Bali V, Schelfhout J, Sher M, Peters A, Patel G, Mayorga M, Cook T, (DeMuro) Romano C. Patient-reported symptoms, impacts, and treatment preferences in refractory or unexplained chronic cough: a qualitative study. Poster presented at the 2022 Advancing Allergy & Immunology Care (ACAAI) Annual Scientific Meeting; November 13, 2022. Louisville, KY.

BACKGROUND: Chronic cough, defined as cough lasting more than 8 weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions; unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. Being oOlder age, female, gender, and being overweight, smoking and asthma are risk factors for RCC or UCC. RCC and UCC are often poorly controlled in current practice. Understanding individuals’ lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies.

OBJECTIVE: We sought to determine respondents’ perceptions of the key symptoms of RCC and UCC. Additionally, we examined the impact of RCC and UCC and their symptoms on respondents’ well-being, health-related quality of life, work productivity, and social relationships. We further sought to identify respondents’ perception of meaningful treatment-related benefits in RCC and UCC.

METHODS: This cross-sectional study enrolled 30 adults (aged ≥18 years) with physician-diagnosed RCC or UCC. Exclusion criteria included being a current tobacco user or having a current diagnosis of COVID-19, or a psychiatric or immunocompromising disorder that would hinder study participation. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes.

RESULTS: A total of 15 respondents with RCC and 15 with UCC were included in the study. Most respondents were female (83%), White (87%), and older with a mean (SD) age of 64.9 (12.4) years. Many respondents had RCC or UCC for a long duration (median 9 years, range 0-24). Half of respondents reported having a coughing episode at least once daily. Common symptoms associated with RCC or UCC were sensation of postnasal drip (80%), hoarseness (77%), tickle or lump in throat (73%), shortness of breath (63%) and excessive mucus (57%). Fewer than half of the respondents (43%) reported that medication had improved their symptoms. Commonly reported cough triggers were smells or environmental irritants (67%) and speaking or singing (67%). In over half of respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents.

CONCLUSION: RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals’ lived experiences may inform the development of RCC and UCC treatment strategies.

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