We hypothesized that the burden of disease associated with chronic cough may include health care factors and concern over the “meaning” of the cough. We sought to understand how chronic cough affected patients socially, psychologically and physically.
All consenting adult patients presenting to our Pulmonary Division with chronic cough between November and February of 2003 were surveyed with a Cough-related Disease Burden Questionnaire (CRDBQ) prior to their evaluation and again 6 months afterward.
139 subjects were available for analysis. Sixty-five returned the second questionnaire. The top four complaints are shown in Table 1. Anxiety over underlying illness correlated with lifestyle interference, frequent doctor visits, medical expense, prescription expenses, frustration and spouse moving out of the bedroom. Sleep disturbances correlated with exhaustion (p <0.001). A third of patients under 65 years old had a spouse or roommate move out of the bedroom. On followup 6 months later, 18% reported complete resolution of cough, 34% had more than 50% improvement, 20 % had less than 50% improvement, 28 % reported that cough was worse (1/56) or unchanged (26.7%). Improved cough outcome was associated with less anxiety about an underlying serious illness at baseline (p<0.001).
Both psychological and physical sufferings or burden of disease appear to be chief reasons for seeking medical evaluation. Aside from Anxiety, two important major sources of suffering for the patients are a) frequent physician visits and testing, and b) sleep disturbances.
Frequent doctor’s visit and testing for cough as a disease burden is an important consideration since many chronic cough algorithms employ empirical therapy and multiple return visits. Anxiety, physician visits, medications, and sleep disturbances weigh highly in patients concerns about chronic cough.Table 1—
Top 4 Complaints of Patients with Chronic CoughComplaintsF (%)M (%)<65 yrs (%)65 y/o (%)Cough <18 mos (%)Cough 18 mos (%)Frustrated/Irritable/Angry787879767481Frequent MD visit & testing for cough777577766982Sleep Disturbances788282768376Interferes w/ social gatherings747578716980
Kaiser Lim, None.