Systematic evaluation and treatment of chronic cough in a community setting

Abstract

Chronic cough is a common symptom of patients in the United States. The vast majority of patients with chronic cough are treated by primary- and specialty-care physicians. The Cough Center in Southern California represents the first independent, community-based facility devoted entirely to diagnosing and treating cough. This article details that experience and represents the first ever attempt to evaluate quality-of-life (QOL) improvement, after treatment, in the community setting. Three hundred and ninety patients were evaluated at The Cough Center for chronic cough. Patients were investigated in a systematic fashion and empirically treated. A subjective assessment of treatment success was made using the Leicester QOL questionnaire. An objective assessment was made by documenting frequency and severity of coughing episodes. In the initial assessment of patients with cough, only 37% were identified as having had a systematic and dedicated work up. Using both subjective and objective measurements, it was determined that 73% of patients improved with an empiric course of treatment. Almost 17% demonstrated no improvement and 10% were lost to follow up. By analyzing treatment outcomes in a community setting, insight can be gained. Physicians need to become more diligent in systematic evaluation and treatment. Also, they should not be deterred from seeking resolution of cough just because it has persisted for a lengthy period of time or has several causes. Most importantly, the prevalence of patients having "unexplained cough" could very well be much greater than that reported at university-based, specialty cough clinics.

Chronic cough – assessment of treatment efficacy based on two questionnaires

“…Thus, we cannot exclude that our presumptive diagnosis of cough underlying disease was wrong, resulting in comorbidity-directed intervention rather than true causative cough treatment. On the other hand, the efficacy of chronic cough treatment has also been questioned by other authors [6, 26]. Our results are similar to those reported by Levine.…”

“…Our results are similar to those reported by Levine. This author documented a complete response to treatment in 41%, partial response in 32% and no response in 16% of patients with chronic cough [26]. Recent papers suggest that the main factor in the pathomechanism of chronic cough is hypersensitivity of the cough reflex, while GERD, UACS or asthma may only be triggers and not the real causes of cough.…”

“…One may intuitively suppose that the more complex the cough etiology is, the worse is the effect of cough treatment. However, according to results by Levine, the efficacy of chronic cough treatment did not depend on the number of cough causes [26]. …”

Classification of Cough as a Symptom in Adults and Management Algorithms

“…With respect to chronic cough, although all studies were prospective and none mentioned any harms, 11 studies met our criteria for quality assessment and all had a high risk of bias (Table 4). [18][19][20][21][22][23][24][25][26][27][28] Although 10 were prospective studies, none mentioned any harms. Although six used a validated cough outcome tool, none had a control group.…”

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult

“…Because of lack of blinding, 100% (two of two) of the randomized controlled trials 29 , 41 were rated as fair and as having at least a moderate risk of bias. Because of the retrospective nature, lack of use of standardized or previously validated outcome measures being used to assess for change in cough, 4 , 33 , 42 or unclear subject selection methods, 27 100% (four of four) of the retrospective observational studies were rated as poor or as having a high risk for bias. Th e combined dropout rate for the 23 studies was 10.2% (421 of 4,110).…”