21% of patients with chronic cough prescribed opioid-containing cough suppressant
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Key takeaways:
- Adults with chronic vs. non-chronic cough faced a higher adjusted likelihood for an opioid-containing cough suppressant prescription.
- Medicaid was also linked to increased odds for this type of prescription.
A prescription for an opioid-containing cough suppressant was found in more adults with chronic vs. non-chronic cough, according to results published in Therapeutic Advances in Respiratory Disease.
“In addition to attempting to identify a specific cause of chronic cough, clinicians should determine what treatment — pharmacologic or otherwise — and duration of treatment will be most effective and appropriate for each patient,” Michael Weiner, MD, MPH, research scientist at Regenstrief Institute and professor at Indiana University School of Medicine, told Healio. “New treatments may improve effectiveness or safety for long-term use.”
In a retrospective cohort study, Weiner and colleagues assessed 23,210 adults (mean age, 54 years; 66% women; 72% white; 36% with Medicare) with chronic cough, found via midwestern U.S. electronic health record data, to uncover how many patients with this condition have opioid-containing cough suppressant prescriptions vs. 229,538 adults (mean age, 48 years; 61% women; 69% white; 24% with Medicare) with non-chronic cough.
Researchers defined chronic cough as having “at least three medical encounters with cough, with 56 to 120 days between first and last encounter.”
The chronic cough cohort had a higher median number of encounters vs. the non-chronic cough cohort (85 vs. 39), but the median follow-up period was shorter in the chronic cough cohort (2.23 years vs. 7.7 years).
Among those with chronic cough, 21% had a prescription for an opioid-containing cough suppressant (56 opioid-containing cough suppressant prescriptions per 100 patients), whereas only 7% of those with non-chronic cough had this type of prescription (14 opioid-containing cough suppressants prescriptions per 100 patients).
Receipt of at least three of these prescriptions was noted in 34% of the chronic cough cohort while receipt of more than 10 of these prescriptions occurred in fewer patients (0.5%), according to researchers.
“This indicates that opioids, which play an important role in chronic cough care, are not used as long-term therapy in most cases,” Weiner said in a press release.
A frequent opioid prescribed to those with chronic cough was hydrocodone (31% of prescriptions).
Between those with chronic cough and those with non-chronic cough, the chronic cough group faced a higher likelihood for having an opioid-containing cough suppressant prescription (aOR = 1.98; 95% CI, 1.88-2.08) in a model adjusted for several factors: cohort, age, race, gender, urbanicity, insurance and year.
“This is a high odds ratio and may prompt further thinking about therapeutic strategies as well as follow-up of patients to gauge effectiveness,” Weiner told Healio.
When divided by insurance type, 38% of patients with chronic cough and Medicaid had an opioid-containing cough suppressant prescription
“This is a high fraction and might be related to burden of disease, insurance-related factors or other issues,” Weiner said.
Additionally, 18% of patients with chronic cough and Medicare and 15% of patients with chronic cough and commercial insurance had a prescription for an opioid-containing cough suppressant.
Other patient factors linked to increased odds for an opioid-containing cough suppressant prescription included non-white vs. white race (aOR = 1.38; 95% CI, 1.32-1.45), urban vs. non-urban residence (aOR = 1.23; 95% CI, 1.16-1.31), Medicaid vs. commercial insurance (aOR = 2.76; 95% CI, 2.62-2.91) and self-pay vs. commercial insurance (aOR = 1.35; 95% CI, 1.25-1.46).
When evaluating the number of opioid-containing cough suppressant prescriptions between subgroups, researchers found a higher number in the chronic cough cohort vs. the non-chronic cough cohort (1.76 times higher).
Compared with patients with commercial insurance, the number of opioid-containing cough suppressant prescriptions was greater among those with Medicaid (1.59 higher), Medicare (1.23 higher) and self-pay (1.33 higher).
“For investigators, various methods of identifying chronic cough in medical records should be considered, compared and validated,” Weiner told Healio.
“New studies should examine issues such as diagnostic procedures; specialty consultations; duration of cough and treatment; dose-response effects; treatment failures and changes to treatment; costs of care; and outcomes of both disease and treatment,” Weiner added.
Reference:
- New study examines use of opioids for chronic cough. https://www.regenstrief.org/article/opioids-for-chronic-cough/. Published Aug. 22, 2024. Accessed Aug. 22, 2024.