Nearly one-quarter of patients see chronic cough unresolved 18 months after PCP evaluation

SAN ANTONIO — Almost one-quarter of patients with chronic cough evaluated in the primary care setting saw their symptoms unresolved 18 months later, according to data presented here.

“With this study, we were trying to identify high-risk patients who — once being diagnosed with chronic cough — are more likely to develop unresolved symptoms on further follow-up,” Sylvia Li, MD, a resident in the department of medicine at Northwestern University Feinberg School of Medicine, told Healio.

In the retrospective review presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting, Li and colleagues utilized electronic medical records to identify 174 patients that had new-onset chronic cough diagnosed by primary care physicians between 2010 and 2019.

Of the total study pool, 23.6% still had unresolved symptoms 18 months after their third visit, which Li called a “very significant amount of time.”

The researchers called patient BMI and smoking status “similar” between the group with resolved chronic cough (mean age, 59.6 years; 65.4% women) and the group with unresolved chronic cough (mean age, 58.5 years; 58.5% women).

The researchers noted that chest X-rays were the most common diagnostic tool and were abnormal in 34.4% of patients with unresolved chronic cough compared with 26.9% of patients with resolved chronic cough.

“A fifth of patients don’t have a chest X-ray, and that’s a part of chronic cough evaluation. Having that on your mind when you’re evaluating a patient with chronic cough is important just to make sure we’re all doing our due diligence to rule out [causes],” Li said.

Several factors were associated with unresolved symptoms, including:

• six or more PCP visits (OR = 4.14; P = .009);
• a history of concomitant autoimmune disease (OR = 3.97; P = .035); and
• white race (OR = 3.04; P = .024).

The found associations “are a good starting point ... but compared with all the data we have, that’s not really an impressive number of statistically significant differences to just be able to look out for in the future,” Li said.

To Li, the study emphasizes that chronic cough is “a really difficult condition to manage” and presents a challenge in identifying those who are at high risk for unresolved symptoms.

“Moving forward, we’re hoping to expand on diagnostic patterns, therapeutics prescribed and maybe get some more information further down the line in the story of how these patients present,” Li said.

She also highlighted the importance of physicians understanding chronic cough management guidelines, as well as knowing tendencies of the condition.

“Having that kind of knowledge and with very close follow-up, it should come out that you’re able to find those higher-risk patients,” Li said.