Chest
Original ResearchCoughEffect of the Management of Patients With Chronic Cough by Pulmonologists and Certified Respiratory Educators on Quality of Life: A Randomized Trial
Section snippets
Study Design
The study was an 8-week, prospective, randomized, parallel-group, clinical trial approved by the University of Calgary, Calgary Health Region Office of Medical Bioethics (Calgary, AB, Canada). Blinding was not feasible.
Outcome Measures
The primary objective was to determine whether CREs can improve the QOL of patients with chronic cough. The secondary objectives were to determine whether CREs could improve QOL in patients with chronic cough to the same extent as patients seen only by MDs, the effects on the
Results
After appropriate screening, 198 patients (44% of the patients attending the chronic cough clinic) were randomized to care by an MD or a CRE. Reasons for exclusion from the study were an abnormal chest radiograph finding or previously recognized lung disease (25%), other comorbidities (13%), or worrisome symptoms (9%) [Fig 2]. Only 9% of referred patients were unwilling to participate in this study, were unable to return for follow-up, or were excluded because of limited language skills.
Discussion
This study demonstrated that CQLQ improved in patients with chronic cough after 8 weeks of CRE management. The screening process identified patients who can be managed safely by CREs, and their outcomes were as good as those of patients with chronic cough managed by MDs. The use of CREs reduced wait times and was cost-effective.26 CREs are employed across Canada, and extending their mandate to include chronic cough should be feasible in other Canadian centers.
There were other differences
Acknowledgments
Author contributions: Dr. Field had full access to the data in the study, and takes responsibility for the integrity and accuracy of the data. Data were acquired and analyzed by Ms. Conley, Drs. Field, Leigh, and Cowie, and Mr. Thawer. Drs. Field and Cowie were responsible for the study concept and design. Dr. Field drafted the manuscript. All of the authors critically revised the manuscript. No medical writer was involved in the drafting or editing of the manuscript. All of the authors
References (0)
Cited by (16)
Assessment of intervention fidelity and recommendations for researchers conducting studies on the diagnosis and treatment of chronic cough in the adult: CHEST guideline and expert panel report
2015, ChestCitation Excerpt :There was no mention of whether there was deviation from the protocol or guideline on the part of the interventionist in any of the studies reviewed. As summarized from Table 2, 56.5% (13 of 23)21,23,24,26,29–33,37–40 of the studies were conducted in general respiratory clinics, 17.4% (four of 23)4,25,27,34 in cough specialty clinics, and 26.1% (six of 23) in a variety of other types of primary care, hospital, or general medicine clinics.22,28,35,36,41,42 All but three of the studies21,23,37 appeared to have multiple physicians participating in patient management.
Tools for assessing outcomes in studies of chronic cough: CHEST Guideline Expert Panel report
2015, ChestCitation Excerpt :In brief, the approach required assessment of four domains: risk of bias, consistency, directness, and precision. These domains were considered qualitatively, and a summary rating of high, moderate, or low strength of evidence was assigned after discussion by two reviewers (R. R. C. and D. C. M.) (Table 2).14,16,19–22,24,29,31,32,34–36,39–100 In some cases, high, moderate, or low ratings were impossible or imprudent to make.
Evaluating cough assessment tools: A systematic review
2013, ChestCitation Excerpt :Seventy-eight studies met the inclusion criteria for this review.6–83 Eight studies were randomized controlled trials9,31,34,56,69,70,72,76; the remaining 70 were observational studies. Forty-two studies reported outcomes for a tool measuring cough frequency, and 56 reported outcomes for a tool measuring cough impact.
The difficult-to-treat, therapy-resistant cough: Why are current cough treatments not working and what can we do?
2013, Pulmonary Pharmacology and Therapeutics
Funding/Support: Innovation funding was provided by the Calgary Health Region Department of Medicine for salary support.
This article was presented at the American Thoracic Society International Meeting in May 2008.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).