Impact of chronic cough on activities of daily living and response to acute high intensity exercise

Project title

Impact of chronic cough on activities of daily living and response to acute high intensity exercise

Description

Co-Investigators

Professor Daniel Peckham - Leeds Institute of Medical Research at St James’s

Dr Ian Clifton - Leeds Teaching Hospitals NHS Trust

Professor Alyn Morice – Hull York Medical School

Professor James Hull – Royal Brompton Hospital, London

Professor Surinder Birring – Kings College Hospital NHS Foundation Trust

Dr Peter Cho - Kings College Hospital NHS Foundation Trust

Project Overview

Chronic cough is a common and debilitating condition that affects up to 10% of the global population. The health impact of chronic cough is multifaceted and manifests both physical and psychological symptoms including syncope, chest pain, lethargy, depression and anxiety. It is now also recognised that chronic cough often leads to social isolation and may impact an individual’s ability or confidence to undertake routine daily tasks and lead an active lifestyle. The latter is concerning given regular physical activity is widely accepted to promote health and well-being, in addition to lowering the risk of developing chronic disease across the lifespan.

It has previously been reported that in some individuals both the frequency and intensity of cough worsens with physical exertion. Indeed, it has been proposed that the immediate increase in ventilation required to undertake even low intensity activities can impact cough regulatory mechanisms. Although the underlying mechanisms remain unclear, cough may be upregulated via increased ventilation and distension stress that act directly on the airway and chest wall; local mediator release, changes in airway surface osmolarity; direct activation of neural pathways via chemical or mechanical stimulation and/or impact of alterations in sympathetic activity and catecholamine release with increased cardiac output and pulmonary blood flow. In contrast, other studies indicate that exercise may attenuate symptoms by down-regulating cough hypersensitivity through activation of slowly adapting pulmonary stretch receptors, C-fibres, chest wall nervous sensors and/or increase in circulating catecholamines.

Despite these observations, only limited evidence exists concerning the association between chronic cough and the ability to undertake physical activity - an intrinsically related aspect of daily living that contributes significantly to overall quality of life. In other fields of respiratory medicine (e.g., asthma and COPD), disease related impact on the capability to undertake physical activity is central to many of the most widely used quality of life assessment tools, but this has yet to be systematically evaluated in individuals with chronic cough.