Virtual Consultations Provide Effective Care to Patients With Chronic Cough

Virtual visits to Emory University’s Multidisciplinary Chronic Cough Clinic (MDCCC) via synchronous, 2-way audiovisual encounters demonstrated effectiveness in managing patients with complex chronic cough in lieu of in-person consultations during the COVID-19 pandemic.

Data from 30 virtual MDCCC consultations for patients with refractory chronic cough before management were evaluated in research published in International Forum of Allergy & Rhinology. Patients had a mean age of 60.2 years and mean cough duration of 5.2 years. The mean Cough Severity Index score, available for 26 of the patients, was 23.72 of 40, suggesting significant baseline symptoms.

The primary underlying cough diagnoses were cough hypersensitivity syndrome (CHS), consistent with neurogenic cough/irritable larynx syndrome in 13 (43.3%) patients, reflux/esophageal dysmotility in 13 (43.3%), and unrecognized angiotensin-converting enzyme inhibitor use, asthma, interstitial lung disease, and chronic eosinophilic pneumonia in 1 (0.03%) each. Associated possible contributors and secondary diagnoses included CHS in 10 (33.3%) patients, gastroesophageal reflux disease in 2 (0.06%), asthma in 2 (0.06%), and upper airway cough syndrome in 1 (0.06%).

During the virtual consultations, providers administered limited examinations and gathered patient information to determine their present illness and past medical histories. Specialists across different health care sectors, including allergy, immunology, pulmonology, interventional pulmonology, gastroenterology, otolaryngology, and speech-language pathology, collaborated to formulate clinical plans and recommend further testing based on this initial evaluation.

Interprofessional collaboration within the virtual MDCCC allowed patients to see upward of 5 providers simultaneously while maintaining clinical efficiency.

Patients were contacted to complete a postencounter survey consisting of 5 questions rating satisfaction levels with their virtual consultation on a scale from 0 to 10. Of the 30 patients who received virtual consultations, 17 (56%) responded.

The authors’ findings showed:

• 13 (76.4%) respondents rated the convenience of seeing multiple providers via a single visit as 9 or 10
• 15 (88%) strongly agreed that the treatment plan was clearly communicated and that the providers explained their condition in an understandable manner
• 13 (76.4%) rated their comfort seeing the providers using telemedicine as 9 or 10.
• 12 (70%) stated that they would strongly recommend the virtual MDCC to others.

Although the survey results demonstrated that the virtual MDCCC provides efficient services for patients with chronic cough, “a larger study is needed to show the benefits of this care model, including streamlined diagnosis, patient outcomes, and decreased health care costs,” the authors concluded.

Unexplained chronic cough, as defined by a persistent cough lasting more than 8 weeks, is a significant problem, with 5% to 10% patients seeking medical assistance and 46% patients receiving referrals to specialists. Due to its multifactorial nature, determining the etiology and management of chronic cough is challenging. These challenges often lead to fragmented evaluation by different medical specialties, excessive testing, and duplication of efforts.

Reference

Kuruvilla M, Hatcher J, Shelly S, et al. Virtual interprofessional chronic cough clinic: An efficient and appealing approach to a complex problem. Int Forum Allergy Rhinol. Published online April 17, 2021. doi:10.1002/alr.22805