Cough in Fibrotic Interstitial Lung Disease: Effects and Implications
Bibliographic record
Abstract
Cough is one of three main symptoms of fibrotic interstitial lung disease (fILD) (1) and is likely promoted by an imbalance between cough-suppressive and cough-stimulating factors (2).Coughenhancing effects of architectural distortion on vagal afferents, expressed predominantly in airways (3), may explain why, in our experience, cough tends to be prominent among patients with the most severe traction bronchiectasis/bronchiolectasis.Cough frequency and/or effects on how patients feel and function can be assessed in several ways.Visual analogue scales (VASs) are patient-reported outcome measures that ask respondents to place a tic on an unmarked, typically horizontal, 100-mm line with anchors at either end, which, in the case of cough severity, could read "No cough" (left) and "Worst cough imaginable" (right).The score is the distance in millimeters from the left end to the tic.The absence of reliably effective, nonopioid antitussives forces many patients with fILD with cough to endure this distressing symptom (4).In addition to better antitussives, our field needs an improved understanding of how cough affects patients' disease journeys and its implications for longitudinal disease behavior.In this issue of the Journal, Khor and colleagues (pp.1035-1044) used data from the Canadian Registry for Pulmonary Fibrosis (CARE-PF) to examine cough severity VAS ratings (VASc) in patients with idiopathic pulmonary fibrosis (IPF) or non-IPF fILD (5).VASc was prominently right-skewed, but about 40% in each group had a rating >30 mm.Correlations between VASc and lung physiology were weak, and although VASc was highly variable within subgroups defined by ILD-GAP (gender age physiology) index, higher ILD-GAP stage was associated with more severe cough.Multivariate analyses revealed associations between higher-enrollment VASc and lower FVC% and DL CO %, worse health status, greater impairment in healthrelated quality of life (HRQL), and gastroesophageal reflux.Higher enrollment VASc (continuous or dichotomized around a >30-mm threshold) was also associated with greater annual decline in DL CO %, disease progression (according to guidelines [6]), and shorter time to death.Longitudinal analyses revealed modeled mean VASc increases over time (IPF: 2.2 mm/yr; non-IPF: 1.1 mm/yr).Compared with nonprogressors, fILD progressors had higher enrollment VASc; however, modeled VASc slopes (change per year) did not differ between progressors and nonprogressors or between patients taking versus not taking ILD-targeted therapies.We applaud Khor and her Canadian coinvestigators for developing CARE-PF-an incredible real-world data resource-and for calling more attention to a troubling symptom for many patients with fILD.Their analyses, some including data from nearly 4,000 patients, reinforce that cough impairs health status and HRQL in some patients with fILD.Their results remind us that although cough
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.003 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.004 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".