Canadian Chronic Cough Initiative

OCT. 6, 2021 MONTREAL – Coughing is one of the most common reasons for visiting a family physician and it can be a symptom of many ailments.

Yet, a cough that does not go away for 8 weeks or more is one of the most challenging conditions for a physician to treat and is often under-recognized and poorly managed.

Those suffering from chronic cough can find it frustrating or even disabling and it can have a major impact on their quality of life. If left untreated, chronic cough can cause incontinence, fractured ribs, anxiety or depression.

Now, for the first time, a team of Canadian and international experts in respiratory medicine, other health care professionals who treat chronic cough and those with lived experience have come together to release the Canadian Chronic Cough Initiative.

Produced by the non-profit organization, Respiplus, the report documents the prevalence of chronic cough in Canada today, its impact on those who have the condition and recommended approaches to diagnosing and managing chronic cough. The report also offers suggestions for improving how we deal with the challenges created by this condition and details the promise of potential new treatments for coughs that will not go away.

“We have to make people aware that they have a medical condition known as chronic cough and that there is something that can be done about it. There’s no need for patients to keep suffering,” says Dr. Imran Satia, assistant professor of respiratory medicine at McMaster University, and a co-author of the report.

“As respiratory specialists we have an obligation to acknowledge just how debilitating chronic cough can be for patients and to use the best tools available to us to properly diagnose and treat it,” says Dr. Paul Hernandez, president of the Canadian Thoracic Society, professor of respiratory medicine at Dalhousie University, Halifax and a co-author of the report.

The report also contains results from a survey of non-physician healthcare providers who deal with chronic cough (primarily respiratory therapist or certified respiratory educators) showing about three-quarters of those polled felt chronic cough was a major health problem.

In this era of COVID-19 the topic is particularly timely as the pandemic has created more issues for patients with chronic cough due to cough being a major symptom of the infection.

“It’s really, really hard to be in public, during COVID, when you could have a cough attack,” says one person. “I’ve been places and having to run out of the store just so I can have my cough attack, because everybody looks at you like you’re infectious and have COVID.”

It is estimated that worldwide the number of people with chronic cough could be as high as 12%. Recent data from Canada suggest the number could be even higher here.

While having a cough of long duration can often be explained by exposure to noxious substances such as smoke or air pollution it is also a symptom of other respiratory diseases and chronic conditions such as bronchitis or reflux disease. However, some adults have a persistent cough despite undergoing numerous tests and treatments. This condition goes by several names, including idiopathic chronic cough, unexplained chronic cough and chronic refractory cough.

couple walking along grass path

Canadian family physicians who helped prepare the report talk about how frustrating and challenging it can be to help their patients suffering from chronic cough and how in many instances they are forced to admit failure.

The Canadian Chronic Cough Initiative outlines how these people with chronic refractory cough can benefit from certain medications and behavioral therapy including speech therapy. It also talks about the value of specialized cough clinics and new medications currently undergoing clinical trials specifically aimed at this hard-to-treat population.

“While medical science has a lot to offer patients with chronic cough, this is also a condition where people can manage their own care and help control the program,” said Dr. Jean Bourbeau, another study co-author and Montreal respirologist who has been instrumental in helping develop self-care programs for patients with several chronic respiratory conditions.

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For access to the full report or executive summary click here.