Kardos Peter, Worth Heinrich, Koehler Ulrich, Horack Martin, Karmann Barbara, Jannowitz Christina, Gillissen Adrian
Lungenzentrum Frankfurt, Frankfurt am Main, Germany.
Pneumologische and Kardiologische Praxisgemeinschaft, Fürth, Germany.
Front Med (Lausanne). 2025 Aug 4;12:1623378. doi: 10.3389/fmed.2025.1623378. eCollection 2025.
Chronic cough (CC) is common in clinical practice, with refractory chronic cough (RCC) and unexplained chronic cough (UCC) being defined by guidelines from the European Respiratory Society, German Respiratory Society (DGP), and German Society of General Practice and Family Medicine (DEGAM) as separate entities. This study aimed to investigate the prevalence of RCC/UCC in an outpatient setting of pulmonologists.
This cross-sectional observational study was conducted in 16 pulmonologists' offices in Germany. Adult patients with a specialist's diagnosis of RCC or UCC and who provided informed consent were included. Active smokers were excluded.
Of 22,140 consecutive out-patients screened, 421 were eligible for general analysis, and 226 met the RCC/UCC criteria per DGP guidelines for prevalence analysis. Among the 421 patients, 71.3% were female, 77.9% had therapy-resistant chronic cough (TRCC), and 22.1% had UCC. The main causes of TRCC were otherwise controlled asthma (59.1%) and gastroesophageal reflux disease (19.1%). Diagnosis had been established on average 6.4 ± 7.6 years prior. Common medications included inhaled corticosteroids (ICS/LABA: 45.6%, ICS mono: 26.8%), and herbal antitussives (23.3%). Codeine was used in 4.3% and morphine in 0.7%. Non-drug therapies like physiotherapy were infrequently used. Prevalence projections for RCC/UCC in Germany were 0.21 and 0.64%, based on different models.
This study, the first in a secondary care setting in Germany to determine RCC/UCC prevalence in outpatients, found a higher prevalence in women and a long history of suffering. These findings underscore the need for improved diagnostic procedures and new therapeutic developments for RCC/UCC. Key limitations include the potential impact of the Covid-19 pandemic on data collection, a relatively small UCC sample, and potential referral bias due to the secondary care setting.
慢性咳嗽（CC）在临床实践中很常见，难治性慢性咳嗽（RCC）和不明原因慢性咳嗽（UCC）被欧洲呼吸学会、德国呼吸学会（DGP）以及德国全科和家庭医学学会（DEGAM）的指南定义为不同的实体。本研究旨在调查肺科门诊中RCC/UCC的患病率。
这项横断面观察性研究在德国的16个肺科医生办公室进行。纳入经专科医生诊断为RCC或UCC且提供知情同意的成年患者。排除当前吸烟者。
在连续筛查的22140名门诊患者中，421名符合一般分析条件，226名符合DGP指南的RCC/UCC标准用于患病率分析。在这421名患者中，71.3%为女性，77.9%患有治疗抵抗性慢性咳嗽（TRCC），22.1%患有UCC。TRCC的主要原因是其他方面得到控制的哮喘（59.1%）和胃食管反流病（19.1%）。诊断平均在6.4±7.6年前确立。常用药物包括吸入性糖皮质激素（ICS/LABA：45.6%，单用ICS：26.8%）以及草药止咳药（23.3%）。4.3%的患者使用可待因，0.7%的患者使用吗啡。很少使用物理治疗等非药物疗法。基于不同模型，德国RCC/UCC的患病率预测分别为0.21%和0.64%。
本研究是德国二级医疗环境中首次确定门诊患者RCC/UCC患病率的研究，发现女性患病率较高且患病时间长。这些发现强调了改进RCC/UCC诊断程序和新治疗方法开发的必要性。主要局限性包括新冠疫情对数据收集的潜在影响、相对较小的UCC样本以及二级医疗环境导致的潜在转诊偏倚。
