Journal of Health and Medical Sciences
Published: 12 August 2020
Approach of Primary Physicians in the Management of Chronic Cough, in Najran City, Saudi Arabia
Nasser Saeed Alqahtani
Najran University, KSA
Download Full-Text Pdf
Keywords: Chronic Cough, Primary Care, Physicians, Approach
Background: Chronic cough can impair quality of life, with serious biomedical and psychosocial impacts. This condition should be managed well by physicians at primary health care level. Objective: To evaluate the approach of primary physicians in the management of chronic cough. Materials and Methods: Cross-sectional study was conducted using an interviewer-administered questionnaire from September 2018-March 2019 in Najran City, Saudi Arabia. All primary physicians (n = 134) working at different primary health care facilities during the study period who agreed to participate were included. Results: The prevalence of chronic cough at primary physician's practice was 25%. The study revealed around 61 % of primary physicians (n=134) have good clinical experience of the management of chronic cough despite the widespread of clinical guidelines. They make definitive diagnosis of chronic cough as following; 66% based on history &physical examination,61% based on further tests and 60 % based on response to empiric therapy. They diagnose their cases secondary to allergy (63%), inflammation (60%), infection (59%), medications (42%) and malignancy (33%). The study showed inadequacy of participants in treating the chronic cough; 63% prescribe a decongestant & an antihistamine for upper airway cough syndrome (UACS), 81% prescribe an inhaled bronchodilators or corticosteroids for asthma, 79% prescribe an antacid agent for gastro-esophageal reflux disease (GERD) and 60% refer to specialized clinic. About 46% of participants approach the child with chronic cough as same as adult approach. Conclusion: Chronic cough is high prevalent in practice of primary care physicians. Although the widespread dissemination of management guidelines of chronic cough, the inadequacy in clinical practice of primary physicians still occurs. Design educational programs and increased awareness for patients and their families about chronic cough are responsible solutions.
Chang AB, Glomb WB. Guidelines for Evaluating Chronic Cough in Pediatrics. Chest.2006 Jan;129(1 Suppl):260S-283S.
Irwin RS, Madison JM. The Diagnosis and Treatment of Cough. N Engl J Med. 2000 Dec 7;343(23):1715-21.:10.1056/NEJM200012073432308
O'Grady KAF, Grimwood K, Toombs M, Sloots TP, Otim M, Whiley DM et al. Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: Protocol for a randomised controlled trial. BMJ Open. 2017 Mar 1;7(3):1-12.
Roberto Walter Dal Negro, Massimiliano Povero, Alessandro Zanasi, Paola Turco. Persistent Cough: Changes in Prevalence, Impact, and Beliefs From 2006–2015 in Italy. EMJ. 2019;4:55-62.
Mahashur A. Chronic dry cough: Diagnostic and management approaches. Lung India. 2015;32(1):44–49. :10.4103/0970-2113.148450.
Mackley R, Schatzberger T, Parker S. S34 Management of chronic cough in primary careThorax 2013;68:A20.
Park, D. (1) “A clinical review of chronic cough from a primary care perspective”, Osteopathic Family Physician, 3(1), pp. 2-9. Available at: (Accessed: 27July2020).
Lai, K., Shen, H., Zhou, X., Qiu, Z., Cai, S., Huang, K., et al. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis. 2018;10(11):6314–6351. .
Irwin RS, French CL, Chang AB, Altman KW; CHEST Expert Cough Panel*. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest. 2018;153(1):196–209. .
Nantha YS. Therapeutic-diagnostic Evaluation of Chronic Cough Amongst Adults: Causes, Symptoms and Management at the Primary Care Level, Malaysia. J Family Med Prim Care. 2014;3(3):207–212. :10.4103/2249-4863.141611.
Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):1S–23S. :10.1378/chest.129.1_suppl.1S.
Morice AH, McGarvey L, Pavord I; British Thoracic Society Cough Guideline Group. Recommendations for the management of cough in adults. Thorax. 2006;61 Suppl 1(Suppl 1):i1–i24. :10.1136/thx.2006.065144.
Poulose V, Tiew PY, How CH. Approaching chronic cough. Singapore Med J. 2016;57(2):60–63. :10.11622/smedj.2016028.
Irwin R.S., Glomb W.B., Chang A.B. Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. CHEST.2006, Volume 129, Issue 1, 174S - 179S. .
Chang AB. Cough: are children really different to adults? Cough. 2005;1:7. Published 2005 Sep 20. :10.1186/1745-9974-1-7.