Systematic evaluation and treatment of chronic cough in a community setting

Chronic cough is a common symptom of patients in the United States. The vast majority of patients with chronic cough are treated by primary- and specialty-care physicians. The Cough Center in Southern California represents the first independent, community-based facility devoted entirely to diagnosing and treating cough. This article details that experience and represents the first ever attempt to evaluate quality-of-life (QOL) improvement, after treatment, in the community setting. Three hundred and ninety patients were evaluated at The Cough Center for chronic cough. Patients were investigated in a systematic fashion and empirically treated. A subjective assessment of treatment success was made using the Leicester QOL questionnaire. An objective assessment was made by documenting frequency and severity of coughing episodes. In the initial assessment of patients with cough, only 37% were identified as having had a systematic and dedicated work up. Using both subjective and objective measurements, it was determined that 73% of patients improved with an empiric course of treatment. Almost 17% demonstrated no improvement and 10% were lost to follow up. By analyzing treatment outcomes in a community setting, insight can be gained. Physicians need to become more diligent in systematic evaluation and treatment. Also, they should not be deterred from seeking resolution of cough just because it has persisted for a lengthy period of time or has several causes. Most importantly, the prevalence of patients having "unexplained cough" could very well be much greater than that reported at university-based, specialty cough clinics.