People with chronic cough can suffer with this symptom for years without a proper diagnosis and treatment. This is because chronic cough is difficult to diagnose, and there are many causes of cough in general. It is often a diagnosis of exclusion, requiring several consultations with different physicians and specialists and frequently several different tests are needed to rule out other conditions that can cause coughing.
In this blog we will explore what role pharmacists can play in helping identify those patients with acute versus chronic cough in pharmacies and guiding them towards the appropriate resources in order to get a proper diagnosis and treatment.
What is the difference between an acute, sub-acute and chronic cough?
The difference between an acute, sub-acute, and chronic cough is is how long the cough lasts and is related to it’s cause or diagnosis.
Acute cough: will usually last less than 3 weeks often associated with or following an upper respiratory tract infection.
- Sub-acute cough: can last anywhere from 3-8 weeks and can have many underlying causes.
- Chronic cough: is a cough lasting more than 8 weeks and its specific cause may not be known.
Difficulties in Identifying Patients in Pharmacy
It is very difficult to fully assess the number of patients coming into the pharmacy seeking over-the-counter treatments for cough. That is because many people will go straight to the cough and cold section in the pharmacy and select their own products without ever consulting a pharmacist. Pharmacists like most healthcare professionals today, are very busy, and are unable to proactively pursue a discussion with all people with a cough. It is impossible for them to monitor the cough and cold section to watch for these individuals. Unless it is initiated by the individual, a pharmacist will not usually sit down with cough suffers and further investigate their cough symptoms, identify how long they have been coughing and determine the potential triggers or causes. In the end, it is going to be up to the individual with the cough to approach their pharmacist.
Anyone who has ever been to the over-the-counter cough and cold section in any pharmacy can attest to the fact that there are many different types of cough medications available. Unless people actually consult a pharmacist when buying one of the many medications available it is not possible for the pharmacist to capture who is purchasing these products and for what reasons.
Chronic cough is underdiagnosed
Chronic cough is underdiagnosed. The general population and even many healthcare professional view chronic cough more as a symptom and not as separate condition (which it can be). It is difficult to diagnose because it is a relatively new way to look at cough. It sometimes requires many tests and specialists’ visits to really exclude all possible causes. Some possible causes of cough include:
- 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 (now referred to as upper airway cough syndrome) and polyps
When navigating the health care system to get a proper diagnosis, steps will need to be taken by the individual with cough as well as the healthcare team. If patients don’t advocate for themselves, a chronic cough diagnosis can be missed and therefore remain underdiagnosed. Once a diagnosis has been made, then it will help align healthcare providers on the treatments and monitoring.
What Place do Over-the-Counter Cough Preparations Have in Treating Chronic Cough?
Certainly, over-the-counter cough medicines can have a place in helping to relieve symptoms of acute coughs, especially those caused by colds and flus. These non-prescription medications may help in some cases of subacute cough to relieve symptoms. However, chronic cough sufferers sometimes have the mentality that if they are suffering from a cough, all they need to do is go the pharmacy and find the right over-the-counter cough suppressant and voila, no more cough. Obviously, it doesn’t work like that. If there is an underlying cause that is not being treated, they will continue to cough. Cough treatments help to relieve the symptom of cough and do not necessarily treat or remove the underlying cause. Because there are so many brands and types of cough medicine, people will cycle through them thinking they just haven’t found the right one yet. It’s common even to forget what kind of cough medicine they have tried in the past and people often to not make note of the active ingredients of the cough treatment. Instead, they should talk to their pharmacist and have a more systematic approach to arriving at the cause or diagnosis.
The Pharmacist’s Role in Chronic Cough
An important role pharmacists can take is to triage people with chough and provide guidance on information to provide to their doctor or healthcare team. A patient’s background, lifestyle and medical history can be explored with their pharmacist and pharmacists can help patients to keep a diary of their symptoms and triggers. A diary is an efficient way for them to log all relevant information ahead of a doctor’s visit and to not leave out any useful information that a doctor might need to potentially make a chronic cough diagnosis. A good history of the symptoms and a well-kept diary of triggers will make it more efficient for a physician to diagnose the problem.
Smoking is known to be associated with many health problems and conditions and can cause a cough. A very important thing a pharmacist can look at with cough sufferers is their smoking history and, if applicable, assess if now is the right time to start a smoking cessation program and support them. Many pharmacists are well-equipped to support and guide a person to stop smoking.
Examining Potential Triggers
Apart from smoking, a chronic cough can be caused by environmental factors such as air pollution, dust, allergies, acid reflux and even certain medications. Exploring a patient’s background and symptoms closely and reviewing their medications can sometime give pharmacists a clue as to what could potentially be triggering their cough.
Pharmacists can educate a patient on navigating our healthcare system. When to approach their doctor, what information is important, potential causes, what tests are available, what has been tried already, and what medications might help, are all ways pharmacists can aid people to gain the knowledge and to advocate for themselves. They can also educate the patient on what to ask their physician and inform them about potential next tests, steps, or referrals.
Potential Tools to Help Pharmacists
A Diary Template
Although a standard diary template to capture the symptoms and triggers associated with chronic cough does not exist for pharmacists to assess the individual’s situation, a diary can be created with your pharmacist that will capture details such as the following:
- What situations, triggers or environmental factures cause cough
- Dates and times of symptoms, duration, and description of symptoms
- Potential triggers identified, what is usually associated with the cough
- Monitor the frequency of their cough
- What improves the cough (include time, date, duration of improvement)
- Assessing sleep and if cough causes awakening and how frequently
A comprehensive checklist to help patients navigate our healthcare system and get an accurate diagnosis is important and a much-needed tool that needs to be developed. It would be helpful if screening tools and checklists were available in pharmacies for people to self-assess, as well as reminders for pharmacists to also screen patients who have cough.
Medication lists are tools pharmacists already have at their disposal and use frequently. Keeping an up-to-date list of medications including why they are being taken, the benefits, the dose, and how they are best taken, is very helpful for any healthcare professional who may be providing care.
Pharmacists can play an important role in helping to guide, educate, and identify people who potentially suffer from chronic cough when they visit the pharmacy. The pharmacist is an accessible healthcare provider who can discuss concerns regarding cough and may have some solutions. For a chronic cough that is more complicated, the pharmacist can help navigate the healthcare system and provide guidance for the next step in the journey to resolve the issues. More tools need to be developed to help pharmacists guide patients through our healthcare system, which in Canada can sometimes be difficult and complex.
To learn more about chronic cough please go and read our latest report
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.