Zeiger Robert S, Schatz Michael, Butler Rebecca K, Weaver Jessica P, Bali Vishal, Chen Wansu
Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
J Allergy Clin Immunol Pract. 2020 May;8(5):1645-1657.e7. doi: 10.1016/j.jaip.2020.01.054. Epub 2020 Feb 12.
The burden of chronic cough (CC) in patients seeking specialist care is infrequently researched.
To describe patient characteristics and disease burden associated with specialist-diagnosed CC.
Using administrative pharmacy and medical data, we identified patients aged 18 to 85 years with CC diagnosed by pulmonologists, allergists, otolaryngologists, or gastroenterologists. Patients were stratified into 4 subgroups on the basis of the presence or absence of common respiratory diseases or gastroesophageal reflux disease (GERD). Clinical features and health care resource utilization (HCRU) in the baseline and outcome years were compared between the CC subgroups. The baseline factors associated with persistence of CC and a comparison of the CC cohort to a matched noncough cohort were also determined.
The 11,290 patients with specialist-diagnosed CC were aged about 61 years and 66.7% were females. The CC cohort experienced frequent GERD (44.1%), asthma (31.2%), obesity (24.3%), upper airway cough syndrome (20.4%), common cough complications (19.4%), and hospitalizations (9.8%). The patients with CC with both respiratory disease and GERD exhibited at baseline and follow-up the most common cough comorbidities, higher HCRU, specialist care, and dispensed respiratory and nonrespiratory medications including proton pump inhibitors, antitussives, psychotherapeutics, oral corticosteroids, and antibiotics compared with the other subgroups. A 40.6% persistence of CC occurred similarly between CC subgroups. In addition, patients with CC in the matched analysis experienced significantly more comorbidities, laboratory evaluations, HCRU, and antitussives than patients without cough.
Specialist-diagnosed CC was associated with considerable disease burden, particularly among those with both respiratory disease and GERD. In addition, CC burden was more pronounced than in matched patients without cough.
寻求专科治疗的慢性咳嗽（CC）患者的负担鲜有人研究。
描述与专科诊断的CC相关的患者特征和疾病负担。
利用行政药房和医疗数据，我们确定了年龄在18至85岁之间、由肺科医生、过敏症专科医生、耳鼻喉科医生或胃肠病学家诊断为CC的患者。根据是否存在常见呼吸道疾病或胃食管反流病（GERD），将患者分为4个亚组。比较了CC亚组在基线年和随访年的临床特征和医疗资源利用（HCRU）情况。还确定了与CC持续存在相关的基线因素，并将CC队列与匹配的非咳嗽队列进行了比较。
11290例经专科诊断为CC的患者年龄约61岁，66.7%为女性。CC队列中GERD（44.1%）、哮喘（31.2%）、肥胖（24.3%）、上气道咳嗽综合征（20.4%）、常见咳嗽并发症（19.4%）和住院（9.8%）的发生率较高。与其他亚组相比，患有呼吸道疾病和GERD的CC患者在基线和随访时表现出最常见的咳嗽合并症、更高的HCRU、专科护理以及包括质子泵抑制剂、止咳药、心理治疗药物、口服糖皮质激素和抗生素在内的呼吸和非呼吸药物的配药情况。CC亚组之间CC持续存在的发生率相似，为40.6%。此外，在匹配分析中，CC患者比无咳嗽患者经历了更多的合并症、实验室检查、HCRU和止咳药。
专科诊断的CC与相当大的疾病负担相关，尤其是在患有呼吸道疾病和GERD的患者中。此外，CC负担比匹配的无咳嗽患者更为明显。
