Chronic productive cough is associated with death in smokers with early COPD

Nirupama Putcha, M. Bradley Drummond, John E. Connett, Paul D. Scanlon, Donald P. Tashkin, Nadia N. Hansel, Robert A. Wise

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Cough and phlegm are common in COPD. Previous studies have shown conflicting evidence regarding their association with mortality and lung function. We sought to better understand how cough and phlegm impact mortality and lung function in COPD. We analyzed data from the Lung Health Study, consisting of 5,887 smokers with mild to moderate airflow obstruction followed longitudinally. We assessed the association between baseline symptoms of cough alone, phlegm alone, and cough and phlegm with 12.5-year mortality and annual lung function decline. Average age at entry was 48.5 years (± 6.8) with 63% males and 4% African Americans. Cough alone was present in 17%, phlegm alone in 12%, while 31% had both. Neither symptom alone was associated with death, but the combination was associated with increased risk of death after adjustment for age, gender, race, smoking status at year 5, pack-years smoked, randomization group, baseline FEV1 percent predicted (HR 1.27, 95% CI 1.02-1.59). Individuals with cough and phlegm together more commonly died of respiratory causes than those without. Cough with phlegm was associated with 48 mL lower baseline FEV1 (95% CI-90,-6), while neither symptom alone was associated with baseline FEV1. No symptom was associated with FEV1 longitudinally. Cough and phlegm together are associated with mortality and lung function decrement in mild-to-moderate COPD, independent of lung function and smoking status. Respiratory causes of death are common among those with cough and phlegm. Such information can help to identify subsets of individuals with COPD having higher risk for adverse outcomes.

Original languageEnglish (US)
Pages (from-to)451-458
Number of pages8
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Volume11
Issue number4
DOIs
StatePublished - Aug 2014

Bibliographical note

Funding Information:
NP is supported by the institutional training grant funded by NHLBI (T32HL007534). MBD is supported by a K23 award from NHLBI. JEC reports grants funded by NHLBI. PDS reports fees paid to the institution on his behalf for consultancy by private entities, grants to the institution on his behalf paid by NIH and private entities, and royalties paid by Lippincott Williams & Wilkins. DPT reports consultancy fees paid to him by private entities, grants to the institution on his behalf paid by NIH and private entities, and payment for lectures paid to him by private entities. NNH reports grants funded by NIH. RAW reports money paid to him for consultancy by private entities, grants paid to the institution on his behalf by private entities, and stock options paid to him by a private entity. NP takes responsibility for the content of this manuscript, including the data and analysis. She was also responsible for manuscript concept, data analysis, drafting of the manuscript and revisions. MBD was responsible for manuscript concept, data analysis, and revisions for intellectual content. NNH was responsible for study design, data analysis and revisions for intellectual content. JEC, PDS, DPT and RAW were responsible for data collection, manuscript concept, study design, data analysis and revisions for intellectual content. All authors approved the final manuscript.

Keywords

  • Lung function.
  • Subtypes
  • Survival
  • Symptoms

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