Management of cough in Canadian primary care and specialty practices: A survey of current knowledge of clinicians and allied health professionals

Abstract

RATIONALE Cough is one of the most common causes for medical consultation. However, we do not know whether its management is optimal in Canada. Although guidelines are available, awareness of these and implementation of their recommendations are uncertain. OBJECTIVE The objective of this research was to evaluate the diagnostic approach and management of cough, as well as knowledge of cough guidelines in Canada. METHODS A cross-sectional online survey of general practitioners (GPs), specialists (SPs) and allied health professionals (AHPs) was conducted anonymously in Canada. Participants answered multiple-choice questions on etiology, diagnosis, follow-up and treatment (only physicians) of cough and knowledge and application of cough guidelines. MEASUREMENTS AND MAIN RESULTS A total of 248 respondents completed the survey (43 GPs, 27 SPs, and 178 AHPs). In the investigation of a patient with chronic cough, a chest radiograph was the most common test ordered by physicians (GPs: 51.2%, SPs: 59.3%) and spirometry with bronchodilator reversibility (61.2%) by AHPs. GPs most often treated cough of unknown etiology with combined inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) (25.8%) and SPs with a nasal corticosteroid (NCS)(29.8%). NCS was also the most often prescribed treatment for cough considered originating in the upper respiratory tract (GPs: 60.4%, SPs: 76.2%). When cough was believed to be due to asthma or gastroesophageal reflux disease, treatment was appropriate in most cases. Awareness of current cough guidelines content was poor in all groups (GPs: 14.0%, SPs: 51.9%, AHPs: 26.6%). CONCLUSIONS Physicians and AHPs’ knowledge and application of guidelines for the management of chronic cough remains poor.