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A Comparison of Gender Differences in Health-Related Quality of Life in Acute and Chronic Coughers^*

^* From the Departments of Medicine (Ms. French and Dr. Irwin) and Psychiatry (Dr. Fletcher), University of Massachusetts Medical School, Worcester, MA.

Correspondence to: Richard S. Irwin, MD, FCCP, University of Massachusetts Medical School, Division of Pulmonary, Allergy, and Critical Care Medicine, 55 Lake Ave North, Worcester, MA 01655; e-mail: IrwinR{at}ummhc.org

	Abstract

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Study objectives: To determine whether the health-related quality of life (HRQOL) of women and men is adversely affected by acute cough (AC), affected differently by AC, or affected differently by AC and chronic cough (CC).

Design: Analysis of consecutively and prospectively collected AC data from two time periods, and previously prospectively and consecutively collected CC data that had not been previously analyzed. When no differences were found in the two cohorts of acute coughers, as was the case in the greatest majority of comparisons, the two samples were pooled, treated as one sample of acute coughers, and compared with chronic coughers.

Settings: Primary care and cough clinics in an academic, tertiary care medical center.

Participants: Subjects prospectively seeking medical attention complaining of AC for < 3 weeks and CC for at least 8 weeks.

Measurement: All subjects completed the cough-specific quality-of-life questionnaire (CQLQ) prior to contact with a physician and medical intervention.

Results: Of 62 acute coughers, 32 were women and 30 were men (p = 0.25). Total CQLQ scores for women were 59.9, and for men they were 59.2. (There was no difference in total CQLQ scores in the two cohorts of acute coughers.) The mean (± SD) combined total CQLQ score of women and men of 59.57 ± 10.4 was higher (t₉₀ = 11.39; p < 0.0001) than the score in an historical control group of women and men who were not complaining of cough (35.06 ± 8.40). In acute coughers, there were no gender differences in the total or six subscale scores when the two cohorts were considered separately or combined. Of 172 chronic coughers, 116 were women and 56 were men (p < 0.0001). Women with CC rated themselves significantly higher than did women with AC on the total CQLQ and on five of the six subscales. Women with AC did not rate themselves higher on any of the CQLQ subscales. Total CQLQ scores for men with AC and CC were similar. Men with CC, compared with men with AC, scored significantly higher in two of six subscales (and significantly lower in one subscale) and scored similarly in three subscales.

Conclusions: AC, like CC, adversely affected the HRQOL of women and men. Unlike CC, AC did not adversely affect the HRQOL of women more than men. The HRQOL of women is more adversely affected than the HRQOL of men, the longer a cough lasts.

Key Words: acute cough • gender differences in acute cough • gender differences in acute and chronic cough • gender differences in cough and quality of life • health-related quality of life • quality of life

	Introduction

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Multiple prospective studies¹ of patients complaining of chronic cough (CC) due to a variety of diseases have shown that CC is more common in women compared to men. Additional studies have shed light on why this may be so. Tussigenic inhalation challenges with capsaicin have shown that normal women and women with CC have lower cough thresholds than normal men and men with CC.²³ With respect to health-related dysfunction associated with CC, we have previously demonstrated⁴ that the health-related quality of life (HRQOL) of women is more adversely affected than men and have concluded that women with CC are probably more likely to seek medical attention than men because they are more apt to experience physical complaints such as urinary stress incontinence, which provokes psychosocial issues such as embarrassment.

To our knowledge, the literature on gender differences in acute cough (AC) is limited to a brief mention⁵ of the demographics of AC and CC study groups during the psychometric testing of our cough-specific quality-of-life questionnaire (CQLQ). In this previously published study, while women (n = 116) significantly (p < 0.0001) outnumbered men (n = 38) in the CC group by 3:1, there were similar numbers of women (n = 16) and men (n = 14) in the AC group.

In order to learn more about gender differences in HRQOL in patients who seek medical attention complaining of AC, we sought to determine the following: (1) whether the HRQOL of women with AC is more adversely affected than that of men with AC; (2) whether there are specific differences in the ways that AC adversely affects the HRQOL of women and men; and (3) whether there are differences in how AC and CC affect women and men.

	Materials and Methods

TOP Abstract Introduction Materials and Methods Results Discussion References

 
To compare the HRQOL of women with AC to that of men with AC, pooled data, which were prospectively collected from 62 subjects who presented to primary care physicians complaining of AC, were analyzed from two time periods. AC was defined as a cough < 3 weeks in duration. Data from the first 30 subjects had been collected consecutively and prospectively during psychometric testing of the CQLQ.⁵ These data have not previously been reported. Data from the remaining 32 subjects were consecutively and prospectively collected to enhance our database. With the exception of the group ages presented below, there were no other demographic differences between the two AC cohorts.

As described in detail below in the "Results" section, tests of the equivalence of these two samples of patients with AC indicated that patients in the original sample of acute coughers were significantly older on average than those in the second sample. Because the two samples of patients with AC differed significantly in terms of age, we tested differences between the two samples prior to each of our tests between patients with ACs and CCs, for female and male patients. When differences were found between the two samples of acute coughers, we treated and reported them as separate samples in our comparisons with patients with CC. When no differences were found, as was the case in the majority of comparisons, we pooled the two samples and treated them as one sample of patients with AC and compared this pooled sample with patients with CC.

To determine whether there were differences in how AC and CC affected the HRQOL of women and men, comparison analyses were performed of CQLQ data from acute coughers that had been collected as described above and data from chronic coughers that had been prospectively collected during our previous study.⁴ These analyses have not been previously performed or reported. CC was defined as a cough of at least 8 weeks duration.

Based on psychometric testing, the CQLQ has been determined to be an internally consistent, reliable, and valid instrument with which to assess the impact of HRQOL in chronic and acute coughers.⁵ The CQLQ is a 28-item, paper-and-pencil survey that is scored on a 4-point Likert-type scale (1, strongly disagree; 2, disagree; 3, agree; and 4, strongly agree). There is an overall or total score that is the sum of the individual item scores. There are scores for six separate subscales and 28 individual item scores. The lowest possible achievable total score indicating no adverse effects of cough on HRQOL is 28; the highest possible total score indicating the most adverse effects is 112. The six subscales of the CQLQ, named according to their content, include the following: physical complaints; psychosocial issues; functional abilities; emotional well-being; extreme physical complaints; and personal safety fears.

All subjects completed the CQLQ prior to any contact with a physician associated with the study and prior to medical intervention. Subjects referred for an evaluation of CC to our Cough Clinic had been selected for inclusion on a consecutive and unselected basis. Subjects with AC who were being seen in a walk-in, primary care clinic were selected for inclusion in the study on a consecutive basis during evening hours 5 days a week. There were no exclusionary criteria.

Prior to embarking on this study, approval was obtained from our institutional review board for conducting research in human studies. Differences between groups were compared with the Student unpaired t test, the Mann-Whitney U test, ² analysis, the Fisher exact test, analysis of variance (ANOVA), and Games-Howell tests of contrasts.⁶ The 0.05 level of significance was used throughout.

	Results

TOP Abstract Introduction Materials and Methods Results Discussion References

 
Characteristics of Acute Coughers
This cohort was composed of 62 subjects. Of the 62 subjects, 32 (51.6%) were women with a mean (± SD) age of 42.2 ± 14.3 years, and 30 (48.4%) were men with a mean age of 48.6 ± 16.9 years. The original sample of acute coughers was significantly older on average (t₆₀ = 3.67; p < 0.001) than those in the second sample, with a mean age of 52.3 ± 14.5 years (median age, 49.3 years; age range, 19.3 to 83.9 years) vs 38.8 ± 14.4 years (median age, 35.1 years; age range, 18.6 to 87.8 years), respectively. Women in the original sample were older than women in the second sample, with a mean age of 48.9 ± 13.1 years (median age, 46.4 years; age range, 19.2 to 80.0 years) vs 35.5 ± 12.6 years (median age, 33.1 years; age range, 18.6 to 69.8 years; t₃₀ = –2.95; p = 0.006), respectively, and men in the original sample were older than those in the second sample, with a mean age of 56.1 ± 15.5 years (median age, 52.9 years; age range, 32.6 to 83.9 years) vs 42.1 ± 15.8 years (median age, 39.1 years; age range, 22.2 to 87.8 years; t₂₈ = – 2.45; p = 0.02), respectively. On the other hand, there was no difference in ages between the women and men within each of the two groups, neither within the two separate samples (t₂₈ = 1.37; p = 0.18 [original sample] and t₃₀ = 1.30; p = 0.20 [second sample]) nor in the combined samples (t₆₀ = 1.61; p = 0.11). The first sample was composed of 16 women (53.3% [not significantly different from 50%]; p = 0.72) and 14 men (46.7%). There were 16 men and 16 women in the second sample. Thus, the number of women in each sample did not differ from the number of men. Moreover, the number of men and women did not differ between the two samples (²₁ = 0.07; p = 0.79). Also, there was no statistical difference between the two groups on gender, and, as shown next, in the duration and presumptive causes of AC.

All acute coughers had been complaining of cough for < 3 weeks at the time they sought medical attention. Based on presumptive, pretreatment criteria,⁷ the presumptive causes of AC were upper respiratory infection (91.9%), asthma (8.1%), gastroesophageal reflux disease (3.2%), and aspiration due to pharyngeal dysfunction (1.6%). The spectrum and frequency of causes between women and men were not different. Nor was there a difference between the two samples in the number of times AC was presumptively due to multiple causes simultaneously contributing to cough, with an overall 1.6% having three causes and 3.2% having two causes. The rest of the subjects had only one diagnosis.

Characteristics of Chronic Coughers
This cohort was composed of 172 subjects, of whom 116 (67.4%) were women (mean age, 54.7 ± 13.8 years) and 56 (32.6%) were men (mean age, 51.4 ± 14.9). Women significantly outnumbered men with CC (p < 0.0001). Women had been complaining of CC at the time they sought medical attention for a mean duration of 77.4 ± 82.9 months (median duration, 54 months), and men had been complaining for a mean duration of 63.5 ± 82.6 months (median duration, 24 months). There was no statistically significant difference between women and men with respect to age (t₁₇₀ = 1.43, p = 0.15) or duration of cough (t₁₆₉ = 1.03; p = 0.30).

Based on pretreatment diagnostic criteria,⁸ the spectrum and frequency of the presumptive causes of CC included postnasal drip syndrome from a variety of rhinosinus conditions in 81.2%, gastroesophageal reflux disease in 72.3%, asthma in 31.6%, chronic bronchitis from cigarette smoking in 5.8%, angiotensin-converting enzyme inhibitor in 3.9%, bronchiectasis in 2.5%, aspiration due to pharyngeal dysfunction in 1.9%, hypersensitivity pneumonitis in 1.3%, bronchogenic carcinoma in 0.6%, endobronchial cyst in 0.6%, nonasthmatic eosinophilic bronchitis in 0.6%, or bronchiolitis in 0.6%.⁵ Women were significantly more likely to receive a diagnosis of asthma than were men (37.9% vs 16.7%, respectively; p = 0.007 [Fisher exact test]); otherwise, the spectrum and frequency of diagnoses in men and women did not differ. Women were not any more likely to be suspected of having multiple causes of CC than were men.

Comparison of CQLQ Scores for Women and Men With AC
Total mean (± SE) CQLQ scores did not differ between the two samples of acute coughers either for women (original sample, 61.4 ± 2.93; second sample, 58.4 ± 2.65; t₃₀ = –0.775; p = 0.44) or for men (original sample, 60.6 ± 2.29; second sample, 58.0 ± 2.59; t₂₈ = –0.754; p = 0.46). Total CQLQ scores for women and men were similar within the original sample (t₂₈ = –0.21; p = 0.84), within the second sample (t₃₀ = 0.10; p = 0.92), and within the combined samples (59.9 ± 1.96 vs 59.2 ± 1.74, respectively; t₆₀ = –0.26; p = 0.80). The mean combined score of women and men of 59.6 ± 1.31 was higher (t₉₁ = 11.49; p < 0.0001) than the mean score in a historical control group of women and men who were not complaining of cough (35.1 ± 1.51) that we have previously published.⁵

A comparison of the six subscale CQLQ scores showed that men and women were similar in four subscales. Men in the two samples differed on only one of the six subscales of the CQLQ (psychosocial issues), with men in the original sample having a mean score of 12.0 ± 0.68 vs 10.1 ± 0.59 among men in the second sample (t₂₈ = –2.17; p = 0.039). Women in the two samples differed on only the extreme physical complaints subscale, with women in the original sample having a mean score of 8.25 ± 0.45 vs 6.62 ± 0.49 among women in the second sample (t₃₀ = –2.44; p = 0.02).

A comparison between women and men on the four mean (± SE) subscale CQLQ scores, on which scores did not differ for women or men across the two samples, revealed that all four subscale scores for women and men were similar, as follows: physical complaints, 23.0 ± 0.71 vs 21.6 ± 0.68, respectively (t₆₀ = –1.44; p = 0.16); functional abilities, 9.6 ± 0.45 vs 10.5 ± 0.68, respectively (t₆₀ = 1.16; p = 0.25); emotional well-being, 6.0 ± 0.32 vs 6.8 ± 0.26, respectively (t₆₀ = 1.84; p = 0.070); and personal safety fears, 5.4 ± 0.34 vs 5.5 ± 0.26, respectively (t₆₀ = 0.29; p = 0.77).

While there was a difference in age between the two cohorts of acute coughers, this difference did not affect the gender differences within each group. Men and women with AC were compared on the two measures for which either men or women differed between the two samples. Within the original sample, they did not differ on their mean psychosocial issues scores (women, 12.1 ± 0.88; men, 12.0 ± 0.68; t₂₈ = –0.11; p = 0.91). Nor did they differ in the second sample (women, 10.2 ± 0.74; men, 10.1 ± 0.59; t₃₀ = –0.20; p = 0.84). Within the original sample, women reported higher extreme mean physical complaint scores (8.2 ± 0.45) than did men (6.9 ± 0.43; t₂₈ = –2.21; p = 0.04). However, women did not report significantly different scores from men for extreme physical complaints in the second sample (women, 6.6 ± 0.49; men, 6.8 ± 0.51; t₃₀ = –0.80; p = 0.79).

The 28 individual CQLQ item scores of women and men that make up the six subscales of the CQLQ are summarized in Table 1 . The men in the two samples of acute coughers differed significantly in mean (± SD) scores on only the following 2 of the 28 items: family can’t tolerate it (men in the original sample, 2.5 ± 0.52 [median, 2.5]; men in the second sample, 1.8 ± 0.83 [median, 2.0]; z statistic [Mann-Whitney U test] = –2.33; p = 0.03); and self-conscious (men in the original sample, 2.6 ± 0.85 [median, 3.0]; men in the second sample, 1.9 ± 0.62 [median, 2.0]; z statistic [Mann-Whitney U test] = –2.44; p = 0.02). The women in the two samples differed significantly only on the item asking about wetting of the pants (women in the original sample, 2.63 ± 1.15 [median, 2.5]; women in the second sample, 1.8 ± 1.18 [median, 1.0]; z statistic [Mann-Whitney U test] = –2.22; p = 0.04. Gender differences were explored within each sample for these three items. Within the original sample, there was a significant gender difference in this older cohort only for the wetting of the pants item (women, 2.6 ± 1.15 [median, 2.5]; men, 1.3 ± 0.47 [median, 1.0]; z statistic [Mann-Whitney U test]= –3.31; p = 0.001). There were no significant gender differences on any of the 28 items in the second sample of acute coughers.

Comparison of CQLQ Scores for Women With Chronic and AC
Based on total CQLQ scores (Fig 1 ), women with CC had significantly higher mean (± SE) scores than women with AC (67.1 ± 1.32 vs 59.9 ± 1.96, respectively; t₁₄₆ = 2.66; p = 0.009).

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 1. Comparison by gender of total CQLQ scores for AC and CC. Women with CC had significantly higher total CQLQ scores than women with AC. In contrast, men with CC had similar total CQLQ scores to men with AC. The data are plotted as the mean ± SE.

Because women in the two AC samples differed significantly on their reports of extreme physical complaints, the two groups of women with AC were compared to the women with CC on these complaints using a one-way ANOVA, followed by Games-Howell tests of contrasts. The overall results of the ANOVA were significant (F_2,145 = 5.49; p = 0.005), and the results of Games-Howell tests of contrasts indicated that women with CCs differed significantly only from the newly added sample of younger women with ACs (8.97 ± 0.26 vs 6.62 ± 0.49, respectively; p = 0.001). CC and AC scores in the remaining subscale, physical complaints (21.6 ± 0.51 vs 22.9 ± 0.70, respectively; t_68.12 = –1.46; p = 0.15), were similar. No subscale score was significantly higher in women with AC.

Of the 28 items that make up the six subscales, women with CC scored significantly higher in 11 items than women with AC. These included family can’t tolerate it (p < 0.001), sick to stomach (p = 0.028), retching (p = 0.042), concern of cancer (p = 0.011), had to change lifestyle (p = 0.001), embarrassed (p < 0.001), upset by response of others (p < 0.001), want to be reassured I do not have anything seriously the matter with me (p < 0.001), self-conscious (p = 0.001), and concerned that I have something seriously the matter with me (p = 0.013). Women with AC scored significantly higher in only one item (lost appetite; p = 0.001) compared with women with CC. Women with CC did not differ significantly from either of the two samples of women with AC on their ratings of wetting pants when tested separately, but when the data for the two AC sample groups were combined, their scores were significantly lower than those of the women with CC (p < 0.039).

Comparison of CQLQ Scores for Men With Chronic and AC
Based on total CQLQ scores (Fig 1), men with CC had similar mean scores to men with AC (59.8 ± 1.86 vs 59.2 ± 1.80, respectively; t₈₃ = 0.20; p = 0.82). This is in contrast to the findings in women (Fig 1).

Based on subscale scores, men with CC scored significantly higher than men with AC in two of the six subscales. These included psychosocial issues (12.9 ± 0.46 vs 10.9 ± 0.48, respectively; t₈₃ = 3.102; p = 0.003) and emotional well-being (7.96 ± 0.26 vs 6.8 ± 0.27, respectively; t₈₃ = 2.824; p = 0.006). Scores for men with CC and AC were similar in functional abilities (10.4 ± 0.52 vs 10.6 ± 0.71, respectively; t₈₃ = –0.160; p = 0.87), personal safety fears (6.1 ± 0.26 vs 5.6 ± 0.27, respectively; t₈₃ = 1.239; p = 0.22), and extreme physical complaints (6.6 ± 0.26 vs 6.8 ± 0.34, respectively; t₈₃ = –0.422; p = 0.67). On the other hand, men with AC scored significantly higher than men with CC in physical complaints (21.6 ± 0.69 vs 19.1 ± 0.74, respectively; t_77.6 = –2.54; p = 0.013). Because men in the two AC samples differed significantly on their reports of psychosocial issues, as reported above, the two groups of men with AC were compared with the men with CC on these complaints using a one-way ANOVA, followed by Games-Howell tests of contrasts. The overall results of the ANOVA were significant (F_2,82 = 5.18; p < 0.01), and the results of the Games-Howell tests of contrasts indicated that men with CC differed significantly (p 0.05) in the psychosocial subscale scores from the newly added younger sample of men with AC (12.9 ± 0.46 vs 10.1 ± 0.59, respectively).

Of the 28 items that make up the six subscales, men with CC scored significantly higher in 3 items than men with AC. These were embarrassed (p = 0.005), want to be reassured that I do not have anything seriously the matter with me (p = 0.008), and concerned that I have something seriously the matter with me (p = 0.01). Men with CC also scored higher than the second sample of men with AC on family can’t tolerate it (p < 0.001) and self-conscious (p < 0.001), but men with CC did not differ from the men with AC in the original sample on either item. Men with AC scored significantly higher in four items. These included lost appetite (p = 0.01), hoarseness (p = 0.03), hurts to breathe (p = 0.02), and ache all over (p < 0.001).

	Discussion

TOP Abstract Introduction Materials and Methods Results Discussion References

 
The 28-item CQLQ was designed to evaluate for the major meaningful psychosocial and physical complaints of cough. Based on extensive psychometric testing that has been previously performed and reported, the CQLQ has been shown to have dimensionality that is consistent with a cough-specific quality-of-life instrument, and to be a valid and reliable method by which to assess the impact of cough on the HRQOL of patients with both AC and CC from a variety of causes.⁵

Utilizing the CQLQ, we first compared the results in women with AC to those in men with AC, and then compared the results in acute coughers with those previously obtained in chronic coughers. This study design had the potential to allow us to more fully assess whether there were gender differences in the HRQOL in patients complaining of AC and why. While a portion of the gender data in chronic coughers has been previously published,⁴ the analyses that appear in this study have not been previously performed or reported. While the analyses of data in this study were performed in a post hoc fashion, all of the data had been collected prospectively. The analyses involved the following steps: (1) comparing women with AC to men with AC when the two cohorts of acute coughers were considered separately and when they were combined; and (2) comparing women with AC to women with CC and men with AC to men with CC when the two cohorts of acute coughers were considered separately and combined. Because there were very few differences between the two cohorts of acute coughers (ie, age, one of six subscale scores for men, one of six subscale scores for women, 2 of 28 individual item scores for men, and 1 of 28 individual item scores for women) and no gender differences between the two cohorts, the greatest majority of data for acute coughers could be pooled and treated as one sample of patients with AC for comparison with patients with CC. From this study, three important findings regarding gender differences emerged that, to our knowledge, have not been previously reported.

First, our results have demonstrated that AC, like CC, adversely affects the HRQOL of women and men. The mean total CQLQ scores for women and men with AC were 59.9 and 59.2. The combined mean score of women and men (59.57 ± 10.4) was higher (t₉₀ = 11.39; p < 0.0001) than the score found in a historical control group of women and men who had not complained of cough (35.06 ± 8.40). We think that this finding in acute coughers helps to explain why cough continues to be the single most common complaint for which patients seek medical care from primary care physicians⁹ in the United States and why the expenditure for over-the-counter cough suppressants has been estimated to exceed $1 billion annually.¹⁰

Second, AC, unlike CC, did not adversely affect the overall HRQOL of women more than men. This finding is based on a comparison of the results of the total CQLQ scores in which women and men scored similarly. There were no gender differences in how AC adversely impacted HRQOL because there were no differences between women and men in any of the six subscale scores or in 24 of the 28 individual item scores. While women complained significantly more than men in two items (wetting the pants and exhaustion), they complained significantly less in two other items (concern of cancer and having to make lifestyle changes). The gender differences in these four items failed to significantly affect the overall total HRQOL scores because they balanced each other out.

Third, the HRQOL of women is more adversely affected than the HRQOL of men the longer a cough lasts. This finding is based on a comparison of total and subscale CQLQ scores for women with AC and CC, and for men with AC and CC. While total scores and four of six subscale scores for women with CC were significantly higher than for women with AC, no subscale score was significantly higher in women with AC when the two cohorts of acute coughers were considered separately or combined. In contrast, total CQLQ scores for men with AC and CC were similar when the two cohorts of acute coughers were considered separately or combined. We think that this finding helps to explain why women with CC seek medical attention for their cough at a significantly greater rate than men with CC.⁴ With respect to subscale scores, men with CC compared with those with AC scored significantly higher in two of six subscales (eg, psychosocial issues and emotional well-being), significantly lower in one subscale (eg, physical complaints), and similarly in three subscales (eg, functional abilities, personal safety fears, and extreme physical complaints). As determined by a one-way ANOVA, followed by Games-Howell tests of contrasts, the significance in psychosocial subscale scores between chronic coughers and the combined groups of acute coughers was attributed to the lower scores in the younger cohort of acute coughers compared to the older cohort (12.9 ± 0.46 vs 10.1 ± 0.59, respectively; p < 0.01).

Why is the HRQOL of women more adversely than that of men the longer a cough lasts? We speculate that it is related to adverse occurrences such as wetting pants that we have shown are significantly more frequent in women whether they have an AC or CC. After integrating our constellation of findings in this study, particularly the results of the individual item scores, with selected studies from the literature⁴ and clinical reasoning, we suggest that while wetting the pants for a short period of time may be tolerable, it is likely to become intolerable when it continues for months and years, especially in older women. By comparing the differences in the 28 individual item scores in the women in the two cohorts of acute coughers, we determined that the two cohorts were significantly different in only 1 item (wetting the pants), and the older cohort of women complained more than the younger cohort (p = 0.04). With respect to wetting the pants, our findings and reasoning confirm what has been known about urinary incontinence in the general population for years.^11121314 That is, stress (ie, AC and CC) urinary incontinence is more common in women (especially older women) than in men.

Potential Limitations of This Study
While there were very few differences between the two cohorts of acute coughers, we do not believe that these differences affected the three major findings of this study and our conclusions for the following reasons. First, although there were differences in ages in men and women in the two cohorts, in one of six subscale scores for men, in one of six subscale scores for women, in 2 of 28 individual item scores for men, and 1 of 28 individual item scores for women, there were no gender differences in the CQLQ between the two cohorts. Second, the data from the two cohorts were only combined for analysis when they were determined to be similar. Third, the major findings and conclusions were based solely on data that were shown to be similar between the two cohorts. On the other hand, because the two cohorts had different ages, we may have learned something very important in designing future studies. Because there was a difference in age between the two AC cohorts, and this difference may have explained some or all of the few differences that were observed in the CQLQ, age will need to be taken into account in planning future studies that assess the impact of cough on HRQOL.

While women with CC were more likely than men with CC to have asthma as a presumptive contributing condition, the spectra and frequencies of causes of AC and CC were similar between men and women. Because asthma was diagnosed singly or in combination with other conditions in a minority of women and men with CC, we do not think that the underlying causes of cough can explain the gender differences in HRQOL. Nevertheless, because we did not characterize the psychological attributes of our subjects, it is not possible to know whether or not underlying psychological (or other comorbid) conditions contributed to our gender results. This issue deserves further study.

Last, because we did not measure cough reflex sensitivity in our study, it is not possible to know whether or not a higher cough reflex sensitivity contributed to our gender differences in HRQOL. This concept also deserves further study.

	Footnotes

 
Abbreviations: AC = acute cough; ANOVA = analysis of variance; CC = chronic cough; CQLQ = cough-specific quality-of-life questionnaire; HRQOL = health-related quality of life

Presented and published in part in abstract form at the annual meeting of the American Thoracic Society, May 21, 2002, Atlanta, GA.

Received for publication April 30, 2004. Accepted for publication March 31, 2005.

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TOP Abstract Introduction Materials and Methods Results Discussion References

 

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