What is the most common symptom that brings patients in to see their family doctor? Cough. In fact, Chronic Cough makes up to 40% of patient referrals to lung specialists despite there being no evidence of lung disease in most of these cases. Specialized chronic cough clinics can help diagnose patients, help them understand why they cough, offer solutions, and improve their quality of life. They can also be a cost-effective option for our current fragile healthcare system.
In this blog we will explore the challenges of chronic cough and why we need chronic cough clinics, how to set up them up, and the challenges faced.
Challenges of Chronic Cough
Although most cases of chronic cough are not life threatening, it does have a major impact on one’s quality of life.
Chronic cough sufferers will often:
- Miss work, school, or social activities.
- Quit their jobs (leading to money and family troubles)
- Self isolate
- Suffer from anxiety and depression
- Become embarrassed or stigmatized in public (especially in the age of COVID-19)
70% of cough sufferers who see a lung specialist for chronic cough are found to suffer from things like asthma, COPD, reflux, post nasal drip or upper airway disease. So, what about the other 30%? They suffer from cough hypersensitivity syndrome.
An Interesting Condition: Cough Hypersensitivity Syndrome
Cough hypersensitivity syndrome is an interesting condition requiring a different treatment approach from other lung conditions causing cough. This syndrome has parallels with nerve pain conditions. The nerve fibers responsible for causing cough in the bronchial tubes are denser and more sensitive to irritants. So, chronic cough in some cases has an actual neurological basis. Some people respond to speech therapy, cough avoidance and cough suppressive techniques, and breathing exercises to help them disrupt coughing fits. Some nerve pain medications have shown success in treating chronic cough, but it’s important to understand which patients should be given these medications and which shouldn’t. This is where specialized cough clinics can really help.
Setting Up a Chronic Cough Clinic
The Dream Team
When setting up a chronic cough clinic, there is obviously a difference between the ideal situation and reality. The ideal model would include:
- A respiratory specialist
- Dedicated cough educators
- Trained speech therapist
- Rapid access to a gastroenterologist, ear nose and throat and an allergy specialist
- Fast access to a pulmonary function lab and diagnostic imaging
Again, this list is the ideal model or “dream team”. Budget restriction and staff shortages being what they are today make this model difficult if not impossible to fulfill.
A More Reasonable Model
A more reasonable model would have a respiratory specialist in charge, not only to diagnose and follow chronic cough patients, but to manage referred patients with respiratory disorders like COPD, bronchiectasis, cancer, and other lung diseases, and conditions that can mimic lung disease. These patients need to be assessed by a physician.
Along with a respiratory specialist, a trained cough specialist in the form of a nurse, pharmacist or certified respiratory educator (CRE) is needed for a chronic cough clinic to operate. A CRE will explain the details of chronic cough, cough avoidance and suppressive strategies and breathing exercises to help avoid coughing fits.
Roadblock to Setting up a Chronic Cough Clinic
It should come as no surprise that the biggest hurdle in setting up a chronic cough clinic is budget. Convincing an administrator to invest in a chronic cough clinic now is difficult. But administrators should look at the bigger picture when analysing the cost of a specialised cough clinic and the money these clinics can save the healthcare system in the long run. Not to mention the patients they benefit.
Cough Clinics; A Cost-Effective Approach to Helping Patients
There are several reasons why a chronic cough clinic can help patients and be a cost-effective approach in managing this condition. Chronic cough clinics can:
- Diagnose patients faster and reduce wait times: often, before a diagnosis is made, it can take several years of doctor’s visits and referrals (which can be very costly).
- Avoid unnecessary testing.
- Prevent patients from taking unnecessary prescription medications that are not effective.
- Avoid missed days of work, school, and disability payments.
- Support in managing anxiety and depression that is common.
- Cost much less to run by a CRE than the cost of these cases being managed by a physician alone.
- See chronic cough sufferers that respiratory specialists do not necessarily want to take on as patients because they don’t have a diagnosed lung condition causing cough.
- Try different (out of the box) techniques such as speech therapy that can work very well for some patients.
Specialised Chronic Cough Clinics in Canada
In Canada, we have dedicated cough clinics in Alberta and Ontario. The demand is such, that they get emails from patients wanting an appointment from across Canada and even the US. Other Provinces are taking an interest and are sending healthcare professionals like nurses and respiratory therapists to tour these established clinics. They get an idea of what it takes to set up and run a clinic in their province. Canada could support 6-10 chronic cough clinics spread across the country, and they would all be very busy.
Chronic Cough is a condition that has a significant impact on the quality of life of its sufferers. The more we learn about chronic cough, the more we understand that it requires a multi-faceted approach to treatment. Specialized clinics can help diagnose patients faster, get them the right treatment and significantly improve their quality of life. As more and more people are diagnosed with chronic cough the need for these clinics will continue to grow.
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.