'There is often a high degree of frustration and anger in patients with chronic cough.... Even after a meticulous evaluation, the diagnosis may still be unclear.'

Chronic coughers report anxiety over the possibility of underlying serious illness, uncomfortable public attention, and anger and frustration with their constant coughing -- in addition to the physical discomfort it causes.

The Mayo team's findings, based on a survey of chronic coughers, will be presented as an abstract at the American College of Chest Physicians Chest 2005 meeting in Montreal.

"We are seeking to understand how chronic cough adversely affects the patient socially, psychologically and physically," says Kaiser Lim, MD, Mayo Clinic pulmonologist and allergist and lead study investigator.

"It's important for people with chronic cough to have empathy and realize that there are physicians who are working to help understand this problem," Dr. Lim adds. "For patients with chronic cough, the psychological and physical sufferings appear to be paramount reasons for seeking medical help."

Disruption of Family Life

In a 12-week prospective study, Dr. Lim and colleagues surveyed 146 chronic cough patients about how the condition affected them. The patients completed a questionnaire about their cough-related difficulties and suffering prior to medical evaluation and again six months later.

Of those who took the initial survey, 56 completed the repeat questionnaire.

The top problems for chronic coughers when they were first evaluated at Mayo Clinic -- often as a referral from other medical centers -- were these:

For patients under age 65 with chronic cough, one-third of their spouses or roommates had moved out of the bedroom. Patients also indicated that sleep disturbance due to cough led to daytime exhaustion and fatigue.

"This suggests the possibility of more serious than anticipated disruption of family life," says Dr. Lim.

Long, Tedious Diagnostic Process

Although the typical diagnostic approach for chronic cough -- testing one treatment individually after another -- was designed to be cost-effective and efficacious, according to Dr. Lim, survey results suggest that the long and tedious process wears on patients.

"There is often a high degree of frustration and anger in patients with chronic cough," says Dr. Lim. "This is because in nonsmoking patients who do not have immune system problems, the diagnostic approach for chronic cough is a systematic elimination of probable causes that may cause irritation. There is no single test that will determine what causes chronic cough. Even after a meticulous evaluation, the diagnosis may still be unclear."

An estimated 23 million Americans see their physicians each year for cough, according to Dr. Lim. How many of those have chronic cough -- coughing for more than 21 days -- is yet unconfirmed.

Dr. Lim recently received Mayo Clinic grant funding for further research into the science behind chronic cough and plans to continue his work in the laboratory and with chronic cough patients.