Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif.
Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
J Allergy Clin Immunol Pract. 2022 Jun;10(6):1587-1597. doi: 10.1016/j.jaip.2022.02.032. Epub 2022 Mar 8.
The identification of patients at high risk for diseases provides clinicians essential information to better manage such patients. Persistent chronic cough (PCC) is a condition with high clinical burden and limited knowledge of the risk factors that drive the persistent symptoms.
To understand the risk factors of PCC in patients with CC diagnosed by specialists.
In this retrospective study, adults aged 18 to 85 years diagnosed with CC by a pulmonologist, allergist, otolaryngologist, or gastroenterologist in the period 2011 to 2016 were identified. PCC was defined by another CC code or at least 2 cough events at least 8 weeks but no more than 4 months apart in each of the 2 consecutive years beginning 1 year after the original CC diagnosis. Unadjusted and adjusted risk ratios with 95% CI for patient characteristics at baseline in relationship to PCC were estimated by Poisson regression models with robust error variance.
Of the adults with CC, 3270 (27.4%) had PCC and 5302 (44.5%) did not have CC during follow-up; 3341 (28.1%) had CC in only 1 follow-up year and were excluded from the analysis. Compared with patients without PCC, patients with PCC were noted to have significantly increased adjusted risk ratios for the following baseline features: (1) demographic characteristics (elderly, females, and less educated); (2) comorbidities (chronic obstructive pulmonary disease, chronic sinusitis, bronchiectasis, pulmonary fibrosis, hypertension, depression, and cough complications); (3) medication dispensed (inhaled corticosteroids/long-acting beta-agonists, leukotriene modifiers, nasal corticosteroids, nasal short-acting muscarinic antagonists, proton pump inhibitors, antitussives with narcotics, and neuromodulators); and (4) specialist care, particularly with pulmonologists.
Knowledge of the independent risk factors associated with PCC should aid clinicians in identifying such patients and improve their management.
识别患有疾病的高危患者可为临床医生提供重要信息，以更好地管理此类患者。持续性慢性咳嗽（PCC）是一种临床负担较高的疾病，但对导致持续性症状的危险因素了解有限。
了解专科医生诊断为 CC 的患者中 PCC 的危险因素。
在这项回顾性研究中，确定了在 2011 年至 2016 年间，由肺病学家、过敏症专家、耳鼻喉科医生或胃肠病学家诊断为 CC 的 18 至 85 岁成年人。PCC 的定义为在最初 CC 诊断后 1 年内的 2 个连续年份中，每个年份至少有 2 次咳嗽事件，每次间隔至少 8 周但不超过 4 个月，或至少有另一个 CC 代码。使用泊松回归模型和稳健误差方差估计基线时患者特征与 PCC 之间的未经调整和调整后的风险比，95%CI。
在 CC 成年人中，3270 人（27.4%）在随访期间患有 PCC，5302 人（44.5%）在随访期间没有 CC；3341 人（28.1%）仅在 1 个随访年内患有 CC，因此被排除在分析之外。与没有 PCC 的患者相比，患有 PCC 的患者具有明显增加的调整后风险比，其基线特征包括：（1）人口统计学特征（年龄较大、女性和受教育程度较低）；（2）合并症（慢性阻塞性肺疾病、慢性鼻窦炎、支气管扩张症、肺纤维化、高血压、抑郁症和咳嗽并发症）；（3）配药（吸入皮质激素/长效β-激动剂、白三烯调节剂、鼻皮质激素、鼻短效毒蕈碱拮抗剂、质子泵抑制剂、含麻醉剂的镇咳药和神经调节剂）；和（4）专科治疗，尤其是肺病学专家。
了解与 PCC 相关的独立危险因素应有助于临床医生识别此类患者并改善其管理。
