Posters Examine Impact of Chronic Cough on Quality of Life, Diagnosis Delays

Allison Inserro

Patients with refractory or unexplained chronic cough are concerned about how they appear to others, and it takes them many years to get diagnosed, according to posters presented at the American Thoracic Society 2021 International Conference.

Feelings of being fed up, embarrassed, and worried about how they present to family and friends are some concerns about chronic cough that participants in 2 studies cited to researchers, according to a poster presentation about refractory or unexplained chronic cough at the American Thoracic Society 2021 International Conference.1

The poster was one of several about refractory chronic cough (RCC) or unexplained chronic cough (UCC), which may go undiagnosed for years, according to another presentation. 2

The presentation about the impact on patients focused on the baseline cough severity and quality of life based on answers to questionnaires given to individuals enrolled in 2 phase 3 randomized clinical trials for cough, which were pooled for the purpose of the questionnaires.

These instruments—the Leicester Cough Questionnaire (LCQ) and the Cough Severity Diary (CSD)—have been used previously, but in smaller studies. For this investigation, 1049 and 2038 participants completed the LCQ and the CSD, respectively. The LCQ measures cough-related quality of life on a 7-point Likert scale, encompassing physical, social, and psychological areas. The CSD measures 7 items on an 11-point numeric scale, looking at disruption, frequency, and intensity.

Most of the patients were female, with a mean age of 60; their cough had lasted for 8 years (range, 1-75 years).

On the LCQ, participants rated their psychological and social areas of life as being the most impaired, followed by physical aspects. Mean LCQ domain scores were 3.8 to 3.9 for the physical domain, 3.2 to 3.3 for the psychological domain, and 3.2 to 3.3 for the social domain. Baseline mean LCQ total scores ranged from 10.2 to 10.4.

Mean weekly CSD domain scores were 6.4 for frequency of cough, 6.1 to 6.2 for intensity of cough, and 5.2 to 5.3 for disruption disruption Baseline mean weekly CSD total scores ranged from 6.0 to 6.1.

Another study examined the burden and cost of care on patients in a specialist clinic in the United Kingdom.2 These patients “present to primary care and undergo a series of trials of treatment and diagnostics before being referred, often years later, to a specialized cough clinic,” the authors wrote.

Quantifying the burden of RCC/UCC in terms of health care resource utilization is limited, they added. In this study, adults who were patients of the Manchester University NHS Foundation Trust and with RCC/UCC diagnosed between September 2017 and June 2019 who completed a standardized cough assessment were invited to participate.

The researchers obtained data from the clinic, as well as from the patients’ primary care doctors, going back 5 years before they were referred to the clinic.

Data included duration and severity of cough as measured by the 100-point visual analog scale (VAS), the LCQ, the Charlson Comorbidity Index (CCI), and standard prescription drug costs as measured by the British National Formulary.

Two hundred patients consented; the majority were female, and the median (interquartile range [IQR]) age at diagnosis was 64 (IQR, 55-71) years. Most (68%) had never smoked.

The analysis showed:

  • Median chronic cough duration was 5 (IQR, 2-10) years, and the median severity score according to VAS was 68.5 (IQR, 51-79) mm at the first clinic visit
  • The LCQ was completed by 64% of patients, with a median score of 10.5 (IQR, 7.9-14.0).
  • Only 79 patients had primary care doctors agree to historical data extraction; the researchers received data from 73. This group contained slightly more never-smokers (73%) and 41% of the patients had 2 or more comorbidities as measured by the CCI.

Among patients with data on cough duration (n = 65/73), just 2 were seen within the first year of their cough.

In the 5 years prior to RCC/UCC diagnosis, proton pump inhibitors (PPIs) were the most prescribed, at 905 prescriptions for 34 patients (mean 26.6 prescriptions per patient), for a mean cost of US $143.79 (£117.78) per patient.

PPIs were followed by inhaled corticosteroids: 382 prescriptions for 24 patients (15.9 prescriptions per patient) and a mean cost of US $532.84 (£436.45) per patient. That figure did not include oral and nasal corticosteroids, although they were frequently prescribed as well.

Third on the list was bronchodilators: 272 prescriptions for 24 patients (11.3 prescriptions per patient), for a mean cost of US $83.68 (£68.54) per patient.

The multiple courses of PPIs and corticosteroids prescribed by primary care doctors, at significant cost, are seen in the years leading up to an RCC/UCC diagnosis, the authors said.


1. Birring SS, Dicpinigaitis P, McGarvey L, et al. Baseline cough severity and quality of life in patients with chronic cough participating in two global phase 3 randomized controlled clinical trials. Presented at: ATS 2021 International Conference; May 14-19, 2021; Virtual. Abstract A2359.

2. Baker P, Migas S, Fonseca E, at al. Burden and cost of care in patients diagnosed with refractory or unexplained chronic cough in a UK specialist clinic. Presented at: ATS 2021 International Conference; May 14-19, 2021; Virtual. Abstract A3145.