Characteristics and Management of Patients with Refractory or Unexplained Chronic Cough in Outpatient Hospital Clinics in Spain: A Retrospective Multicenter Study

Abstract

Purpose Chronic cough (cough that persists for ≥ 8 weeks) can cause a range of physical symptoms and psychosocial effects that significantly impair patients’ quality of life. Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are challenging to diagnose and manage, with substantial economic implications for healthcare systems. Methods This retrospective multicenter non-interventional study aimed to characterize the profile and health resource consumption of patients with RCC or UCC who attended outpatient clinics at Spanish hospitals. Data were collected from medical records of patients with RCC or UCC for up to 3 years before study inclusion. Results The patient cohort (n = 196) was representative of the chronic cough population (77.6% female, mean age 58.5 years). Two-thirds of patients (n = 126) had RCC. The most frequently visited doctors were pulmonologists (93.4% of patients) and primary care physicians (78.6%), with a mean of 5 visits per patient over three years’ observation. The most common diagnostic tests were chest x-ray (83.7%) and spirometry with bronchodilation (77.0%). The most commonly prescribed treatments were proton pump inhibitors (79.6%) and respiratory medications (87.8%). Antibiotics were prescribed empirically to 56 (28.6%) patients. Differences between RCC or UCC groups related mainly to approaches used to manage cough-associated conditions (gastroesophageal reflux disease, asthma) in patients with RCC. Conclusion RCC and UCC are responsible for high health resource utilization in Spanish hospitals. Specific treatments targeting the pathological processes driving chronic cough may provide opportunities to reduce the associated burden for patients and healthcare systems.

Characteristics of adults with potential refractory chronic cough identified using an algorithm designed for administrative claims databases: A descriptive study

“…The demographics of RCC cases in our studya high preponderance of females and white ethnicity, and the age (∼60 years) at RCC ascertainmentare in line with findings from smaller studies of patients with RCC from the United States 15,27 and Spain. 28 They also align with demographics of the broad spectrum of patients with chronic cough identified from referrals to specialist clinics, 17,29-31 electronic health records (EHRs), 20 administrative claims data 21,32 and internet surveys, 33 although the populations described by Zeiger et al were more ethnically diverse (less than half were white and up to a third were hispanic). 21,32 Insomnia and stress incontinence were the most common possible cough-associated complications among potential RCC cases, as also seen by Zeiger et al 21 among their chronic chough population using claims data from the Kaiser Permanente Southern California claims database.…”

Burden of refractory and unexplained chronic cough on patients’ lives: a cohort study

“…Information on disease history and cough management, as well as comorbidities and cough-related diseases ( i.e. GORD, asthma, eosinophilic bronchitis, postnasal drip syndrome or upper airway cough syndrome), was collected retrospectively from patients’ existing clinical charts [ 25 ], all diagnoses having been made based on clinical guideline recommendations and practice. Information about the impact of chronic cough on QoL and patients’ everyday life was collected through a parallel cross-sectional survey completed by patients.…”

“…To study these groups, an observational study was undertaken of RCC/UCC patients who attended outpatient pulmonology and allergy clinics in Spanish hospitals. Recently, we reported high health resource utilisation in Spanish hospitals due to RCC/UCC (burden to the healthcare system) [ 25 ]. Herein, as a companion article, we report the impact of chronic cough on patients’ QoL and everyday lives (burden to patients).…”

Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study

“…Cough has specific characteristics, such as delayed onset and unproductive cough, 11 which seriously reduce the quality of life and affect postoperative recovery 12 . Severe coughing can interrupt sleep, disrupt speech, and reduce quality of life 13 .…”

“…[8][9][10] Cough has specific characteristics, such as delayed onset and unproductive cough, 11 which seriously reduce the quality of life and affect postoperative recovery. 12 Severe coughing can interrupt sleep, disrupt speech, and reduce quality of life. 13 The adverse effects of cough include cardiovascular, genitourinary, musculoskeletal, neurological, ophthalmic, psychosocial, respiratory, and cutaneous complications.…”