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Cough Presentation and Cough-Related Healthcare Utilization in Tertiary Care: Analysis of Routinely Collected Academic Institutional Database

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Abstract

Purpose

Routinely collected data (RCD) from electronic health records (EHR) are useful for studying disease epidemiology in the real world. We examined cough presentation and cough-related healthcare utilization using an academic institutional EHR database in Korea.

Methods

In this retrospective cohort study, patients with subacute (3–8 weeks) or chronic cough (> 8 weeks in duration) referred to allergy and asthma clinics were studied. Cases were identified using the search term “cough” or “coughing,” which is the chief complaint, in the data fields. Structured data, including demographics, medical history, symptoms, and diagnostic tests, were analyzed. Healthcare utilization was assessed for drug prescriptions, additional tests, or outpatient visits for 1 year.

Results

Cough was the chief complaint in 13,223 cases (46.7%) among 28,312 new referrals for 8 years. A total of 3810 subacute and 7150 chronic cough patients were analyzed. The common demographic profile was middle-aged woman (mean age 52.1 years), reported in 63% of the cases. Cough was frequently accompanied by anterior nasal (about 50%), lower airway (30%), or acid reflux disease symptoms (20%), and by test abnormalities in chest X-rays (14%), spirometry (23%), or T2 inflammation markers (40%). Chronic cough patients frequently required additional tests (chest CT scan: 24%), drug prescriptions (codeine: 21.5% and oral steroids: 9.9%), and long-term healthcare utilization (16.0%) for 1 year.

Conclusions

Cough is a common chief complaint at allergy and asthma clinics, but the clinical presentation may be heterogeneous. Further studies are needed to understand long-term outcomes and reduce the disease burden.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

RCD:

Routinely collected data

EHR:

Electronic health record

ICD:

International Statistical Classification of Diseases

CRF:

Case report form

PND:

Postnasal drip

ILD:

Interstitial lung disease

GERD:

Gastro-esophageal reflux disease

DM:

Diabetes mellitus

ACEi:

Angiotensin-converting enzyme inhibitor

FeNO:

Fractional exhaled nitric oxide

FEV1:

Forced expiratory volume in 1 s

FVC:

Forced vital capacity

CT:

Computed tomography

ICS:

Inhaled corticosteroid

PPI:

Proton pump inhibitor

OCS:

Oral corticosteroids

IQR:

Interquartile range

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Acknowledgements

None.

Funding

This study was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp.

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Authors and Affiliations

  1. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea

    Jin An, Ji-Hyang Lee, Ha-Kyeong Won, Yewon Kang, Hyouk-Soo Kwon, Tae-Bum Kim, You Sook Cho, Hee-Bom Moon & Woo-Jung Song

  2. Department of Pulmonary, Allergy and Critical Care Medicine, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea

    Jin An

  3. Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea

    Ha-Kyeong Won

  4. Department of Internal Medicine, Dongkang Medical Center, Ulsan, Seoul, Korea

    Yewon Kang

  5. Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jae-Seung Lee, Sei Won Lee, Yeon-Mok Oh & Sang-Do Lee

Authors
  1. Jin An
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  2. Ji-Hyang Lee
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Contributions

Each of the authors confirms that this manuscript has not been previously published and is not currently under consideration by any other journal. Additionally, all authors have approved the contents of this paper and have agreed to the journal submission policies. WJS contributed to the design of the study. JA performed the main analysis and wrote the original draft. JHL, HKW, and YK assisted in the analysis and interpretation of the data. HSK, JSL, SWL, TBK, YMO, YSC, SDL, and HBM collected the data. All authors reviewed the manuscript.

Corresponding author

Correspondence to Woo-Jung Song.

Ethics declarations

Competing interest

The authors declare that they have no competing interest.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the hospital institutional review board (IRB No. 2019–0511).

Consent to Participate

Individual subject informed consent was waived due to the retrospective nature of the study and no prospective engagement with subjects or their legal guardians.

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An, J., Lee, JH., Won, HK. et al. Cough Presentation and Cough-Related Healthcare Utilization in Tertiary Care: Analysis of Routinely Collected Academic Institutional Database. Lung 200, 431–439 (2022). https://doi.org/10.1007/s00408-022-00555-w

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  • DOI: https://doi.org/10.1007/s00408-022-00555-w

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