Chronic Cough Patients Report a Miserable Existence
Troubles with incontinence and spouses moving out of the bedroom only start the list of common troubles for patients who suffer with chronic cough, according to a new report by Mayo Clinic pulmonology specialists. The researchers found that patients with chronic cough - lasting over three weeks - suffer due to various factors, most significantly anxiety due to the possibility of underlying serious illness, uncomfortable public attention, anger and frustration with constant cough, and physical discomfort. The findings from a survey of chronic coughers will be presented as an abstract at the American College of Chest Physicians CHEST 2005 meeting in Montreal.
"We are seeking to understand how chronic cough adversely affects the patient socially, psychologically and physically," says Kaiser Lim, M.D., Mayo Clinic pulmonologist and allergist and lead study investigator. "It's important for people with chronic cough to have empathy and realize that there are physicians who are working to help understand this problem. For patients with chronic cough, the psychological and physical sufferings appear to be paramount reasons for seeking medical help."
Dr. Lim and colleagues conducted a large survey of chronic cough patients to understand the needs of the patients with this condition and to serve them better. In a 12-week prospective study, the researchers surveyed 146 consecutive chronic cough patients about how chronic cough affects them. Patients completed a questionnaire about cough-related difficulties and sufferings prior to medical evaluation and again six months later. Of those who took the initial survey, 56 completed the repeat questionnaire.
The top problems for chronic coughers when they were first evaluated at Mayo Clinic - often as a referral from other medical centers - were:
Interference with lifestyle and leisure
- Frequent physician visits and testing for cough
- Sleep disturbances
- Interference with social gatherings
- Other people's reactions to the coughing
- Frustration, irritability and anger.
For patients under age 65 with chronic cough, one-third of their spouses or roommates had moved out of the bedroom. Patients also indicated that sleep disturbance due to cough led to daytime exhaustion and fatigue.
"This suggests the possibility of more serious than anticipated disruption of family life," says Dr. Lim.
One survey finding suggests that the long and tedious process of diagnosing and treating the underlying problem causing chronic cough may frustrate patients. The diagnostic approach - testing one treatment individually after another - was designed to be cost-effective and efficacious, Dr. Lim explains.
"There is often a high degree of frustration and anger in patients with chronic cough," says Dr. Lim. "This is because in nonsmoking patients who do not have immune system problems, the diagnostic approach for chronic cough is a systematic elimination of probable causes that may cause irritation. There is no single test that will determine what causes chronic cough. Even after a meticulous evaluation, the diagnosis may still be unclear."
According to Dr. Lim, an estimated 23 million Americans see their physicians each year for cough. How many of those have chronic cough - coughing for more than 21 days - is yet unconfirmed.
Dr. Lim recently received Mayo Clinic grant funding for further research into the science behind chronic cough and plans to continue his work in the laboratory and with chronic cough patients.