Burden and impact of chronic cough in UK primary care: a dataset analysis

Abstract

Objective: Chronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting.

Design: Cross-sectional, retrospective cohort study.

Setting: Discover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis.

Participants: Data were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019.

Main outcome measures: Demographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined.

Results: CC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41-87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65-74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs.

Conclusion: One-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.

Keywords: adult thoracic medicine; chronic airways disease; health economics; primary care.

Figure 1

Illustration of point at ‘2nd Visit’ where chronic cough was defined in the study. Chronic cough was diagnosed once there were two or more recorded consultations coded as ‘cough-related’ persisting for at least 8 weeks. At least one of the cough coded entries had to be present at both the first and second visits.

Figure 2

Chronic cough cohort by age and gender. Median (IQR) age was 65 (49–77) years for men and 62 (46–75) years for women.

Figure 3

Chronic cough cohort by age and comorbidities.

Figure 4

Costs per patient per year in those subjects with chronic cough without and with comorbidities before and after chronic cough index date. COPD, chronic obstructive pulmonary disease.