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Cough wg summit 2018


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WG Minutes REG Summit 2018

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Cough wg summit 2018

  1. 1. CHAIR: Lorcan McGarvey DATE: Thursday 22nd March 2018 TIME: 14:00-15:30 VENUE: Park Plaza Hotel, Amsterdam Airport Cough Working Group Meeting
  2. 2. Agenda 1) Update on current project- ‘Burden of cough in UK primary care’. 2) Other research needs in the area of cough and ideas to address them.
  3. 3. 1) Update on current project Burden of cough in UK primary care
  4. 4. Background & Rationale There is a lack of information regarding the extent of the problem and types of cough seen in primary care where most patients are managed. Understanding the burden of cough and its characteristics in general practice will provide a basis to allow future research into chronic cough. Acute cough (<3 wks duration) • Common occurrence usually seen with viral upper respiratory tract infections, but also may occur due to bacterial infections, inhaled foreign bodies or toxic fumes, and in acute asthma or COPD exacerbations2. Subacute cough (lasting 3-8 wks) • Typically post-viral or due to Bordetella pertussis (whooping cough)3. Chronic cough (>8 wks duration, often persisting for months or years) • One of the most common clinical problems seen by doctors in both general and hospital practice4. • Usually caused by asthma, GERD and upper airway cough syndrome • Can be a significant problem for patients with pulmonary conditions, e.g. COPD, lung cancer, IPF and bronchiectasis, and other non-pulmonary conditions, e.g. heart failure2. • May be due to ACE inhibitor medication or occupational/environmental factors, e.g. tobacco smoke3. • In ~20% of referrals to cough clinics chronic cough is considered idiopathic after extensive investigations and treatment trials2. • Can be very difficult to treat especially where no cause is found2. • Is associated with a significant impairment in health status7
  5. 5. To determine the epidemiological pattern and characteristics of cough in UK primary care. Specifically: 1) Prevalence and incidence of cough in UK primary care 2) Demographic and clinical characteristics associated with cough in UK primary care Objectives
  6. 6. Study methodology Retrospective, observational database study utilising the Optimum Patient Care Research Database (OPCRD) o Longitudinal, primary care database comprising ~4.5 million patients from over 650 UK general practices. o Anonymised research quality data with a focus on respiratory disease. o Electronic medical records are complemented by patient reported data. o Data source for >50 publications in the last 5 yrs. Inclusion criteria: • Index date (i.e. date where there is a Read code for cough) between 1/1/2015 and 31/12/2017. • >18 yrs at index date • One year of continuous records prior to index date, specifically records for ACE inhibitor prescriptions and cough Read codes in the year prior to index date. No additional exclusion criteria
  7. 7. Outcomes 1) Prevalence and incidence of cough- a) In patients with at least one primary care consultation with a Read code for cough b) Consultations with a cough Read codes by covariates. 2) Number and frequency of consultations for cough- a) Per patient, including the types of Read codes recorded. (This will guide the determination of the criteria for chronic cough in future database studies.) b) Number of patients with a second consultation for cough within two weeks, a month, two months etc. c) Seasonal mapping of cough Read codes. d) Number of patients with referrals to secondary care. 3) STROBE flow chart of cohort to categorise patients according to primary cause of cough (i.e. acute viral or bacterial infection/ respiratory comorbidity/ non- respiratory comorbidity/ idiopathic cough) 4) Characterisation of patients. a) Comparison of the cohort where cough appears idiopathic versus other cough cohorts. b) In those patients where a cause of cough is found analysis will include whether the index date was before or after diagnosis of cause/comorbidity.
  8. 8. Covariates  Gender  Age (5 yr bands)  Geography, using postcode By regions and by Office of National Statistics urban/rural classifications  Month and season of index date  Smoking status  BMI  Respiratory comorbidities (including date of diagnosis) COPD/ Asthma/ IPF/ Bronchiectasis/ Lung cancer/ Rhinitis/ Other?/ None  Non-respiratory comorbidities (including date of diagnosis) Ischemic Heart Disease/ Cardiovascular Heart Disease/ Heart failure/ GERD/ Eczema/ Depression & Anxiety/ Hypertension/ Diabetes/ Osteoporosis/ Chronic Kidney Disease/ Myocardial Infarction/ Cerebrovascular Disease/ None  Charlson Comorbidity Index  Pharmacology- include treatment trials o Respiratory medications (ICS/SABA/SAMA/LABA/LAMA/Theophylline etc) o Antibiotics o Oral steroids o Allergy medication o GERD medication o ACE inhibitors (including type) o Prescribed antitussives  Association of cough with- o A bacterial respiratory infection o Viral Read code  Cough type determined by Read code o Dry o Productive o Nocturnal o Etc.
  9. 9. Cough Read Codes Browser - Clinical Terms (The Read Codes) Version 3 - Clinical 2017-04-01 Searched for 'Cough' Read code Read term Read code Read term XE0qn Cough Xa02d Coughing ineffective XaLCS Reflux cough X76Hx Character of cough Xa2kc Persistent cough 1719 Bronchial cough 171A. Chronic cough 1719 Chesty cough Xa7u9 Brassy cough H3101 Smokers' cough Xa4fM Croupy cough X76Hy Productive cough Xa7uA Bovine cough 1713 Productive cough -clear sputum Xa4fN Barking cough 1714 Productive cough -green sputum 1712 Dry cough 1715 Productive cough-yellow sputum XaYYO Episodic dry cough XE0qo Productive cough NOS Xa7mD Allergic cough XE0Qw Whooping cough XaBmo Cough on exercise 65VA. Notification of whooping cough XaFwR Unexplained cough H243. Pertussis pneumonia X76Hz Nocturnal cough A33y. Whooping cough - other specified organism 1717 Night cough present 1419 H/O: whooping cough 173B. Nocturnal cough / wheeze A33yz Other whooping cough NOS 171C. Morning cough A33z. Whooping cough NOS 171D. Evening cough Ayu39 [X]Whooping cough due to other Bordetella species Xa7uM Does not cough up sputum Ayu3A [X]Whooping cough, unspecified 171Z. Cough symptom NOS XE0qp Coughing up blood XM1QR Spasmodic cough R0630 [D]Cough with haemorrhage R062. [D]Cough Xa7vH Blood streaked sputum R0620 [D]Cough syncope Xa7vI Frank blood in sputum X208N Cough syncope Xa7vG Bloodstained sputum Xa4N4 Does cough Ua1hB Able to cough up sputum XM0Ch C/O - cough S1271 Cough fracture (of ribs) X75tK Painful cough X76el Cough impulse in inguinal canal XaIO1 Cough with fever Xa7jY Observation of cough impulse of lump E2611 Psychogenic cough Xa7jZ Cough impulse of mass present X76I0 Cough when swallowing Xa7ja Cough impulse of mass absent Xa6a9 Increasing frequency of cough Some of these will need excluding. May want to categorise some of these?
  10. 10. Additional Read Code lists needed • Viral Read codes to determine post-viral cough? • Respiratory bacterial infection Read codes?
  11. 11. Next steps • Finalise the protocol for this first study • Read codes to be reviewed and finalised
  12. 12. 2) Other research needs in the area of cough? How could we address them?