The combined cough frequency/severity scoring: a new approach to cough evaluation in clinical settings

Cough assessment is an important component in the clinical evaluation of patients with respiratory and cardiovascular disorders (asthma, chronic obstructive lung disease, congestive heart failure, etc.). A dry bothersome cough is the most common adverse class effect of all angiotensin-converting enzyme inhibitors (ACE-I). The present study was aimed to determine the feasibility of a new combined frequency/severity cough scoring method in patients with ACE-I induced cough before and after their modification with aspirin addition. The study was designed to compare two different regimens of active treatment: intermediate (500 mg) versus low (100 mg) dose aspirin in ACE-I cough suppression (self-matched control data) and comprised 21 patients (14 men, 7 women; mean age 62 +/- 11 years) on ACE-I treatment. ACE-I treatment was discontinued and the dry cough completely disappeared, but returned in all patients within one week (rechallenge period) after ACE-I reintroducing. Severity of cough was defined as follows: 0--no cough at all; 1--occasional hems; 2--mild, isolated cough, without additional symptoms; 3--moderate, paroxysmal cough, without additional symptoms; 4--severe, strenuous cough, accompanied by chest discomfort. In addition to cough severity score, cough frequency score (0-10) was obtained using a visual analog scale: 0 = I never cough; 10 = I cough all day. Low doses of aspirin were ineffective to suppress ACE-I induced cough. In contrast, intermediate doses completely abolished cough in 14 patients and reduced coughing in all but one patient. Cough severity and cough frequency scores decreased, respectively, from 2.6 +/- 1.1 to 0.7 +/- 1.0 (p<0.001) and from 6.9 +/- 2.2 to 2.1 +/- 2.4 (p<0.0001). Overall, the cough frequency score method alone could identify a beneficial modification of cough in 17 (81%) patients and cough severity score method alone in 17 (76%). Using the combined cough frequency/severity scoring, a beneficial modification of cough could be identified in 20 (95%) of patients. The new combined cough frequency/severity scoring is suitable for clinical practice and can improve the identification of dynamic cough modifications during treatment period as compared with the conventional frequency score method. It may have important implications in the evaluation of patients with respiratory and cardiovascular disorders.