In medical school, chronic cough is not given as much attention as other chronic respiratory diseases. Some examples of other chronic respiratory diseases that are taught much more in depth than chronic cough are:
- Chronic Obstructive Pulmonary disease (COPD) and
- Interstitial Lung Diseases/Pulmonary Fibrosis
Chronic Cough is often times still thought of as a symptom of another disease process and not a separate disease in itself. Which, in many cases, it is.
In this blog we will look at the importance of education in chronic cough. Education in chronic cough is important for medical school students, residents, and physicians alike.
Chronic Cough is Not a Focus in Medical School Education
Medical students are given a broad overview of chronic diseases. Pulmonary physiology is extensively covered but currently chronic cough is not. Even though, cough is one of the chief complaints that will cause patients to consult their family doctor, a walk-in clinic, or a respiratory specialist.So why is there not a lot of focus on it? Because cough is still largely viewed as a symptom of another problem. Chronic cough can be caused by:
- Colds, flu and allergies.
- Environmental irritants such as smoke and pollution.
- Gastroesophageal reflux (GERD).
- Lung conditions such as asthma, COPD, pulmonary fibrosis, and bronchiectasis.
- Post nasal drip and nasal polyps.
With this many possible causes to rule out, chronic cough is barely touched upon as a separate disease in medical school even if it can impact a large number of potential patients.
Chronic Cough in Specialty Training
When looking at the most recent guidelines and objectives for training from the Royal College of Physicians and Surgeons of Canada (RCPSC) for a specific specialty in medicine, (e.g. respirology), only a small proportion mention chronic cough as a specific training objective. Specialist and general practitioners in their day-to-day practices are going to see a good proportion of chronic cough and yet the training is somewhat lacking.
The amount of exposure to chronic cough when in-training in a specialty can depend on:
- Individual clinical experience rotating through different clinics
- The attending physician’s (physician who supervises medical students and residents) level of interest in chronic cough and their own personal approach to diagnosis and treatment.
The amount of exposure to chronic cough when in-training can vary greatly from center to center, clinic to clinic and even attending to attending.
What about Current Canadian Guidelines?
In Canada there are currently no guidelines available for chronic cough. The American College of Chest Physicians (ACCP) has some guidelines that follow the limited evidence available on treatment and management of chronic cough.
With the lack of guidelines, a lot of what is learnt about chronic cough will come from actual clinical experience managing these patients and continuing medical education and presentations.
How to Integrate Chronic Cough Education in Medical Schools and for Specialists in Training
In Canadian medical schools today, there is more and more emphasis on case-based learning. As such, incorporating cases of patient’s presenting with chronic cough will allow medical students to see that yes, chronic cough can be a symptom of disease which is important to diagnose and treat. But also, that there are patients out there that do not respond to treatment, and chronic cough as a separate disease by itself should be considered. Case studies can also help demonstrate how chronic cough can have a significant impact on a patient’s quality of life.Family doctors and different specialist will see chronic cough in their practice, not just respiratory specialists. Gastroenterologists, allergists, and ENTs will all see these types of patients in their practice. Cased based learning will help all specialists and make them aware of chronic cough’s existence. Chronic cough should be integrated in the medical school curriculum just like asthma, COPD, lung cancer and sarcoidosis are. Formal teaching through lectures and rotating in chronic cough clinics would be another way to teach specialist about chronic cough as they will be seeing the referrals from primary care practitioners who need extra help in treating this disease.
Putting the word out there that patients with chronic cough exist, that they are suffering and that their daily lives are clearly impacted is important. Continuing education targeting health care practitioners will help patients access things such as proper testing for diagnosis and treatment. One thing that has had some success is for family physician and specialists organizations spreading the word about chronic cough to their members through continuing education capsules. National medical societies have been approached to try and form a standalone committee on chronic cough they same way that these committees already exist for asthma, interstitial lung disease or COPD.
Healthcare professionals in the field like nurses, pharmacists, family doctors and respiratory therapists who often see chronic cough patients first, could be trained to recognize that although cough is often a symptom of an underlying condition, there will exist a proportion of patients who have stubborn cough with no clear source; unexplained chronic cough, which should be seen as a disease in itself.
Impact of COVID-19 on Chronic Cough
COVID-19 has made it even more disabling for chronic cough sufferers in their everyday lives. Many patients are scared to go in public for fear of being discriminated against because they are coughing and the people around them thinking they are contagious and have COVID-19. Chronic cough can also develop as a consequence of COVID-19.
So, that is why now more than ever we must put chronic cough in the spotlight, acknowledge it exists and have the right tools in place to diagnose and treat these patients.
If you would like to learn more about chronic cough, please go and read our latest report
The Importance of Education in Chronic Cough
About the author
Katrina Metz is currently working as a consultant for RESPIPLUS, striving to improve education in the respiratory domain for healthcare professionals and patients alike. She has over 16 years experience working as a respiratory therapist and clinical research coordinator for the Research Institute of the McGill University Health Center.