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American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 961-964, (2002)
© 2002 American Thoracic Society

Original Articles

Sex-related Differences in Cough Reflex Sensitivity in Patients with Chronic Cough

Jack A. Kastelik, Rachel H. Thompson, Imran Aziz, Josephine C. Ojoo, Anthony E. Redington and Alyn H. Morice

Academic Department of Medicine, University of Hull, Castle Hill Hospital, Cottingham, United Kingdom

Correspondence and requests for reprints should be addressed to Professor Alyn H. Morice, Academic Department of Medicine, University of Hull, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK. E-mail: a.h.morice{at}hull.ac.uk

Among patients attending specialist cough clinics there is an excess of females, but the reason for this sex difference is unknown. We tested the hypothesis that the sensitivity of the cough reflex is greater in female compared with male patients with chronic cough. Inhalation cough challenges with capsaicin and citric acid were performed in a large group of patients with chronic cough. The concentrations of tussive agent causing two (C2) and five (C5) coughs were calculated. Measurements of capsaicin cough reflex sensitivity (median [interquartile range]) were significantly lower for female patients compared with male patients (C2: 1.9 [0.5 to 5.5] versus 5.3 [2.2 to 11.5] µM, p = 0.0026; C5: 8.6 [2.2 to 34.0] versus 51.2 [7.2 to > 100] µM, p = 0.0007). Similarly for citric acid challenge, values were significantly lower for female compared with male patients (C2: 53.5 [17.3 to 145.4] versus 118.1 [41.4 to 381.7] mM, p = 0.0064; C5: 300.0 [97.1 to > 1,000] versus 830.4 [300.0 to > 1,000] mM, p = 0.032). There were significant correlations between capsaicin and citric acid C2 values (rs = 0.54, p < 0.0001) and C5 values (rs = 0.57, p < 0.0001). These findings indicate a sex difference in cough sensitivity in patients with chronic cough, as previously reported in healthy volunteers. This may explain the female preponderance in cough clinics.

Key Words: capsaicin • citric acid • cough • sex




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