Understanding the Challenges of Refractory Chronic Cough: Insights from a Knowledge, Attitudes, and Practices Survey of US Healthcare Professionals

Refractory chronic cough (RCC) is a disease identified in a subset of people who experience chronic cough (CC, defined in adults as a cough lasting > 8 weeks) despite adequate treatment for known cough-related etiologies. RCC can be profoundly burdensome and patients may seek care from different healthcare professional (HCP) specialties; however, existing HCP care pathways are complicated and treatment options limited. To understand current real-world practices in the USA, we surveyed seven types of HCPs involved in care of patients with CC and RCC, and reported their knowledge, attitudes, and practices. A web-based descriptive survey was conducted (December 2024) with US HCPs (N = 717) who had seen ≥ 1 adult patient with CC in the past 6 months. Responses were analyzed overall and by HCP type: pulmonologists, allergists/immunologists, otolaryngologists (n = 100 each), primary care physicians (n = 212), nurse practitioners (n = 51), physician assistants (n = 50), and pharmacists (n = 104). Knowledge, awareness, and practices varied considerably. Overall, 45.5% of HCPs identified CC as lasting ≥ 8 weeks. Terminology to describe RCC differed by HCP type, with 15 different terms selected from predefined options overall, and 46.7% selecting “refractory chronic cough.” Most HCPs were unaware of cough centers (65.4%), agreeing that current diagnostic pathways limit patient access to care (79.5%) and that more practical guidelines are needed (82.3%). Most HCPs agreed or strongly agreed that RCC significantly impacts quality of life (90.4%). This study assessed the real-world understanding and perspectives of US HCPs actively engaged in CC and RCC care pathways, highlighting inconsistently used RCC terminology and the impracticality of current guidance and diagnostic pathways. Interdisciplinary educational initiatives, standardized terminology, improved dissemination of guidelines, and effective diagnostic algorithms are urgently needed. Tailored HCP education should inform accelerated, appropriate RCC diagnosis to improve clinical decision-making and patient outcomes. Refractory chronic cough, or RCC, places physical, social, financial, and emotional tolls on patients living with this disease. In a single day, patients may cough more than 400 times, leading to serious physical symptoms and feeling isolated by their condition. Patients may seek care from multiple healthcare professionals across different specialties to help manage and treat their cough. However, this frequently leads to care that is not well coordinated, repeated testing, and trying different medicines. Current published guidance available to healthcare professionals remains complex with inconsistent and poorly defined terminology, while effective treatment options remain limited. In this study, we sought to capture the clinical understanding and knowledge of RCC among healthcare professionals across several specialties who are directly engaged in the care of these patients in the USA. The results of the survey showed that healthcare professionals selected as many as 15 different phrases to describe RCC. Survey results also highlighted that healthcare professionals thought the diagnostic process for RCC, and guidance on how to manage it, could be improved. To do this, we suggest that further education is needed to help healthcare professionals better understand RCC as a disease. A clear definition of RCC, an appropriate and simpler diagnosis process, and updated management guidelines may also help to improve the care journey for patients with RCC in the USA.