Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis

Abstract

Background Cough is a relevant reason for encounter in primary care. For evidence-based decision making, general practitioners need setting-specific knowledge about prevalences, pre-test probabilities, and prognosis. Accordingly, we performed a systematic review of symptom-evaluating studies evaluating cough as reason for encounter in primary care. Methods We conducted a search in MEDLINE and EMBASE. Eligibility criteria and methodological quality were assessed independently by two reviewers. We extracted data on prevalence, aetiologies and prognosis, and estimated the variation across studies. If justifiable in terms of heterogeneity, we performed a meta-analysis. Results We identified 21 eligible studies on prevalence, 12 on aetiology, and four on prognosis. Prevalence/incidence estimates were 3.8–4.2%/12.5% (Western primary care) and 10.3–13.8%/6.3–6.5% in Africa, Asia and South America. In Western countries the underlying diagnoses for acute cough or cough of all durations were respiratory tract infections (73–91.9%), influenza (6–15.2%), asthma (3.2–15%), laryngitis/tracheitis (3.6–9%), pneumonia (4.0–4.2%), COPD (0.5–3.3%), heart failure (0.3%), and suspected malignancy (0.2–1.8%). Median time for recovery was 9 to 11 days. Complete recovery was reported by 40.2- 67% of patients after two weeks, and by 79% after four weeks. About 21.1–35% of patients re-consulted; 0–1.3% of acute cough patients were hospitalized, none died. Evidence is missing concerning subacute and chronic cough. Conclusion Prevalences and incidences of cough are high and show regional variation. Acute cough, mainly caused by respiratory tract infections, is usually self-limiting (supporting a “wait-and-see” strategy). We have no setting-specific evidence to support current guideline recommendations concerning subacute or chronic cough in Western primary care. Our study presents epidemiological data under non non-pandemic conditions. It will be interesting to compare these data to future research results of the post-pandemic era.

Respiratory manifestations in the Ehlers–Danlos syndromes

“…Acute cough is a common complaint, accounting for 8% of visits to primary care physicians in the general population (Holzinger, Beck, Dini, Stöter, & Heintze, 2014). A meta-analysis identified the underlying diagnosis for acute cough, or cough of all durations, to be respiratory tract infections (73-92%), influenza (6-15%), asthma (3-15%), laryngitis/tracheitis (4-9%), pneumonia (4%), COPD (0.5-3%), heart failure (0.3%), and suspected malignancy (0.2-1.8%) (Bergmann et al, 2021). Median time for recovery was 9-11 days and 79% recovered completely after 4 weeks (Bergmann et al, 2021).…”

“…A meta-analysis identified the underlying diagnosis for acute cough, or cough of all durations, to be respiratory tract infections (73-92%), influenza (6-15%), asthma (3-15%), laryngitis/tracheitis (4-9%), pneumonia (4%), COPD (0.5-3%), heart failure (0.3%), and suspected malignancy (0.2-1.8%) (Bergmann et al, 2021). Median time for recovery was 9-11 days and 79% recovered completely after 4 weeks (Bergmann et al, 2021). Cough accompanied by warning signs of dyspnea, tachypnea, thoracic pain, hemoptysis, fever, tachycardia, or hypotension, particularly in the presence of immunodeficiency, prompt a need for emergency assessment (Holzinger et al, 2014).…”

Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review

“…Acute lower respiratory tract infections (LRTI) are common in primary care. 1 2 Uncomplicated LRTI episodes generally have a favourable natural course in otherwise healthy adults, and antibiotic treatment with amoxicillin confers only little benefit in terms of earlier symptom resolution, both overall and in higher-risk subgroups of patients. 3–5 The clinical spectrum of LRTI patients, however, is heterogeneous in terms of patient and disease-specific characteristics, and thus the risk of hospitalisation and death varies substantially.…”

Investigating suspected lung cancer

“…Outcome is closely correlated to stage at diagnosis,4 but the high prevalence of common lung cancer symptoms (such as cough) presenting in primary care can make timely diagnosis difficult 5…”