Abstract
PurposeThe aim of this study was to understand the perception of family physicians, pulmonologists, and allergists with respect to diagnostic tests performed on patients with chronic cough and treatments prescribed to patients with refractory or unexplained chronic cough. We also assessed how these health professionals perceived the effectiveness of these treatments.MethodsAn anonymous survey was distributed by the scientific societies SEPAR, SEAIC, SEMERGEN, semFYC, and SEMG. Respondents were asked how often they perform diagnostic tests and prescribe treatments (responses from 1 = never to 10 = always) and how they perceived the effectiveness of the drugs used (from 1 = not at all to 10 = very effective). The correlation between perceived effectiveness and frequency of prescription was analyzed.ResultsThe respondents comprised 620 family physicians, 92 pulmonologists, and 62 allergists. The most frequently performed diagnostic tests were chest x-ray and, among pulmonologists and allergists, simple spirometry and bronchodilator tests. The most frequently prescribed drugs were bronchodilators (percentages scoring 8–10 for each specialty: 43.2%, 42.4%, and 56.5%; p = 0.127), inhaled corticosteroids (36.9%, 55.4%, and 54.8%; p < 0.001), and antitussives (family physicians, 33.4%). Regarding perceived effectiveness, only bronchodilators, inhaled or oral corticosteroids, and opioids obtained a median effectiveness score > 5 (between 6 and 7). Correlation coefficients (ρ2) suggested that approximately 45% of prescription was related to perceived effectiveness.ConclusionAlthough chronic cough is a common problem, diagnosis and treatment differ among specialists. The perceived effectiveness of drugs is generally low.
Highlights
Cough is a protective reflex that prevents aspiration and helps to clear the airways
We describe the diagnostic work-up preferred by these specialists in patients with chronic cough, the drugs prescribed by physicians to patients with refractory or unexplained chronic cough, their perception of the effectiveness of these treatments, and the correlation between perceived effectiveness and prescription of different drug families
The survey ran for 6 weeks, from early February to midMarch 2020 and was completed by 620 family physicians, 92 pulmonologists, and 62 allergists
Summary
Cough is a protective reflex that prevents aspiration and helps to clear the airways. When cough lasts over time, it can prove disabling [1]. Chronic cough affects approximately 10% of adults [2], but studies apply different durations. The most recent guidelines define chronic cough as cough lasting more than 8 weeks [3]. In its 2020 guidelines on the management of chronic cough, the European Respiratory Society (ERS) describes the most characteristic phenotypes of chronic cough (asthmatic cough/eosinophilic bronchitis, reflux cough, postnasal drip syndrome/upper airway cough syndrome, and iatrogenic cough) [3] in order to establish “treatable traits”. Even if a diagnosis is reached and appropriate treatment administered, cough persists in many patients (refractory chronic cough), whereas in others, no specific
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