Patient experiences show clearer picture of chronic cough

A new study provides insights on diagnostic testing, management, individual characteristics and quality of life in adults with chronic cough.

“We aimed to describe patients’ experiences relating to chronic cough, which affects about 10% of adults,” Michael Weiner, MD, professor of medicine at Indiana University, said during a prerecorded presentation of an e-poster at the American Thoracic Society Virtual meeting.

The researchers’ objective was to describe patients’ chronic cough-related experiences via surveys and interviews. Weiner and colleagues analyzed electronic health records from the Indiana Network for Patient Care to identify patients with cough by diagnosis codes, outpatient medication prescriptions for benzonatate or dextromethorphan, or narrative text notes. The researchers targeted 42 adults (mean age, 57 years; 83% women; mean cough severity, 4.5) with at least three cough encounters within 56 to 120 days.

The researchers surveyed participants and conducted semi-structured interviews to assess characteristics of chronic cough, including duration, quality, frequency and triggers; patient perceptions of the nature of chronic cough; impact of life, relationships, energy levels, work and other activities; and management, including medical evaluations, treatment, adherence, satisfaction and home remedies.

Forty-two participants completed the survey. Seventy-eight percent reported postnasal drip, 70% gastroesophageal reflux disease, 56% asthma, 29% smoking and 15% COPD. More than half (57%) of participants were referred to a specialist for evaluation of cough, Weiner reported.

Chest imaging or pulmonary function was reported in at least 65% of participants, he said. Fewer patients underwent allergic assessment (33%), endoscopy (30%), sinus imaging (21%) and bronchoscopy (11%). Although diagnostic testing for chronic cough was common, the researchers observed diagnostic uncertainty, which suggests that “better approaches are still needed,” Weiner said.

Sixty-eight percent reported using nonprescription medications to treat their chronic cough.

Common problems related to chronic cough included anxiety or depression in 68%, embarrassment in 65%, fatigue in 56%, sleep difficulties in 50% and urinary incontinence in 35%.

“This emphasizes the need for greater attention in identifying and addressing mental health issues in this population,” Weiner said.

Thirty participants underwent interviews.

“Three themes emerged,” Weiner said. “The first concerned the nature or attribution of cough, where we heard it’s not predictable. The character of the cough varied such as in frequency and duration, and some participants believed that one of their existing medical conditions was causing the cough.

“The second theme concerned evaluation and treatment, where we heard [that with chronic cough] ... nobody seems to be really sure why or what to do. Some participants had seen multiple specialists for cough. In some cases, treatment had failed and participants tried their own home remedies. Although some participants were relieved to have undergone extensive evaluations, others were frustrated about not knowing the cause of the cough.

“The third theme concerned impact and reactions to cough, where we heard that after a while you just kind of give up. ... Participants described the cough’s adverse effects in public places and conversations at work and home, sometimes leading to loneliness.”

The researchers noted several limitations of this study, including more women and its conduct in the Midwestern U.S. region, so the results may not represent men or other regions.

Reference:

Weiner M, et al. Am J Respir Crit Care Med. 2020;201:A6606.