Abstract
Introduction; The management of chronic cough in primary care is poorly understood. A better understanding may facilitate more effective management, by reducing the number of referrals to secondary care. We carried out an observational cohort study to investigate the management of chronic cough in primary care. Methods; We evaluated general practice referral letters and hospital records of 66 consecutive patients attending general respiratory and specialist cough clinics between February 2011 and May 2012. Patients undergoing spirometry, chest X-ray (CXR) and treatment trials of proton pump inhibitors (PPI), oral and inhaled corticosteroids (OCS/ ICS), nasal corticosteroids and antihistamines were recorded. Data was stored in a secure database and analysed using graph pad (California USA).Results;The mean age of patients referred with chronic cough from a primary care centre was 55(15) years, 62% were female and 7.5% were smokers. CXR were performed in 51.5% of patients and 16.6% had spirometry. Trials of PPIs were prescribed in 16.6% of patients. ICS/OCS were prescribed in 34.8% of patients. 6% of patients were prescribed an antihistamine and 12.1% of patients received nasal corticosteroids. Conclusion; These data demonstrate that patients with chronic cough are not receiving the minimum diagnostic standard of CXR and spirometry in primary care (BTS cough guidelines 2006). There is considerable room for improvement for conducting trials of therapy prior to referral to specialist clinics. Secondary care physicians should work together with GPs to address this to achieve earlier diagnosis and treatment of chronic cough.
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