Cause of chronic cough unknown in 37% of primary care patients
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The cause of chronic cough remained unexplained in more than one-third of patients 3.5 years after they first presented to a primary care physician for the condition, researchers wrote.
The findings were published in an online supplement to The Journal of Allergy and Clinical Immunology on Feb. 1 and presented during the American Academy of Allergy, Asthma and Immunology recent annual meeting, held virtually.
“While prior studies have aimed to characterize chronic cough patients at specialty clinic visits, this is the first study to our knowledge that looks at patients presenting to primary care providers with new chronic cough and follows them for 3.5 years from the time of onset,” Amee K. Patel, MD, a fellow in the division of allergy/immunology at Northwestern University Feinberg School of Medicine, told Healio Primary Care.
The study included 98 patients (mean age, 61.1 years) who were newly diagnosed with chronic cough, defined as a cough lasting at least 8 weeks, according to Patel. About 45% of patients were referred to one or more specialists. Of these patients, 31.6% were referred to a pulmonologist, 13.2% were referred to an allergist/immunologist, 12.2% were referred to an otolaryngologist and 8.2% to were referred to a gastroenterologist, Patel said.
Among the 37.8% patients whose chronic cough remained unexplained after 3.5 years, 83.3% received at least one chest X-ray, 37.8% underwent at least one chest CT, 70.3% received at least one antibiotic regimen and 62.2% received at least one oral corticosteroid regimen. The mean age of patients with unexplained chronic cough (UCC) was 63.9 years, their mean BMI was 28.2 kg/m2 and 67.6% were women.
Patel said the small sample size and retrospective design of the study limits its findings; however, “it is still important data because there is very limited information in the literature on UCC patients, despite it being a large health care burden.”
“We are extending this study time frame to increase our cohort sample size and strengthen the inferences we can make from our evidence,” she said.
Data from primary care practices are “especially useful because PCPs are often the initial point of contact for patients with cough,” Patel said.
“Primary providers who understand chronic cough and its subtypes may refer patients to appropriate specialists and start on appropriate therapy without overprescribing steroid courses or antibiotics,” she said. “Furthermore, they can suspect UCC when investigation has not led to a diagnosis in order to coordinate a multidisciplinary treatment approach, which can involve speech pathology, behavioral education techniques, neuromodulatory agents or newer pharmacologic agents specific to UCC that may potentially become available in the upcoming years.”
Patel called for additional studies to ascertain “if there is an over-diagnosing or attribution of upper airway cough syndrome in patients who actually have UCC via neurological sensitivity of the larynx.”