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.
Objective(s): To assess laryngologic symptomatology following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and determine whether symptom severity correlates with disease severity. Methods: Single-institution survey study in participants with documented SARS-CoV-2 infection between March 2020 and February 2021. Data acquired included demographic, infection severity characteristics, comorbidities, and current upper aerodigestive symptoms via validated patient reported outcome measures. Primary outcomes of interest were scores of symptom severity questionnaires. Coronavirus disease of 2019 (COVID-19) severity was defined by hospitalization status. Descriptive subgroup analyses were performed to investigate differences in demographics, comorbidities, and symptom severity in hospitalized participants stratified by ICU status. Multivariate logistical regression was used to evaluate significant differences in symptom severity scores by hospitalization status. Results: Surveys were distributed to 5300 individuals with upper respiratory infections. Ultimately, 470 participants with COVID-19 were included where 352 were hospitalized and 118 were not hospitalized. Those not hospitalized were younger (45.87 vs. 56.28 years), more likely female (74.17 vs. 58.92%), and less likely white (44.17 vs. 52.41%). Severity of dysphonia, dyspnea, cough, and dysphagia was significantly worse in hospitalized patients overall and remained worse at all time points. Cough severity paradoxically worsened in hospitalized respondents over time. Dyspnea scores remained abnormally elevated in respondents even 12 months after resolution of infection. Conclusions: Results indicate that laryngologic symptoms are expected to be worse in patients hospitalized with COVID-19. Dyspnea and cough symptoms can be expected to persist or even worsen by 1-year post infection in those who were hospitalized. Dysphagia and dysphonia symptoms were mild. Nonhospitalized participants tended to have minimal residual symptoms by 1 year after infection.