The clinical characteristics and outcomes of different inhaled therapies in chronic obstructive pulmonary disease patients with frequent cough

Cough is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Patients with cough may exhibit various clinical characteristics and experience varying outcomes based on inhaled therapies they receive. This study aimed to explore the clinical characteristics and outcomes of various inhaled therapies in COPD patients with frequent cough. This was a multicenter, prospective cohort study. Of these patients, the median cough score in COPD assessment test (CAT) was two. Patients were classified into frequent cough group if they scored two or over in the first item of CAT and infrequent cough group otherwise. Patients with frequent cough were then divided into long-acting antimuscarinic (LAMA), long-acting beta2-agonist (LABA)/LAMA, inhaled corticosteroids (ICS)/LABA and ICS/LABA/LAMA groups. Minimum clinically important difference (MCID) (CAT scores decreased ≥2 from baseline) and the improvement of cough (cough score decreased ≥1 from baseline) were collected in the six-month follow-up. Frequent exacerbations (experiencing at least two exacerbations) were collected in the one-year follow-up. Of 906 patients, 581 (64.1%) patients reported frequent cough at the initial visit. Frequent cough was associated with the current smokers and CAT scores (p < 0.05). The MCID showed no significant difference between frequent cough and infrequent cough groups in the follow-up. More patients with frequent cough experienced future frequent exacerbations compared to those with infrequent cough. After receiving inhaled therapies, 62% of patients with frequent cough got the cough improved. More patients with frequent cough treated with LABA/LAMA or ICS/LABA/LAMA attained MCID and fewer experienced exacerbations than those treated with LAMA or ICS/LABA (p < 0.05). The change in cough score showed no difference among various inhaled therapies in patients with frequent cough. COPD patients with frequent cough were related to current smokers and higher CAT scores. These patients had a higher incidence of frequent exacerbations than those with infrequent cough. Patients with frequent cough who were treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID and at a lower risk of exacerbation than those treated with LAMA or ICS/LABA.

咳嗽是慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者的常见临床症状。咳嗽患者的临床特征存在异质性，且其转归与接受的吸入治疗方案密切相关。本研究旨在探讨频繁咳嗽COPD患者的临床特征，以及不同吸入治疗方案对该类患者的疗效转归。本研究为多中心前瞻性队列研究。研究对象的慢性阻塞性肺疾病评估测试（COPD assessment test, CAT）评分中位数为2分。依据CAT首项条目评分，将评分≥2分者划分为频繁咳嗽组，反之则划分为非频繁咳嗽组。随后将频繁咳嗽组患者进一步分为长效抗胆碱能药物（long-acting antimuscarinic, LAMA）组、长效β2受体激动剂/长效抗胆碱能药物（long-acting beta2-agonist/LAMA, LABA/LAMA）组、吸入性糖皮质激素/长效β2受体激动剂（inhaled corticosteroids/LABA, ICS/LABA）组以及吸入性糖皮质激素/长效β2受体激动剂/长效抗胆碱能药物（ICS/LABA/LAMA）组。本研究在6个月随访期间收集了最小临床重要差异（minimum clinically important difference, MCID，即CAT评分较基线下降≥2分）及咳嗽症状改善情况（咳嗽评分较基线下降≥1分）的数据，并在1年随访期间收集了频繁急性加重事件（1年内至少发生2次急性加重）的数据。本研究共纳入906例患者，其中581例（64.1%）在初诊时报告存在频繁咳嗽。频繁咳嗽与当前吸烟状态及CAT评分显著相关（p<0.05）。随访期间，频繁咳嗽组与非频繁咳嗽组的MCID达标率无显著差异。频繁咳嗽组患者未来发生频繁急性加重的比例高于非频繁咳嗽组。接受吸入治疗后，62%的频繁咳嗽患者咳嗽症状得到改善。与接受LAMA或ICS/LABA治疗的患者相比，接受LABA/LAMA或ICS/LABA/LAMA治疗的频繁咳嗽患者MCID达标率更高，且急性加重发生更少（p<0.05）。不同吸入治疗方案对频繁咳嗽患者的咳嗽评分改善幅度无显著差异。频繁咳嗽的COPD患者多为当前吸烟者，且CAT评分更高。该类患者发生频繁急性加重的风险高于非频繁咳嗽患者。与接受LAMA或ICS/LABA治疗的频繁咳嗽患者相比，接受LABA/LAMA或ICS/LABA/LAMA治疗者更易达到MCID，且急性加重风险更低。