Burden on patients
Burden on patients
Patients with refractory chronic cough or unexplained chronic cough (RCC) have a difficult journey to diagnosis of their chronic cough. They may feel their condition is not being dealt with properly as they are referred from physician to physician in an ongoing cycle, all the while experiencing a chronic cough that impacts their quality of life.1 Recognising these patients and how a chronic cough impacts their health-related quality of life will lead the way to confirming their diagnosis.2,3
A European Lung Foundation (ELF) survey* of 1120 European adult patients with chronic cough showed:2
of patients had visited
their doctor ≥ 3 times
for cough
had been given a suggested diagnosis, of which 7% had ≥ 2 diagnoses
of patients felt their
chronic cough had been dealt with thoroughly
Who are these patients?2-4
- Adult patients present with a cough that persists >8 weeks (as defined by ERS guidelines)
- The majority of patients are female
- Patients have a mean age of 51
Common clinical characteristics of chronic cough, including RCC3
Dry or minimally productive cough lasting >8 weeks, often for months or years1
Increased sensitivity to common cough triggers (hypertussia) or sensitivity to factors that normally do not cause cough (allotussia)8,9
Uncontrollable bouts of coughing5
Cough triggered by nontussive stimuli which do not normally cause cough (e.g. cold air, perfume, voice projection, or exercise)6
Cough triggered by smaller amounts of known cough-inducing stimuli (e.g. strong smells from fumes, bleach, or aerosols, secondhand smoke)5,7
What these patients most commonly experience
Possible heightened sensitivity to otherwise innocuous stimuli, including:1
Cold air
Strong odours
Talking or laughing
Which may lead to them trying home remedies, such as sucking on hard candy or cough drops and drinking warm liquids.10
Impact of patient´s quality of life
Patients with RCC could be experiencing an impact to their health-related quality of life in the following aspects of their lives.1,2,9,11
Physical
Patients may experience dizziness, headaches, and exhaustion. Urinary incontinence, musculoskeletal pain, and sleep disturbances are also reported.1,2,3,9,11,12
Social
Patients may experience an impact on their activities, speech interruptions, and may also worry about disturbing their family and friends. Some patients may experience depressive symptoms, anxiousness, embarrassment, and frustration.1,2,3,9,12
Psychological
Patients with chronic cough may experience multiple doctor visits and difficulties in diagnosis, leaving patients feeling that their chronic cough is not đ thoroughly dealt with. These patients may also experience depressive symptoms.1,2,9,11-13
What brings patients with chronic cough into your office?
Patients with RCC may experience multiple physician visits and difficulties in their diagnosis.2,12,13
There are various reasons related to chronic cough as to why patients will come to your practice:3,11
Patients may want reassurance that they don’t have a serious condition.
Patients may also be embarrassed by their cough and feel like they and their family cannot tolerate it anymore.
Being self-conscious or upset by the response of others to their coughing may also be reasons for patients to seek medical attention.
There are physical reasons that may bring them in such as exhaustion, hoarseness, difficulty speaking on the phone.
Patients may also not be able to sleep at night. Some may experience retching or wetting their pants.
The effect of suboptimal treatment
Patients frequently feel frustrated and unsupported, facing significant physical, social, and psychological impacts.1,2,12 A study reported that most patients consider the treatment ineffective, with 72% visiting a doctor at least three times, yet only 53% receiving a diagnosis.2 Patients with chronic cough often receive suppressants like low-dose morphine or codeine, which can sedate and be addictive long-term.3
For more information on the treatment of chronic coughs, click here.
Click the following to learn more
References:
- Satia I, Badri H, Al-Sheklly B, Smith JA, Woodcock AA. Towards understanding and managing chronic cough. Clin Med (Lond ) 2016;16 (Suppl 6 ):s92-s97.
- Chamberlain SAF, et al. The impact of chronic cough: a cross-sectional European survey. Lung 2015;193:401-408.
- Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020;55(1):1901136.
- Irwin RS et al. CHEST Expert Cough Panel. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report.
- Mazzone SB, Chung KF, McGarvey L. The heterogeneity of chronic cough: a case for the endotypes of cough hypersensitivity. Lancet Respir Med 2018;6(8):636–646
- Gibson PG, Vertigan AE. Management of chronic refractory cough. BMJ. 2015 Dec 14;351:h5590.
- Vertigan AE, Gibson PG. Chronic refractory cough as a sensory neuropathy: evidence from a reinterpretation of cough triggers. J Voice. 2011 Sep;25(5):596-601.
- Kardos P, Blaiss M, Dicpinigaitis P. Addressing unmet needs for diagnosis and management of chronic cough in the primary care setting. Postgrad Med. 2021 Jun;133(5):481-488.
- Mazzone SB, McGarvey L. Mechanisms and Rationale for Targeted Therapies in Refractory and Unexplained Chronic Cough. Clin Pharmacol Ther. 2021 Mar;109(3):619-636.
- Mayo Clinic. Chronic Cough: Diagnosis and Treatment. (online) July 9, 2019 [cited 2020 May 20]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580.
- French CT, et al. Gender differences in health-related quality of life in patients complaining of chronic cough. CHEST 2004;125(2):482-488.
- Kuzniar TJ, et al. Chronic Cough From the Patient’s Perspective. Mayo Clin Proc 2007;82(1):56
- Dicpinigaitis PV, Tso R, Banauch G. Prevalence of depressive symptoms among people with chronic cough. Chest. 2006;130(6):1839-1843.
