A real world study of cough burden and quality of life of UK patients who have undergone evaluation for chronic cough

Figures & data

Table 1. Variables collected.

	Patient survey
Demographics and cough characteristics	Age Sex at birth Ethnic origin Highest level of education attained Geographic region Number of adults and children living in household (numerical) Employment status Annual household income (2018) Length of time since first experienced existing cough Cough-VAS - Perceived severity of cough over past 2 weeks* Burden of cough on ability to travel Whether cough symptoms are seasonal / more severe at a certain time of year Time of year that cough is most severe General attitudes and opinions related to management and treatment *The Cough VAS (Visual Analogue Scale) is a vertical 100 mm linear scale on which the subject was asked to mark the severity of their cough within a specific time period between ‘no cough’ (0 mm) and ‘worst ever cough’ (100 mm). The VAS is widely used for the subjective assessment of cough because it is brief, easy to use and is able to assess symptom severity in isolation. In addition to chronic cough, the VAS has also been evaluated in acute and sub-acute cough.
Current health status	EQ5D-VAS – Current perceived general state of health EQ5D-5L – Current perceived health status across 5 domains including ability to walk, wash or dress, conduct usual activities, degree of pain / discomfort and anxiety/depression Patient reported description of general health Patient reported smoking history Diagnosed concomitant conditions ever and currently experienced The EQ-5D (EuroQol 5 dimension) descriptive health profile collects patient responses on mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Patient responses are converted into a continuous summary score that ranges from just less than 0–1, where a higher score indicates a better quality of life. The algorithm used to convert patient responses into a summary score varies by country. The Euro QoL Visual Analogue Scale (EQ-5D VAS) records the patient’s self-rated health on a vertical visual analogue scale, where the endpoints are labelled ‘100- The best health you can imagine’ and ‘0-The worst health you can imagine’.
Impact of cough on quality of life (Leicester Cough Questionnaire)	LCQ: Assessment of cough impact on various aspects of life in past 2 weeks The LCQ is a 19-item questionnaire which measures the effect of cough in three domains: psychological, physical and social. It creates four scores: a psychological domain score, physical domain score, social domain score and total score. The LCQ has been shown to have a significantly strong correlation with cough severity VAS (rs = −0.72) and a strong repeatability in all its scores.
Diagnostic pathway (including the associated burden)	Diagnostic testing completed as part of chronic cough evaluation Types of tests repeated as part of chronic cough evaluation with these HCPs Perceptions around suitability of care received Attitudes and behaviours around type of care received for cough Whether they followed their doctor’s advice Whether they understood why their doctor(s) prescribed the medication that they did
Cough referral pathway and HCP-patient relationships	Duration of time following onset of symptoms that patient first spoke to a doctor or nurse about cough Reason that prompted patient to first talk to doctor or nurse about cough Types of HCP consulted for cough since onset of cough symptoms Frequency of consultations with HCPs seen Whether they understood why their doctor(s) prescribed the testing that they did Whether they have stopped seeking further medical attention due to a lack of success in treating cough
Impact of cough on daily living and work productivity (WPAI)	Hours of work missed during past 7 d due to chronic cough (numerical) Hours of work missed during past 7 d for any other reason (numerical) Hours worked in past 7 ds (numerical) Impact of chronic cough on productivity while working during past 7 days Impact of chronic cough on ability to undertake regular daily activities during the past 7 d The WPAI is an instrument for assessing work productivity. Over a 7-day recall period, six questions assess the percentage of work time missed (absenteeism), the percentage of time impaired while at work (presenteeism), the percentage of overall work impairment, and the percentage of activity impairment. With the exception of the last subdomain, which assesses regular day to day activities, the WPAI is relevant only for those patients in some form of employment.
Cough treatment patterns	Prescription treatments received for cough symptoms (anti-tussives, anti-epileptics, proton pump inhibitors, H2 blockers, nasal, inhaled and oral corticosteroids, anti-histamines, morphine, codeine, amitriptyline etc.) Satisfaction with individual prescription treatments received in terms of relieving cough Duration of time with which cough symptoms were relieved, if at all Non-prescription treatments received via. pharmacy for cough symptoms (cough drops, cough syrups, anti-histamines, decongestants, expectorants etc.) Monthly out-of-pocket spend on prescription medications (£) Monthly out-of-pocket spend on non-prescription medications (£) Home remedies tried for cough symptoms (herbal supplements, neti-pots, saline sprays, Chinese medicine etc.)

Table 2. Demographic characteristics.

Characteristic	Value
Age, years (n = 101)
mean ± SD	54.9 ± 15.2
median (interquartile range)	55.0 (46.5, 65.0)
Gender (n = 99)
female/male, n (%)	70 (70.7)/29 (29.0)
Ethnic origin (n = 98)
White, n (%)	83 (84.7)
Asian, n (%)	7 (7.1)
Black, n (%)	3 (3.1)
Mixed ethnic group, n (%)	4 (4.1)
Other, n (%)	1 (1.0)
Smoking status (n = 99)
Never smoked , n (%)	59 (60)
Previous smoker, n (%)	40 (40)
Duration of chronic cough, months (n = 93)
mean ± SD	94.6 ± 130.2
median (interquartile range)	36.0 (11.0, 120.0)
Highest completed level of education (n = 98)
University degree or post-graduate university degree, n (%)	37 (37.8)
Higher education (non-degree), n (%)	10 (10.2)
A levels/Highers, n (%)	15 (15.3)
GCSE/Standard grade, n (%)	15 (15.3)
Some secondary school, n (%)	16 (16.3)
Less than secondary school, n (%)	2 (2.0)
Other, n (%)	3 (3.1)
Employment status (n = 99)
Full time, n (%)	41 (41.4)
Part time, n (%)	11 (11.1)
Retired, n (%)	27 (27.3)
Currently receiving prescribed treatment for cough (n = 101)
Yes, n (%)	80 (79.2)
No, n (%)	12 (11.9)
Duration of currently prescribed treatments, weeks (n = 80)
mean ± SD	177.3 ± 398.6
median (interquartile range)	44.0 (6.0, 156.0)
Currently prescribed treatments (n = 92)
Inhaled steroid, %	26
Beta agonist, %	24
Proton pump inhibitor, %	21
Nasal steroid, %	19
Second generation antihistamine, %	14
Cough suppressant, %	12
Neuromodulator, %	12
Cough drops/syrup, %	7
Antibiotic, %	5
Oral steroid, %	5
Decongestant, %	3
Ever purchased over the counter medication for chronic cough (n = 101)
Yes, n (%)	71
No, n (%)	29
Ever tried home remedies for chronic cough (n = 101)
Yes, n (%)	39
No, n (%)	61

Table 3. Impact of chronic cough on patient-reported outcomes.

Patient-reported outcome	Score
Cough VAS, mean ± SD (n = 97)
Severity of cough in last 2 weeks	51.3 ± 22.9
Severity of cough on worst day in last 2 weeks	62.9 ± 23.7
EQ-5D VAS, mean ± SD (n = 100)	68.3 ± 20.4
EQ-5D-5L utility index, mean ± SD (n = 96)	0.7 ± 0.3
EQ-5D-5L – Domain – Mobility, n (%), (n = 99)
I have no problems in walking about	56 (56.6)
I have slight problems in walking about	22 (22.2)
I have moderate problems in walking about	15 (15.2)
I have severe problems in walking about	5 (5.1)
I am unable to walk about	1 (1.0)
Missing / No Response	(2)
EQ-5D-5L – Domain – Self-Care, n (%), (n = 98)
I have no problems washing or dressing myself	75 (75.8)
I have slight problems washing or dressing myself	17 (17.2)
I have moderate problems washing or dressing myself	4 (4.0)
I have severe problems washing or dressing myself	3 (3.0)
I am unable to wash or dress myself	- (-)
Missing/No Response	(3)
EQ-5D-5L – Domain – Usual Activities, n (%), (n = 99)
I have no problems doing my usual activities	53 (53.5)
I have slight problems doing my usual activities	26 (26.3)
I have moderate problems doing my usual activities	11 (11.1)
I have severe problems doing my usual activities	9 (9.1)
I am unable to do my usual activities	- (-)
Missing/No Response	(2)
EQ-5D-5L – Domain – Pain/Discomfort, n (%), (n = 98)
I have no pain or discomfort	39 (39.8)
I have slight pain or discomfort	34 (34.7)
I have moderate pain or discomfort	14 (14.3)
I have severe pain or discomfort	8 (8.2)
I am extreme pain or discomfort	3 (3.1)
Missing / No Response	(3)
EQ-5D-5L – Domain – Anxiety/Depression, n (%), (n = 99))
I am not anxious or depressed	50 (50.5)
I am slightly anxious or depressed	30 (30.3)
I am moderately anxious or depressed	12 (12.1)
I am severely anxious or depressed	5 (5.1)
I am extremely anxious or depressed	2 (2.0)
Missing / No Response	(2)
Total LCQ, mean ± SD (n = 101)	12.5 ± 3.7
LCQ Physical subdomain, mean ± SD (n = 101)	4.4 ± 1.3
LCQ Psychological subdomain, mean ± SD (n=)	4.0 ± 1.3
LCQ Social subdomain, mean ± SD (n=)	4.1 ± 1.4
WPAI work impairment
Absenteeism, % (n = 44)	4.5
Presenteeism, % (n = 45)	27.6
Overall work impairment, % (n = 43)	30.3
WPAI activity impairment, % (n = 97)	34.7

Abbreviations. EQ-5D-5L, EuroQuality of life-5 Dimension 5 Level; VAS, visual analog scale; WPAI, work productivity and activity impairment.

Figure 1. Leicester cough questionnaire social, psychological and physical domains.

Figure 2. Work productivity and activity impairment (WPAI) showing mean percentage impairment.