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Canadian Health Care Professionals’ Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey

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Abstract

Introduction

Educational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians’ perceptions, attitudes, and knowledge of chronic cough.

Methods

We administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2 years.

Results

Between July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8 weeks as the definition for chronic cough. Many physicians reported not using international chronic cough management guidelines. Patient referrals and care pathways varied considerably, and patients frequently experienced lost to follow-up. While physicians endorsed nasal and inhaled corticosteroids as common treatments for chronic cough, they rarely used other guideline-recommended treatments. Both GPs and specialists expressed high interest in education on chronic cough.

Conclusion

This survey of Canadian physicians demonstrates low uptake of recent advances in chronic cough diagnosis, disease categorization, and pharmacologic management. Canadian physicians also report unfamiliarity with guideline-recommended therapies, including centrally acting neuromodulators for refractory or unexplained chronic cough. This data highlights the need for educational programs and collaborative care models on chronic cough in primary and specialist care.

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Acknowledgements

The authors of the study would like to thank the survey participants. We also thank Fusion MD Medical Science Network, Inc. (Montreal, Canada) for providing manuscript support with funding from Merck Canada, Inc.

Funding

The study and medical writing support was funded by Merck Canada, Inc.

Author information

Authors and Affiliations

  1. Department of Medicine, McMaster University, Hamilton, ON, Canada

    Elena Kum, Danica Brister, Mustafaa Wahab, Harold Kim & Imran Satia

  2. Division of Respirology, McMaster University, Hamilton, ON, Canada

    Nermin Diab

  3. Merck Canada, Inc., Toronto, ON, Canada

    Ted Abraham & Sevag Sahakian

  4. Southmount Health Care Centre, Stoney Creek, ON, Canada

    Kaiser Qureshy

  5. Division of Respirology, Department of Medicine, Dalhousie University, Halifax, NS, Canada

    Paul Hernandez

  6. Department of Clinical Immunology and Allergy, Western University, London, ON, Canada

    Harold Kim

  7. Royal Victoria Hospital, McGill University, Montreal, QC, Canada

    Maxime Cormier

  8. Canadian Heart Research Centre, Toronto, ON, Canada

    Peter Lin

  9. Division of Allergy & Immunology, Department of Medicine, Queen’s University, Kingston, ON, Canada

    Anne Ellis

  10. Quebec Heart and Lung Institute, Université Laval, Quebec, QC, Canada

    Louis-Philippe Boulet

  11. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Alan Kaplan

  12. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Stephen K. Field

  13. Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, ON, Canada

    Imran Satia

  14. McMaster University Medical Centre, 3U9, 1280 Main St. West, Hamilton, ON, L85 4LA, Canada

    Imran Satia

Authors
  1. Elena Kum
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Contributions

All authors made substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work. All authors were involved in drafting the work or revising it critically for important intellectual content, and all authors approved the final version to be published.

Corresponding author

Correspondence to Imran Satia.

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Competing Interests

EK, DB, and MW report no conflicts of interest. ND is currently supported by the Canadian Asthma Allery and Immunology Foundation Type II Inflammation Sanofi Genzyme Award. TA and SS are employees of Merck Canada, Inc. KQ reports personal fees from Merck. PH reports grants from Boehringer Ingelheim, Cyclomedica, Grifols, and Vertex, and speaker and/or consulting fees from Acceleron, AstraZeneca, Boehringer Ingelheim, GSK, Grifols, Janssen, Sanofi Genzyme, Takeda, and Valeo. MC reports payment or honoraria speaking from GSK, AstraZeneca, Respiplus, Valeo and Covis. Has received support for attending meetings by Sanofi. Participated in advisory boards for Novartis, GSK, AstraZeneca, Sanofi, Boehringer-Ingelheim, Respiplus, Trudell, Valeo, CMD and Covis. PL reports personal fees from AstraZeneca, Boehringer Ingelheim, and GSK. AE has participated in advisory boards for ALK Abello, AstraZeneca, Aralez, Bausch Health, LEO Pharma, Merck, Novartis, and Pfizer, has been a speaker for ALK Abello, AstraZeneca, Miravo, Medexus, and Mylan. Her institution has received research grants from ALK Abello, Aralez, AstraZeneca, Bayer LLC, Medexus, Novartis, and Regeneron. She has also served as an independent consultant to Bayer LLC and Regeneron. LPB has previously received research grants from Amgen, AstraZeneca, GSK, Merck, Novartis, and Sanofi-Regeneron and speaker and/or consulting fees from AstraZeneca, Covis, Novartis, GSK, Merck, and Sanofi-Regeneron. AK is a member of advisory boards/speaker’s bureaus for AstraZeneca, Behring, Belus, Boehringer Ingelheim, Covis, Cipla, Eisai, GSK, Merck Frosst, Novo Nordisk, Pfizer, Novartis, Sanofi, Teva, Trudell, and Valeo. SKF served on an advisory board for Merck and sponsored talks for GSK and Boehringer-Ingelheim. IS is currently supported by the E.J. Moran Campbell Early Career Award, McMaster University and reports grants from ERS Respire 3 Marie Curie fellowship, Merck, GSK and MITACS and speaker and/or consulting fees from Merck, GSK, AstraZeneca, Roche, Genentech and Respiplus.

Ethical Approval

This survey did not collect patient or clinical data and therefore did not require ethics board review.

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Informed consent was obtained from all participants in the study.

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Kum, E., Brister, D., Diab, N. et al. Canadian Health Care Professionals’ Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey. Lung 201, 47–55 (2023). https://doi.org/10.1007/s00408-023-00604-y

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