Chronic Cough Etiology Within a Tertiary Care Center: A Retrospective Chart Review

• Type of Material: Article
• Authors: Krittin J. Supapannachart, Emory University; Amanda S. Fryd, Emory University; Sandeep Shelly, Emory University; Anjali Warrier, GCS Medical College; Andrew Tkaczuk, Emory University; Jeanne L Hatcher, Emory University; Adviteeya N. Dixit, Emory University; Keriann Van Nostrand, Emory University; Anand Jain, Emory University; Amanda I. Gillespie, Emory University; Merin Kalangara, Emory University; Adam M Klein, Emory University
• Language: English
• Date: 2022-10-02
• Publisher: Wolters Kluwer
• Publication Version: Final Published Version
• Copyright Statement: Published by Wolters Kluwer – Medknow; © 2022 International Journal of Advanced Medical and Health Research
• License: Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
• Final Published Version (URL): https://journals.lww.com/iamr/fulltext/2022/09020/chronic_cough_etiology_within_a_tertiary_care.7.aspx
• Title of Journal or Parent Work: International Journal of Advanced Medical and Health Research
• Volume: 9
• Issue: 2
• Start Page: 101
• End Page: 106
• Grant/Funding Information: Nil.
• Keywords: chronic disease; throat; chronic cough; population health; ear; epidemiology; respiratory diseases; multidisciplinary care; nose
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Purpose: Chronic cough occurs in 12% of the population and is associated with significant morbidity and healthcare utilization. Little is known about chronic cough patients requiring referral to higher level care facilities; such knowledge may improve primary care physician chronic cough referral algorithms. Methods: A retrospective study was conducted on patients with primary complaints of chronic cough presenting to Emory Healthcare, Atlanta between 2009 and 2020. Data on socio-demographics, etiology, treatment, and health behavior were extracted from the electronic medical records of patients with chronic cough that had been seen by at least by 1 cough specialist at a tertiary care center. The Chi-square test and analysis of variance helped determine differences in socio-demographic variables between patients with different primary cough etiologies. Results: A total of 1152 patients met the inclusion criteria for this study. Common etiologies of chronic cough were found to be neurogenic (n = 196, 17%), gastroesophageal reflux disease (n = 114, 9.9%), asthma (n = 93, 8.1%), and chronic obstructive pulmonary disease (n = 80, 6.9%). A multifactorial etiology was found in 213 (18.5%) patients and 99 (8.6%) patients were still undergoing further work up. Significant differences in age, sex, race, smoking status, and chronic cough duration were noted based on the underlying etiology. Interestingly, although nonsignificant, patients with pulmonary etiologies tended to live in areas with higher poverty rates. Conclusion: The most common etiology was neurogenic cough, typically a diagnosis of exclusion that goes undiagnosed in primary care settings. Primary care physicians should have a low threshold for referral to otolaryngologists and academic institutions should consider establishing multidisciplinary cough clinics to facilitate work up and treatment.