Using 2003–2018 National Ambulatory Medical Care Survey data for office-based visits and 2003–2018 National Hospital Ambulatory Medical Care Survey data for emergency department (ED) visits, we conducted cross-sectional analyses to examine cough medication (CM) use trends in the United States (US) ambulatory care settings. We included adult (≥18 years) patient visits with respiratory-infection-related or non-infection-related cough as reason-for-visit or diagnosis without malignant cancer or benign respiratory tumor diagnoses. Using multivariable logistic regressions, we examined opioid antitussive, benzonatate, dextromethorphan-containing antitussive, and gabapentinoid use trends. From 2003–2005 to 2015–2018, opioid antitussive use decreased in office-based visits (8.8% to 6.4%, P_trend = 0.03) but remained stable in ED visits (6.3% to 5.9%, P_trend = 0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. Benzonatate use more than tripled (office-based:1.6% to 4.8%; ED:1.5% to 8.0%; both P_trend < 0.001). Dextromethorphan-containing antitussive use increased in ED visits (1.8% to 2.6%, P_trend = 0.003) but stayed unchanged in office-based visits (3.8% to 2.7%; P_trend = 0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006–2008 to 2.4% in 2015–2018, P_trend < 0.001) but was negligible in ED visits. In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan-containing antitussive and gabapentinoid use remained low (<3%).

Background: This cross-sectional study estimated prevalence and health-related burden of possible refractory or unexplained chronic cough (RCC). Methods: This secondary analysis of survey data from France, Germany, Italy and Spain included respondents who self-reported current chronic cough (CC; cough ≥8 weeks) and no smoking/vaping, lung cancer history, interstitial lung disease or angiotensin-converting enzyme inhibitor/oral steroid use. Respondents who scored ≥4 (of 10) on a cough severity visual analogue scale and did not report “a great deal” of relief from ≥1 category of eligible medications for CC-associated conditions were included in the possible RCC group; of these, respondents who received ≥2 or 3 categories of eligible medications were also included in possible RCC subgroups 1 and 2, respectively. Remaining respondents were included in the non-RCC group. Demographics/clinical characteristics and cough/health-related burden were assessed. Results: Of 591 respondents with CC, 165 (27.9%) were included in the possible RCC group; 56 (9.5%) and 11 (1.9%) also met criteria for possible RCC subgroups 1 and 2, respectively. The possible RCC group versus non-RCC group had a higher proportion of females (66.7% versus 57.3%; p=0.037), lower mean EuroQoL five-dimension, five-level health questionnaire index (0.72 versus 0.80; p<0.001), lower mean Leicester Cough Questionnaire score (13.49 versus 15.95; p<0.001) and more mean healthcare visits within the past 6 months (9.87 versus 6.26; p<0.001). Conclusion: Up to 27.9% of this European population with CC may have RCC and experience increased health-related burden relative to non-RCC.

Among patients with chronic cough (CC) in the 2012–2021 statewide OneFlorida Clinical Research Consortium database, we examined trends in cough medication (CM) prescribing prevalence over time in repeated cross-sectional analyses and identified distinct CM utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Among eligible adults (≥18 years) without cancer/benign respiratory tumor diagnoses, we identified CC patients and non-CC patients with any cough-related diagnosis. In the GBTM analysis, we calculated the number of monthly prescriptions for any CMs (excluding gabapentinoids) during the 12 months from the first qualifying cough event to identify distinct utilization trajectories. From 2012 to 2021, benzonatate (9.6% to 26.1%), dextromethorphan (5.2% to 8.6%), and gabapentinoid (5.3% to 14.4%) use increased among CC patients, while opioid antitussive use increased from 2012 to 2015 and decreased thereafter (8.4% in 2012, 14.7% in 2015, 6.7% in 2021; all p < 0.001). Of 15,566 CC patients and 655,250 non-CC patients identified in the GBTM analysis, CC patients had substantial burdens of respiratory/non-respiratory comorbidities and healthcare service and concomitant medication use compared to non-CC patients. Among CC patients, GBTM identified three distinct CM utilization trajectories: (1) no CM use (n = 11,222; 72.1%); (2) declining CM use (n = 4105; 26.4%); and (3) chronic CM use (n = 239; 1.5%). CC patients in Florida had limited CM use with increasing trends in use of benzonatate, dextromethorphan, and gabapentinoids and a decreasing trend in opioid antitussive use. CC patients, particularly with chronic prescription CM use, experienced substantial disease burden.

Background: Chronic cough (CC), characterized as a cough lasting >8 weeks, is a common multi-factorial syndrome in the community, especially in older adults. Methods: Using a pre-existing algorithm to identify patients with CC within the 2011–2018 Medicare beneficiaries, we examined trends in gabapentinoid use through repeated cross-sectional analyses and identified distinct utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Individuals without CC but with any respiratory conditions related to cough served as a comparator group. Results: Among patients with CC, gabapentinoid use increased from 18.6% in 2011 to 24.1% in 2018 (p = 0.002), with a similar upward trend observed in the non-CC cohort but with overall lower usage (14.7% to 18.4%; p < 0.001). Patients with CC had significantly higher burdens of respiratory and non-respiratory comorbidities, as well as greater healthcare service and medication use compared to the non-CC cohort. The GBTM analyses identified three distinct gabapentinoid utilization trajectories for CC and non-CC patients: no use (77.3% vs. 84.5%), low use (13.9% vs. 10.3%), and high use (8.8% vs. 5.2%). Conclusions: Future studies are needed to evaluate the safety and effectiveness of gabapentinoid use in patients with refractory or unexplained CC in real-world settings.