Bunniran S, Henning C, Parikh B, Davenport E, Sweeney C, Calhoun S, Lim K. Exploring perceived gaps in diagnosis and care for patients with refractory chronic cough: a survey of healthcare professionals' knowledge, attitudes, and practices in the United States. Poster presented at the Academy of Managed Care Pharmacy (AMCP) 2026; April 13, 2026. Nashville, TN. [abstract] J Manag Care Pharm. 2026 Apr; 32(4-a):S107.

BACKGROUND: Refractory chronic cough (RCC) is a disease identified in a subset of people who experience chronic cough (defined in adults as a cough lasting >8 weeks), despite adequate treatment for known cough-related etiologies. RCC is considered a diagnosis of exclusion, and patients may endure persistent coughing for several years before a diagnosis. Without a coordinated approach across multidisciplinary care, patients can often be re-tested, re-trialed, and require frequent follow-up. These gaps in care contribute to patient frustration and may lead to increased healthcare utilization and costs. To assess real-world diagnosis and management of RCC, we surveyed US healthcare professionals (HCPs) to understand their knowledge, attitudes, and practices.

METHODS: A cross-sectional, web-based survey was conducted in December 2024 among HCPs who had treated ≥1 adult patients with chronic cough in the past six months. Participants included allergists/immunologists (A/Is), otolaryngologists (ENTs), pulmonologists, primary care physicians (PCPs), pharmacists, nurse practitioners (NPs), and physician assistants (PAs). Survey questions explored perceptions of diagnostic pathways and delays, as well as treatment practices for RCC.

RESULTS: Responses from 717 HCPs were analyzed: A/Is, ENTs, pulmonologists (n=100 each), PCPs (n=212), pharmacists (n=104), NPs (n=51), and PAs (n=50). Nearly half of HCPs (46%) reported an average RCC diagnosis of 6–12 months, while a quarter (25%) indicated 1–2 years. HCPs (n=401, except PCPs and pharmacists) estimated that they would conduct their own diagnostic tests for 65% of patients with suspected RCC, regardless of previous testing. Of HCPs who provided reasons for repeated testing (n=397), these included perceptions of outdated prior testing (63%), preference for specific diagnostic facilities/personnel (47%), the need to establish a baseline for future evaluations (47%), and lack of access to prior test results (46%). Of HCPs (n=613, except pharmacists), around half (47%) reported that patients with RCC typically require ≥4 follow-up visits annually to manage treatment.

CONCLUSIONS: The findings suggest gaps in RCC diagnosis and management are driven by fragmented care, redundant testing, and frequent follow-up. A coordinated, cross-specialty cough management pathway is needed to streamline evaluations, enable faster escalation to definitive therapies, and improve patient outcomes while reducing cost of care.