Defining chronic cough: A systematic review of the epidemiological literature

Woo Jung Song, Yoon Seok Chang, Shoaib Faruqi, Min Koo Kang, Ju Young Kim, Min Gyu Kang, Sujeong Kim, Eun Jung Jo, Seung Eun Lee, Min Hye Kim, Jana Plevkova, Heung Woo Park, Sang Heon Cho, Alyn H. Morice

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Purpose: Recent evidence suggests a global burden of chronic cough in general populations. However, the definitions vary greatly among epidemiological studies, and none have been validated for clinical relevance. We aimed to examine previous epidemiological definitions in detail and explore the operational characteristics. Methods: A systematic review was conducted for epidemiological surveys that reported the prevalence of chronic cough in general adult populations during the years 1980 to 2013. A literature search was performed on Pubmed and Embase without language restriction. Epidemiological definitions for chronic cough were classified according to their components, such as cutoff duration. Meta-analyses were performed for the male-to-female ratio of chronic cough prevalence to explore operational characteristics of epidemiological definitions. Results: A total of 70 studies were included in the systematic review. The most common epidemiological definition was identified as 'cough ≥3 months' duration without specification of phlegm (n=50); however, it conflicted with the cutoff duration in current clinical guidelines (cough ≥8 weeks). Meta-analyses were performed for the male-to-female ratio of chronic cough among 28 studies that reported sex-specific prevalence using the most common definition. The pooled male-to-female odds ratio was 1.26 (95% confidence interval 0.92-1.73) with significant heterogeneity (I2=96%, P<0.001), which was in contrast to clinical observations of female predominance from specialist clinics. Subgroup analyses did not reverse the ratio or reduce the heterogeneity. Conclusions: This study identified major issues in defining chronic cough in future epidemiological studies. The conflict between epidemiological and clinical diagnostic criteria needs to be resolved. The unexpected difference in the gender predominance between the community and clinics warrants further studies. Clinical validation of the existing definition is required.

Original languageEnglish
Pages (from-to)146-155
Number of pages10
JournalAllergy, Asthma and Immunology Research
Issue number2
StatePublished - 2016

Bibliographical note

Publisher Copyright:
© The Korean Academy of Asthma, Allergy and Clinical Immunology.


  • Cough
  • Definition
  • Epidemiology


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