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Cynthia L. French, MS, RN, CS; Richard S. Irwin, MD; Frederick J. Curley, MD; Carole J. Krikorian, RN

Arch Intern Med. 1998;158:1657-1661.

Background  Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown.

Objectives  To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects.

Methods  The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered.

Results  The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean±SD of 8.6±4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P<.02). After cough disappeared with treatment, ACOS complaints decreased to a mean±SD of 1.9±3.2 (P<.0001) as did total (mean±SD, 4.8±4.5 to 1.8±2.2) (P=.004), psychosocial (mean±SD, 4.2±6.8 to 0.8±2.3) (P=.004), and physical (mean±SD, 2.2±2.9 to 0.9±1.8) (P=.05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained.

Conclusions  Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.

From the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester.

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