Patient satisfaction with the management of refractory and unexplained chronic cough in Canada: Results from a national survey

Abstract

Background: Chronic cough (persisting for ≥8 weeks) is a common disorder affecting approximately 5 to 10% of adults worldwide that is sometimes refractory to treatment (refractory chronic cough [RCC]) or has no identifiable cause (unexplained chronic cough [UCC]). There is minimal information on the patient's experience of RCC/UCC in Canada. The aim of this study was to evaluate the patient journey and perceptions related to RCC/UCC management in Canada.

Methods: Our exploratory study included Canadians in the Leger Opinion Panel and focused on individuals with RCC or UCC. Key entry criteria were: age ≥18 years, cough on most days for ≥8 weeks, no smoking within 1 year, no serious respiratory disease or lung cancer, and not taking angiotensin-converting enzyme inhibitors. Individuals who met entry criteria were invited to complete an approximately 30-minute online survey with questions on demographic characteristics, healthcare professional (HCP) interactions, diagnosis of underlying conditions, current treatments, and satisfaction with HCPs and chronic cough therapies.

Results: A total of 49,076 individuals completed the chronic cough screening questionnaire (July 30, 2021 to September 1, 2021): 1,620 (3.3%) met entry criteria for RCC or UCC, and 1,046 (2.1%) completed the online survey (mean age of 45 years, 61% female). Most respondents (58%) reported their chronic cough was managed by a general practitioner (GP). Forty-four percent of respondents did not have a diagnosis of an underlying condition for their cough. Breathing tests (39%) and chest imaging (34%) were the most common diagnostic tests. Cough suppressants (18%) were the most frequent current treatment. Respondents were moderately satisfied with their HCPs, but more than half considered their treatment ineffective and 34% had considered no longer seeking medical attention because of a lack of treatment success.

Conclusions: Individuals with RCC/UCC in Canada are largely unsatisfied with the effectiveness of treatment. Additional HCP education and new treatment options are needed to improve patient satisfaction.

Fig 1

(A) Current main healthcare professionals for chronic cough and (B) involvement of respondents in treatment decisions. For (A), respondents were asked “Who do you consider to be the main person responsible for the treatment and management of your cough at this time?” For (B), respondents were asked “Overall, how would you describe your involvement in treatment decisions for your chronic cough?” ENT, ear, nose, and throat specialist. GE, gastroenterologist.

Fig 2

Respondents’ ratings of (A) satisfaction with HCP and (B) agreement with statements about HCP. For (A), respondents were asked “Thinking about the healthcare professional who has MAIN responsibility for your chronic cough treatment and management, overall how satisfied are you with them on the following factors?” (7-point scale where 1 = very dissatisfied and 7 = very satisfied). For (B), respondents were asked “Based on your experience with your healthcare professional who has MAIN responsibility for your chronic cough, to what extent do you agree with the following statements with regards to your chronic cough?” (7-point scale where 1 = strongly disagree and 7 = strongly agree).

Fig 3. Respondents’ perceptions of the most important benefits of cough treatment.

Respondents (N = 1,046) were asked: “Other than a cure for your chronic cough, what are the THREE most important benefits a cough treatment could provide? Please assign rankings (1 to 3) with 1 being the most important, 2 the next most important, etc.” Responses that were ranked in the top 3 by >5% of respondents are shown.