Change in Psychologic, Physiologic, and Situational Factors in Adults After Treatment of Chronic Cough

We hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL).

Major tenets of the Theory of Unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8 weeks treated in our cough clinic. At baseline, 3 and 6 months, subjects completed 3 Punum Ladders rating cough severity, CQOL Questionnaire, the Depression, Anxiety, and Stress Scales - 21, and the Duke Functional Social Support Questionnaire. Cross-sectional baseline and longitudinal regression analyses were conducted.

80 subjects (55 women), mean age 58.5±11.1 years and cough duration 86.0±123.7 months were enrolled. At baseline, worse cough severity was significantly associated with less education and worse ability to speak bothered by cough and urge to cough. Worse CQOL was significantly associated with worse depression symptoms, urinary incontinence, ability to speak and use of self-prescribed remedies and younger age. Significant improvements in depression and stress symptoms occurred at 3 and 6 months. Anxiety symptoms improved, particularly in the first 3 months. Improvement in cough severity was significantly associated with less education, male gender, and improvement in ability to speak and urge to cough. Improvement in CQOL was significantly associated with improvement in urinary incontinence, urge to cough, anxiety symptoms and use of self-prescribed remedies.

Using the Theory of Unpleasant Symptoms, we have come to appreciate that managing psychological, physiological, and situational factors in addition to just focusing on identifying the cause(s) of cough is important to maximize improvement in CQOL.

Chest. 2017 Jul 03 [Epub ahead of print]

Cynthia L French, Sybil L Crawford, Carol Bova, Richard S Irwin

Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA. Electronic address: ., Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School., Graduate School of Nursing, University of Massachusetts, Worcester, MA., Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.

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