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Quality of Life in Adults with Chronic Cough: A Mixed Methods Study Informing the Development of a Quantitative Patient Preference Study

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Abstract

Objectives

This study aimed to describe quality of life for patients with chronic cough (CC) and identify meaningful attributes that affect patient treatment preferences to inform the design of a quantitative preference study.

Methods

Eligible patients (≥ 18 years) with a CC (> 8 weeks) participated in qualitative interviews with two defined steps. Step one: concept elicitation and bidding games were used to collect descriptions of patient experiences with CC and identify important CC-related attributes. Step two: attributes were confirmed using concept elicitation and bidding games and prioritized using structured card sort activities. Purposive sampling ensured diversity of patient experiences. Qualitative content analysis was used to analyze participant narratives, and descriptive statistics were used to summarize card sort results. This study follows a fully mixed concurrent dominant status design, with qualitative (dominant) and quantitative components.

Results

A total of 20 participants were interviewed with a mean age of 61.4 years (range 24–79 years). Coughing episodes, described as intense consecutive coughs that made catching breath difficult, were important to most participants (n = 17). Participants emphasized the emotional impact of episodes including feelings of uncertainty, loss of control, self-consciousness, and fear. Severity of CC was most often judged by frequency (n = 11) and intensity (n = 12) of cough. Daily, physical, or social activities were impacted for most participants. Impact on sleep (n = 14) included waking during the night, difficulty falling asleep, and daytime fatigue. Medication-related taste disturbances were an important consideration for what participants were willing to accept in exchange for cough relief.

Conclusions

This study emphasizes the importance of coughing episodes for adults with CC and provides initial evidence that taste alterations are an important component of patient treatment decisions for CC.

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References

  1. French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158(15):1657–61.

    Article  CAS  PubMed  Google Scholar 

  2. Morice AH, McGarvey L, Pavord I, B.T.S.C.G. Group. Recommendations for the management of cough in adults. Thorax. 2006;61(Suppl 1):i1-24.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pavord ID, Chung KF. Management of chronic cough. Lancet. 2008;371(9621):1375–84.

    Article  PubMed  Google Scholar 

  4. Hulme K, Deary V, Dogan S, Parker SM. Psychological profile of individuals presenting with chronic cough. ERJ Open Res. 2017. https://doi.org/10.1183/23120541.00099-2016.

    Article  PubMed  PubMed Central  Google Scholar 

  5. H.M.S. Harvard Health Publishing, That Nagging Cough (2018). https://www.health.harvard.edu/staying-healthy/that-nagging-cough. Accessed on 8 Oct 2023.

  6. Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, Jo EJ, Kim MH, Plevkova J, Park HW, Cho SH, Morice AH. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J. 2015;45(5):1479–81.

    Article  PubMed  Google Scholar 

  7. Meltzer EO, Zeiger RS, Dicpinigaitis P, Bernstein JA, Oppenheimer JJ, Way NA, Li VW, Boggs R, Doane MJ, Urdaneta E, Weaver JP, Schelfhout J, Fonseca E. Prevalence and burden of chronic cough in the United States. J Allergy Clin Immunol Pract. 2021;9(11):4037-4044.e2.

    Article  PubMed  Google Scholar 

  8. Meltzer E, Zeiger R, Schatz M, Dicpinigaitis P, Bernstein J, Oppenheimer J, Way N, Li V, Weaver J, Doshi I, Urdaneta E, Boggs R. P351 Chronic cough in America: prevalence and patient characteristics. Ann Allergy Asthma Immunol. 2019;123(5, Supplement):S54.

    Article  Google Scholar 

  9. McGarvey LP, Birring SS, Morice AH, Dicpinigaitis PV, Pavord ID, Schelfhout J, Nguyen AM, Li Q, Tzontcheva A, Iskold B, Green SA, Rosa C, Muccino DR, Smith JA, C.-a.C.-. Investigators. Efficacy and safety of gefapixant, a P2X receptor antagonist, in refractory chronic cough and unexplained chronic cough (COUGH-1 and COUGH-2): results from two double-blind, randomised, parallel-group, placebo-controlled, phase 3 trials. Lancet. 2022;399(10328):909–23.

    Article  PubMed  Google Scholar 

  10. Coast J, Al-Janabi H, Sutton EJ, Horrocks SA, Vosper AJ, Swancutt DR, Flynn TN. Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations. Health Econ. 2012;21(6):730–41.

    Article  PubMed  Google Scholar 

  11. Nancy Leech AJO. A typology of mixed methods research designs. Qual Quant. 2009;43(2):265–75.

    Article  Google Scholar 

  12. Kivunja CAABK. Understanding and applying research paradigms in educational contexts. Int J Higher Educ. 2017;5:26–41.

    Article  Google Scholar 

  13. Judith Green NT. Qualitative methods for health research. New York: SAGE Publications Ltd; 2018.

    Google Scholar 

  14. Hollin IL, Craig BM, Coast J, Beusterien K, Vass C, DiSantostefano R, Peay H. Reporting formative qualitative research to support the development of quantitative preference study protocols and corresponding survey instruments: guidelines for authors and reviewers. Patient. 2020;13(1):121–36.

    Article  PubMed  Google Scholar 

  15. Gibson P, Wang G, McGarvey L, Vertigan AE, Altman KW, Birring SS, Panel CEC. Treatment of unexplained chronic cough: CHEST guideline and expert panel report. Chest. 2016;149(1):27–44.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Irwin RS, French CL, Chang AB, Altman KW, Panel CEC. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest. 2018;153(1):196–209.

    Article  PubMed  Google Scholar 

  17. Patton M. Qualitative research and evaluation methods: integrating theory and practice. New York: SAGE Publications Inc; 2015.

    Google Scholar 

  18. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.

    Article  Google Scholar 

  19. Patrick DL, Burke LB, Gwaltney CJ, Leidy NK, Martin ML, Molsen E, Ring L. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO Good Research Practices Task Force report: part 2—assessing respondent understanding. Value Health. 2011;14(8):978–88.

    Article  PubMed  Google Scholar 

  20. T. Kjaer. A review of the discrete choice experiment—with emphasis on its application in health care. Health Econ Papers No. 1.Syddansk Universitet (2005).

  21. Pinto D, Danilovich MK, Hansen P, Finn DJ, Chang RW, Holl JL, Heinemann AW, Bockenholt U. Qualitative development of a discrete choice experiment for physical activity interventions to improve knee osteoarthritis. Arch Phys Med Rehabil. 2017;98(6):1210-1216.e1.

    Article  PubMed  Google Scholar 

  22. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

    Article  PubMed  Google Scholar 

  23. Vernon M, Leidy NK, Nacson A, Nelsen L. Measuring cough severity: perspectives from the literature and from patients with chronic cough. Cough. 2009;5:5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hulme K, Dogan S, Parker SM, Deary V. ‘Chronic cough, cause unknown’: a qualitative study of patient perspectives of chronic refractory cough. J Health Psychol. 2019;24(6):707–16.

    Article  PubMed  Google Scholar 

  25. Brignall K, Jayaraman B, Birring SS. Quality of life and psychosocial aspects of cough. Lung. 2008;186(Suppl 1):S55–8.

    Article  PubMed  Google Scholar 

  26. Chamberlain SA, Garrod R, Douiri A, Masefield S, Powell P, Bücher C, Pandyan A, Morice AH, Birring SS. The impact of chronic cough: a cross-sectional European survey. Lung. 2015;193(3):401–8.

    Article  PubMed  Google Scholar 

  27. Everett CF, Kastelik JA, Thompson RH, Morice AH. Chronic persistent cough in the community: a questionnaire survey. Cough. 2007;3:5.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dicpinigaitis PV, Tso R, Banauch G. Prevalence of depressive symptoms among patients with chronic cough. Chest. 2006;130(6):1839–43.

    Article  PubMed  Google Scholar 

  29. Maggie Oates KC, Lorrie CI, Storm B, Erica JLW, Brigette MB, Julie P. Audio, video, chat, email, or survey: how much does online interview mode matter? PLoS One. 2022;17(2):e0263876.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors acknowledge the patients who participated in this study, providing important insights into their experiences with chronic cough. We would also like to acknowledge Rebecca Watkin and Liz Wing, who provided medical editing support and written permission to be acknowledged.

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC, 27701, USA

    Theresa Coles, Molly McFatrich, Nicole Lucas, Erin Daniell & Reed Johnson

  2. Merck & Co., Inc., Rahway, NJ, USA

    Helen Ding & Jonathan Schelfhout

  3. Duke Clinical Research Institute, Durham, NC, USA

    Aparna Swaminathan & Reed Johnson

  4. Duke University Medical Center, Durham, NC, USA

    Aparna Swaminathan

  5. Duke-Margolis Center for Health Policy, Durham, NC, USA

    Reed Johnson

Authors
  1. Theresa Coles
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  2. Molly McFatrich
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  7. Jonathan Schelfhout
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  8. Reed Johnson
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Corresponding author

Correspondence to Theresa Coles.

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Funding

Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.

Ethics Statement

This study was approved by the Duke University Institutional Review Board (Pro00106225). All participants provided verbal consent prior to the interview and received remuneration of $100.

Conflicts of interest

Dr. Coles had a consulting agreement with Regenxbio. Dr. Coles, Ms. McFatrich, Ms. Lucas, Ms. Daniell, Dr. Swaminathan, and Dr. Johnson were funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA to conduct this study. Helen Ding is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and shareholders in Merck & Co., Inc., Rahway, NJ, USA. Jonathan Schelfhout was an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA at the time of the study. No other authors have conflicts to report.

Data availability statement

The datasets generated during and/or analyzed during the current study are not publicly available due to the potential of sharing personally identifiable data, but subsets of data are available from the corresponding author on reasonable request.

Author contributions

Dr. Coles designed and is responsible for the study, interpreted results, wrote the draft manuscript, and revised the manuscript. Ms. McFatrich, Ms. Lucas, and Ms. Daniell provided feedback on the design and analysis of the study, assisted with protocol preparation and IRB submission, recruited, enrolled, consented and interviewed participants, conducted analyses, drafted sections of the manuscript, interpreted results, and provided feedback on the manuscript. Dr. Ding and Dr. Schelfhout provided feedback on the design and analysis of the study, interpreted results, and provided feedback on the manuscript. Dr. Swaminathan assisted in recruitment of participants, provided feedback on design of study, interpreted results, and provided feedback on the manuscript. Dr. Johnson provided feedback on design of the study, assisted in development of the interview guides, and reviewed the manuscript.

Consent to participate

Informed verbal consent was obtained from all participants prior to the start of interviews.

Consent for publication

All authors provide this consent.

Code availability

Not applicable.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 73 kb)

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Coles, T., McFatrich, M., Ding, H. et al. Quality of Life in Adults with Chronic Cough: A Mixed Methods Study Informing the Development of a Quantitative Patient Preference Study. Patient 17, 253–262 (2024). https://doi.org/10.1007/s40271-023-00654-7

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  • DOI: https://doi.org/10.1007/s40271-023-00654-7

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