Cough Duration (months)

66 (107)

Breathing Pattern characteristics• 51% (n=25) had a predominant upper chest movement (UCM)

breathing pattern.

• 31% (n=15) had increased RR (>16); 16% (n=8) had decreased RR (<12)

• Significant correlation between RR and breathing pattern (rs=0.3, p=0.038)

• Significant difference in RR when participants with an increased UCM were compared to participants with abdominal movement (ABM) breathing pattern.

Median(IQR) – ABM 13(5), UCM 16(7) (p=0.04).

• 96% were nose breathers

Conclusions

• High proportion of people with chronic cough have increased upper chest movement

• A 1/3 of our participants had increased respiratory rate

• Our findings provide some evidence to support the role of breathing pattern retraining exercises for people with chronic cough

Conclusions

• Further research is needed :

• to investigate whether there is a relationship between breathing pattern characteristics and cough symptoms.

• to investigate whether breathing pattern exercises included in CST are effective in changing people’s breathing patterns

• To investigate whether changes in breathing pattern effect cough symptoms in individuals

Acknowledgement• We would like to thank the Physiotherapy Research

Foundation.

References1. Morice, A.H., et al., Recommendations for the management of cough in adults. Thorax,

2006. 61 Suppl 1: p. i1-24.

2. Lundbäck, B., et al., Obstructive lung disease in northern Sweden: respiratory symptoms assessed in a postal survey. Eur Respir J, 1991. 4(3): p. 257-66.

3. Montnémery, P., et al., Prevalence of obstructive lung diseases and respiratory symptoms in southern Sweden. Respir Med, 1998. 92(12): p. 1337-45.

4. Cullinan, P., Persistent cough and sputum: prevalence and clinical characteristics in south east England. Respir Med, 1992. 86(2): p. 143-9.

5. Lúdvíksdóttir, D., et al., Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Chest, 1996. 109(5): p. 1262-8.

6. Janson, C., et al., Determinants of cough in young adults participating in the European Community Respiratory Health Survey. Eur Respir J, 2001. 18(4): p. 647-54.

7. Ford, A.C., et al., Cough in the community: a cross sectional survey and the relationship to gastrointestinal symptoms. Thorax, 2006. 61(11): p. 975-9.

8. Haque RA, Usmani OS, Barnes PJ (2005) Chronic idiopathic cough: a discrete clinical entity? Chest 127 (5):1710-1713. doi:10.1378/chest.127.5.1710

9. Morice AH (2002) Epidemiology of cough. Pulm Pharmacol Ther 15 (3):253-259. doi:10.1006/pupt.2002.0352

References

10. Chamberlain, S., et al ., Non-Pharmacological Interventions for refractory chronic cough patients: Systematic Review. Lung, In Press

11. Chamberlain, S., et al., Cough Suppression therapy: Does it work? Pulmonary, Pharmacology and Therapeutics, 2013. 26: 524-527.

12. Vertigan AE, Theodoros DG, Gibson PG, Winkworth AL (2006) Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy. Thorax 61 (12):1065-1069. doi:10.1136/thx.2006.064337

13. Patel AS, Watkin G, Willig B, Mutalithas K, Bellas H, Garrod R, Pavord ID, Birring SS (2011) Improvement in health status following cough-suppression physiotherapy for patients with chronic cough. Chron Respir Dis 8 (4):253-258. doi:10.1177/1479972311422547

14. Pryor JA., Prasad SA (2008) Physiotherapy for Respiratory and Cardiac Problems: Adults and Paediatrics. 4th Edition. London,; Elsevier Churchill Livingstone pp591.