Effect of the Management of Patients With Chronic Cough by Pulmonologists and Certified Respiratory Educators on Quality of Life: A Randomized Trial

Abstract

The role of certified respiratory educators (CREs) is to educate, assess, and help to manage patients with asthma and COPD in Canada. This study was undertaken to see whether CREs could assist pulmonologists (MDs) in managing patients with chronic cough. An 8-week prospective, parallel design, randomized, controlled trial to determine whether CREs using a protocol-driven algorithmic approach could assist in the management of patients referred to a university tertiary care medical center for the assessment and treatment of chronic cough. Patients were randomly assigned to a CRE-led or MD study arm for the management of chronic cough. Patients were screened to exclude those patients whose cough was due to life-threatening conditions. The primary outcome was measured with the cough-specific quality-of-life questionnaire (CQLQ). A total of 198 patients were randomized, and 8-week results were available on 151 patients (mean [+/- SD] age, 49.8 +/- 13.4 years; female gender, 70%; median cough duration, 16 months). At 8 weeks, total CQLQ scores improved in the CRE-led patients (score [+/- SD] range, 58.1 +/- 14.9 to 50.0 +/- 15.8; p = 0.0003). CQLQ scores improved in four of six domains but not in the physical or emotional domains. Improvements in CRE-led patients were similar to those in MD-managed patients (initial CQLQ score, p = 0.261 [CRE vs MD]; CQLQ score at 8 weeks, p = 0.42 [CRE vs MD]). In a composite analysis of both CRE and MD patient data, CQLQ scores improved in patients whose cough resolved (56.3 +/- 13.6 to 41.5 +/- 13.6; p < 0.0001), in those whose cough improved but did not disappear (60.9 +/- 14.2 to 50.5 +/- 13.9; p < 0.0001), but did not improve in those whose cough did not improve (58.1 +/- 13.3 to 58.6 +/- 12.7; difference not significant). CREs can help to safely, economically, and effectively manage properly screened patients with chronic cough. The use of CREs may shorten wait times for specialist consultation for these patients.