PURPOSE:Chronic cough is a common reason for pulmonologist consultation, accounting for up to 38% of outpatient referrals. To meet the demands, other health care professionals are used to compensate for the shortage of physicians. Certified respiratory educators (CRE) provide services that traditionally have been provided by physicians such as education, teaching proper inhaler technique, and providing advice to patients. In the absence of radiographic abnormalities, hemoptysis, or systemic symptoms, chronic cough is rarely due to a life-threatening condition but may profoundly effect quality of life (QOL).
METHODS:After being screened to rule out life-threatening conditions, 123 patients with chronic cough were randomized to care by a pulmonologist (MD) or CRE. All patients had a normal chest radiograph within 2 months of assessment. All patients had spirometry. A cough-specific QOL questionnaire (French et al, Chest 2002) was completed at the first visit and after 6 months. In the CRE arm, all patients were assessed with a form-directed history and physical exam and treatment was directed at the likely cause(s) of the cough. Care and follow up in the other arm was at the discretion of the MD.
RESULTS:The mean age of the patients was 50.3 years, 74% were female, 8% were current smokers, and median cough duration was 18 months. Overall QOL was similar in the two groups at 6 months (initial overall QOL score: CRE vs MD, p=0.023, score at 6 months: CRE vs MD, p=0.37). Overall QOL improved similarly in the 2 arms at 6 months (CRE: 56.3+/-13.8 to 46.3+/-14.3, n=65, p<0.0001, MD: 62.0 +/- 13.3 to 48.7 +/- 15.5, n=58, p<0.0001).
CONCLUSION:At 6 months, QOL improved in each of the 6 domains. Chronic cough patients without abnormal chest x-rays, hemoptysis, or systemic symptoms will experience similar improvements in cough-specific QOL whether assessed and managed by a pulmonologist or certified respiratory educator.
CLINICAL IMPLICATIONS:Certified respiratory educators can effectively manage properly screened patients expediting their care and shortening wait times for pulmonologists.
DISCLOSURE:Stephen Field, No Financial Disclosure Information; No Product/Research Disclosure Information