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Central processes and cough in idiopathic pulmonary fibrosis

Hett, Kirsty 2023. Central processes and cough in idiopathic pulmonary fibrosis. PhD Thesis, Cardiff University.
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Background: Cough in Idiopathic Pulmonary Fibrosis (IPF) is a debilitating symptom that adversely affects quality of life. Three studies have been performed to advance our understanding of the central processes involved in cough and IPF and lay a foundation for future research. Methods: A multimodal fMRI study was conducted to determine brain structure and cerebrovascular physiology in 17 patients with IPF and 16 matched controls. A cross-sectional questionnaire study was conducted in 120 patients with IPF to determine relationships between psycho-morbidity and cough, measured in 3 different ways (cough VAS, Cough Quality of Life Questionnaire and 24-hour objective cough counts). Multiple regression was used to identify predictors of cough. A subgroup of 12 patients and 11 carers participated in a qualitative interview study to identify cough triggers and relievers, characterise how patients with IPF and their families perceive cough and evaluate its impact on their daily lives. Results: IPF patients have a trend towards reduced grey matter and have reduced cerebral perfusion in areas linked to the default mode network. From interviews, cough is interwoven with breathlessness and fatigue in a spiralling triad. This was supported by the multiple regression analysis that found breathlessness was a significant predictor of all subjective and objective cough measures. Catastrophising is a novel finding which was the only psychological factor to correlate with all three measures of cough. Conclusions: Patients with IPF can tolerate brain fMRI, and the results support further investigation of central cough mechanisms, such as cough challenge testing, in this population. Additional physiological information should be simultaneously collected to advance understanding of abnormal cerebral physiology and its impact. The neural relationship between breathlessness, cough, and catastrophising should be evaluated as there may be a shared common pathway that is amenable to treatment.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 18 January 2024
Last Modified: 18 Jan 2024 13:11

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