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Woman's 30-year Cough 'caused Broken Ribs, Pain And Heartache'

Mrs Naughton said the condition was "very tiring"

A woman who has had a chronic cough for 30 years said it has been like dealing with "an alien who has invaded my body".

Joan Naughton said people often reacted "unkindly" to her condition, which medical experts said affected about 10% of the UK's population.

The 73-year-old, from Stockport in Greater Manchester, said her coughing had led to broken ribs and left her often feeling so embarrassed, she wanted "the ground to open up and swallow me".

Prof Jacky Smith, who has treated Mrs Naughton, said having the condition "really impacts people's quality of life" and the public needed to show more understanding to those dealing with it.

The NHS defines a chronic cough as a "persistent cough lasting eight weeks or more", which can be triggered by "talking, laughing, certain strong smells and changes in temperature".

It said it can due to acid reflux, excess mucus in the throat, a cold or chest infection or a reaction to medication, but in some cases, there was "no obvious cause".

It added that that a chronic cough can lead to "poor sleep, headaches, disordered breathing, exhaustion, depression, stress incontinence and fear of being out in public".

'Really ruins things'

Mrs Naughton said the condition was "very tiring".

"My husband calls it the 'machine gun cough' because it's rapid and continues for longer than you would like," she said.

"You can pull your back from coughing too much and I have broken ribs in the past."

She said it caused her "a lot of heartache" in public and had become even harder to deal with in recent times.

"Since Covid, it's much worse because people assume I'm contagious and that I'm going to pass some dreadful disease on to them," she said.

"It's very, very embarrassing and causes me a lot of heartache when I'm in public."

She said on one occasion, she had suffered a coughing fit at a classical music concert which was so bad, the conductor made a point of mentioning it after the interval.

"We made our way back in for the second half and when we sat down, the conductor said 'before we start, let's all settle down and stop coughing', which I felt was directed at me.

"And then he started the second half, which I continued to cough the whole way through.

"So now, I have quite a dislike for any Debussy music, based on that experience."

Prof Jacky Smith said there needed to be greater awareness of the condition, as it affected "one in 10 people, so it's really common".

"In a lot of people, treating [the causes] will make the cough go away, but it's really a problem when those treatments don't work and it becomes a chronic cough," she said.

"In that situation, it can be there for years and it really ruins people's lives."

She said it "really impacts people's quality of life".

"It really ruins things like going to weddings, funerals, going to the cinema - anywhere where people have got to be quiet."

She said women were more likely to be affected than men and "commonly starts in people between 50 and 70 years of age" and there was "a lot more work" to be done to find out the reasons why it happened, but there were treatments were "on the horizon".

Until those were available though, she said she wanted the general public to be more tolerant.

"People need to understand that chronic coughing isn't necessarily Covid or something that's catching, and try to be a bit kinder," she said.

Related internet links

Manchester University NHS Foundation Trust: Chronic Cough

Chronic Cough May Be Hereditary

Chronic cough is among the most common reasons for seeking medical care, with middle-aged women the group most affected. New studies at Uppsala University also show that this condition appears to be a hereditary phenomenon. The studies have been published in ERJ Open Research and PLOS ONE.

"More than 10% of the population has a chronic cough, which has been shown to entail several negative consequences: reduced quality of life, reduced ability to work and voice problems. At present, we have insufficient knowledge about what causes coughing and how best to treat it," notes Össur Ingi Emilsson, Docent in Lung, Allergy and Sleep Research at the Department of Medical Sciences at Uppsala University.

Two recently published studies from the department have investigated both how cough is currently managed in Swedish healthcare, and whether chronic cough can be hereditary. One of the studies, based on data from the Swedish healthcare register, showed that one to two percent of the entire Swedish population sought care for chronic cough between 2016 and 2018, usually in primary care. Of those who sought care, the majority appear to have had a long-standing cough. The prevalence is highest among women between the ages of 40 and 60, with around 21,000 women seeking treatment for cough in these three years.

"Women generally seem to have a slightly more sensitive cough reflex, so the threshold for abnormal coughing is lower in women than in men. For me, it was unexpected that only one to two percent of patients seek help for a troublesome cough when over ten percent are affected. This can be partly explained by the lack of effective treatments. There also appeared to be some differences in care between different parts of the country, suggesting that better guidelines are needed for investigating and treating chronic cough," continues Emilsson.

Another study by the same research team has provided a clue as to why some individuals develop chronic cough. Cough appears to be a hereditary phenomenon. In a large population study in northern Europe of 7,155 parents and their 8,176 adult children aged 20 years and over, it was found that if one parent has had chronic dry cough, their offspring were over 50% more likely to have chronic dry cough. This link was independent of confounding factors such as asthma, biological sex and smoking.

"A similar relationship was seen for productive cough, but in those cases smoking had a greater impact on prevalence. These results suggest that there is a genetic link to chronic cough," adds Emilsson.

The research team has already begun a treatment study into chronic cough. Based on these new findings, the group is now moving forward with studies on genetic variants in collaboration with the Icelandic company deCODE genetics, which analyses the human genome. The aim is to identify which genetic variants are linked to chronic cough.

"This could provide a better understanding of the occurrence of chronic cough, which may ultimately result in better treatments for this difficult-to-treat condition," explains Emilsson.

Trials Show New Drug Can Ease Symptoms Of Chronic Cough

Two trials of a new drug have shown that at low doses, it can ease the often distressing symptoms of chronic cough with minimal side effects.

Principle researcher Jacky Smith, a Professor of Respiratory Medicine at The University of Manchester and a consultant at Wythenshawe Hospital, says Gefapixant has the potential to have a significant impact on the lives of thousands of suffers.

Higher doses can reduce the sense of taste, though at 50mg, the effect is much reduced, say the research team.

The drug is being developed in collaboration with the pharmaceutical company MSD, who have funded the trials.

The study published in Lancet respiratory medicine today shows that in a 12-week trial of 253 patients- the largest of its kind- 80% of patients had a clinically significant response to a dose of 50mg.

A dose of 7.5mg reduced the coughing by 52%, 20mg by 52% and 50mg by 67% from baseline. Around a quarter did not respond to the drug.

And another 16-day study describing a 57 patient trial, also published in the European Respiratory Journal this week, showed that as little as 30mg of the drug could be effective - much lower than previously thought.

Both studies were randomised and double blind, in which neither the participants nor the experimenters knew who received the treatment.

The drug is now in two larger global phase 3 trials, carried out to confirm and expand on the safety and effectiveness results from the previous research.

Chronic coughing is thought to affect between 4 and 10% of the population, some of whom cough thousands a time a day over many years.

While many patients improve with treatment of associated conditions such as asthma, gastroesophageal reflux disease and nasal disease, many do not.

The condition can cause abdominal pain, urinary incontinence in women, as well as anxiety, depression and difficulty sleeping.

Professor Smith said: "This drug has exciting prospects for patients who suffer from the often distressing condition of chronic cough.

"Effective treatments for cough are a significant unmet clinical need and no new therapies approved in over 50 years.

"Billions of pounds are spent annually on over-the-counter cough and cold medicines despite a lack of evidence to support their efficacy, concerns about the potential for abuse and risk of harm in overdose."

Gefapixant is able to target P2X3receptors in the nerves which control coughing and the team monitored the impact of the drug using a special cough monitoring device they developed which counts coughs.

The drug was initially developed as a pain killer, until the researchers discovered it had a significant impact on chronic cough.

Some unlicensed drugs have also been shown to improve chronic cough, but their use is limited by unpleasant side effects.

It is thought a chemical called adenosine triphosphate (ATP), released as a response to inflammation in airways, may be an important mechanism for patients with chronic cough.

Professor Smith added: "We can't yet say when or if this drug will be available on prescription, however, if the phase 3 trial is successful then it would certainly be a major step towards everyday use.

"Though it's fair to say the drug is not a cure for chronic cough, it can and often does reduce the frequency of coughing substantially"

"That could make a big difference to patients who often struggle with this condition which can make such a big impact on their lives."

Retired journalist Nick Peake, from Warrington, who was a television director at ITV and the BBC, has been suffering from chronic cough for 25 years.

He said: "Coughing has blighted my life : every day without fail I cough for the first two hours, soon after I wake up often every 30 seconds. It wears me out.

"It comes and goes through the day: usually after a meal, or when I have a change of atmosphere - out of warm into cold, or if I exercise too hard.

"It often stops me getting to sleep at night, but then I might wake up at 3 or 4 in the morning and start coughing.

He added: "The coughing interferes with conversations, sometimes it stop me singing which I love to do. It's embarrassing when I'm with people - I find myself apologising a lot, and I have no control over it.

"So I'm often in despair about it and it can make me miserable. How my wife has put up with it all this time I don't know.

"It's been going on for so long and I'm thoroughly fed up with it, and desperate for a cure to be found."

Jacky Smith is Professor of Respiratory Medicine at The University of Manchester and Honorary Consultant at Wythenshawe Hospital, and Director of NIHR Manchester Clinical Research Facility (CRF)

The papers are Gefapixant in two randomized dose-escalation studies in chronic cough and Gefapixant, a P2X3 receptor antagonist, for the treatment of refractory or unexplained chronic cough in a phase 2b randomised controlled trial

Nick Peake's blog Cough Up can be found at http://coughup.Blogspot.Com 

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