Productive Cough, a Forgotten Phenotype of Refractory Chronic Cough

<b>Background:</b> Despite sputum production being a common and troublesome symptom in refractory chronic cough (RCC) patients, it has rarely been described in the literature and may be particularly challenging to manage. <b>Aims:</b> We aimed to describe reported sputum expectoration in a cohort of patients presenting with chronic cough to future guide their ongoing investigation and management. <b>Methods:</b> Over a 12-month period (January-December 2019), we performed a retrospective case note analysis of new referrals to a specialist clinic identified as having a productive cough (defined as &gt;1 teaspoon of phlegm daily) at first clinic visit. <b>Results:</b> Patients with productive cough represented over a fifth (89/401, 21.7%) of new referrals [(69.7% female, mean age 61 years (IQR 51-70)]. 75.3% of patients had no evidence of co-existing lung disease on CT imaging or lung function testing. 35.7% of this cohort (n=32) reported expectorating an egg cupful or more of sputum/day in the absence of bronchiectasis in 73.4% of cases. Urge-to-cough, a sensation provoking coughing, originated in the throat in 76.8% of cases. Bronchoscopy was performed in 21 cases, yielding clinically significant results in 66% (n=14) of cases. Treatment approaches included opioids, speech and language therapy and azithromycin. All bar one improved in post treatment severity scores. <b>Conclusions:</b> Patients with RCC can cough up significant volumes of sputum in the absence of underlying lung disease. This group have similar demographics to those with dry RCC. This is the first piece of work to our knowledge to describe this cohort. Future work needs to acknowledge this forgotten phenotype to inform ongoing management decisions.