Background:

Frequent Productive Cough (FPC) is associated with increased risk of exacerbations in patients with asthma and/or COPD and may reflect complex underlying pathobiology. Exacerbations are related to an increased risk of major cardiovascular (CV) outcomes in patients with COPD [Shafuddin: ERJ Open Research 2021] but the relationship of FPC and CV outcomes is unknown. We evaluated the relationship of FPC with major CV and respiratory outcomes in patients with COPD diagnosis.

Methods:

NOVELTY (NCT02760329) was an observational multi-country study of patients with a diagnosis of asthma and/or COPD. FPC was defined at baseline using the SGRQ scores of >=3 for both cough and sputum. During 3-year follow-up, major CV outcomes (MACE) were new diagnosis of nonfatal AMI, heart failure, coronary artery disease, CV death; MACRE also included the respiratory outcome (R) of hospitalized COPD exacerbations. Kaplan-Meier curves and Cox proportional models (adjusted for age, sex, smoking status, history of exacerbations and CV disease) were applied.

Results:

2295 patients with COPD were evaluated; 898 (39%) had FPC at baseline. FPC at baseline increased the risk of MACRE by 39% (adj.HR 1.39; 95%CI: 1.11-1.74) and MACE (adj.HR 1.49 [0.96-2.30]).

Conclusions:

In patients with COPD, FPC was associated with increased risk of cardiopulmonary outcomes. The mechanisms have not been fully explored but may reflect underlying inflammation. This underlines the importance of managing the drivers of respiratory symptoms in COPD.