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Background Acute cough is the most common symptom among children in primary care, but the impact of cough episodes was never investigated in Italian families. Methods A cross-sectional telephone survey was conducted on a representative sample of Italian families, randomly selected from general population; a specific and validated questionnaire was used. Results The sample (604 calls) was uniform by geographical distribution, and by children age and gender. Mean cough episode was 3.1/year, they were short lasting (only 4.7% > 2 weeks). Independent predictors of children cough episodes were parents’ active smoking habit and work ( p  < 0.05). The mean nursery/school absenteeism was mostly < 7 days, but of a 7–15-day duration in near 30% of cases. The pediatrician was contacted immediately only by 25% of parents and a second consultation (mostly a lung physician) usually occurred after 2–3 weeks of cough. Meanwhile, home/pharmacist suggested remedies were adopted in 50–70% of cases. Usual prescriptions were mucolytics (85.8%), antitussive agents (55.6%), non-steroideal anti-inflammatory drugs (33.8%), antibiotics (regularly or episodically 80%), and corticosteroids (systemic steroids in less than 50%, but via aerosol in more than 80% of cases). Moreover, pediatricians claimed to use homeopathic drugs regularly or episodically in almost 50%. The respondents’ willingness to spend out-of-pocket for an “effective remedy” against cough was of € 20 (>€ 30 in 18.4% of cases). Conclusions Parents’ actions against cough episodes were variable, depending on their beliefs, smoking habit, and occupational status. The parents’ perceived efficacy of usual prescriptions is poor, and their willingness to pay out-of-pocket for an “effective remedy” against cough is high. The interest for alternative treatments is not negligible in these circumstances.

Acute cough is the most common symptom among children in primary care, but the economic impact of cough episodes has never been investigated in Italian families. A cross-sectional telephone survey was conducted on a representative sample of Italian families, randomly selected from general population. Collected data were analyzed to evaluate the economic impact of cough episodes according to, first, Italian Family Perspective and, second, National Health System Perspective (NHS-P). The costs considered in the analysis were the cost of drugs used (antibiotics, corticosteroids, antitussive drugs, and aerosol therapy) and the cost of child care during nursery/school absenteeism. Six hundred four valid questionnaires were analyzed: mean age of children is 7 years (SD=3.3) and that of parents is 40 years (SD=6.2). Mean rate of cough episodes was 3.15/year, and in general, they were short lasting (94.6%, <2 weeks). Nursery/school absenteeism was mostly <7 days (63.2%), but almost 30% of respondents declared 7-15 days. The respondents' willingness to spend out-of-pocket for an \"effective remedy\" against cough was an average of €20 (>€30 in 19.7% of cases). The overall economic impact on Italian families was estimated as €1,204 (SD=€88); it resulted in a cost per cough episode equal to €337, mainly due to nursery/school absenteeism (94.6%), whereas pharmaceutical expenditure was marginal (5.4%). Cough episodes are acute (lasting <1 week, mainly) but frequent, causing a considerable socioeconomic impact. The pharmaceutical costs are in line with parents' willingness to pay but these costs result negligible when compared to those related to school absenteeism, generally not perceived by parents.

Children's cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions - sometimes substantially. The objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life. A specific questionnaire consisting of 18 questions was prepared. The questionnaire was completed by 300 pediatricians (all members of PAIDOSS: Italian National Observatory on Health of Childhood and Adolescence) who represented ~300,000 children. A vast majority of children have cough throughout the year (99.3% of respondents have cough during autumn/winter and 64.7% in spring/summer). Allergic disease is the most frequent suspected cause of chronic cough in children (53%), and this is supported by the high demand for consultations: 73% seek the opinion of allergologists, 62% of otorhinolaryngologists and only 33% of pulmonologists. The majority of pediatricians (92%) reported that they prescribe therapy in acute cough regardless of cough guidelines. Moreover, the survey pointed out the abuse of aerosol therapy (26% in acute cough and 38% in chronic cough) and of antibiotics prescription (22% in acute cough and 42% in chronic cough). Our survey suggests that some Italian pediatricians' therapeutic attitudes should be substantially improved in order to achieve better management of cough in children and to minimize the burden of cough.

Background Cough is one of the most common discomforts affecting general population, which can disrupt subjects’ quality of life due to its physical, social, and psychological effects. Aim of the study was to investigate the impact of cough and related beliefs of general population. Methods A cross-sectional telephone survey was carried out by means of a specific, validated questionnaire on a representative sample of Italian general population. All the interviews were carried out according to the Computer Assisted Telephone Interview (CATI) methodology by expert, professional interviewers. Distributions of all answers were calculated in the overall sample. Results A total of 1,251 subjects (mean age: 49 years; females 44.2 %) completed the interviews. The overall number of telephone calls was 5362, and the corresponding redemption rate was 1/4.3 (23.%). The sample was representative of national population in terms of geographical distribution, age, gender, and smoking habit. The majority of respondents was convinced that cough is merely a symptom of several different diseases, but 46.4 % of respondents affirmed that cough should be regarded as “a disease” per se. Only 29.1 % of subjects say that they usually do not complain of any cough over the year, while 18.4 % reported ≥ 3 episodes of cough/year. These episodes have a duration ranging 10–30 days in 19.9 % of subjects, and > 30 days in 6.9 % of subjects. The majority of respondents is worried about their cough only after 1 week, but 76.9 % of subjects is much more worried if cough affects a child. After a few days of cough, 23.1 % of subjects use domestic remedies; 20.9 % ask their pharmacist, and 33.4 % their doctor, being GPs (69.6 %) and lung physicians (16.2 %) the most asked professionals. The occurrence of bronchitis, pneumonia, upper airway infections, and allergic troubles are the most feared events. The majority of respondents are convinced that antibiotics and steroids should not be regarded as the gold standard for treating persistent cough (61.2 and 58.2 %, respectively), while anti-tussive drugs and aerosols in general are regarded as the most effective strategies (69.1 and 74.1 %, respectively). Moreover, 33.8 % of the sample is in favour of homeopathic drugs, while 23.2 % had already used an homeopathic anti-tussive syrup, and 27.6 % of subjects are really interested in using the homeopathic approach. The willingness to pay for an effective anti-tussive remedy was: 46.3 % up to 10 €; 27.8 % up to 20 €, and 13.3 % more than 20 €. Conclusions Cough confirms its high impact in Italy, and a substantial proportion of individuals regards cough as “a disease”. Only one out of three Italians refers to their doctor, but when cough is already persistent. Cough in children is much more feared than in adults. The majority of Italians have a proper and conservative position versus both antibiotic and the systemic steroid uses against cough. The Italian attitude to aerosol therapy confirms very high. Differently from the cough guidelines, anti-tussive drugs are highly valued among Italian people. The attitude and the interest to homeopathic anti-tussive remedies proves high. Finally, the willingness to pay for an effective anti-tussive remedy is quite high in Italy.

To review the literature on identifying cough and to make evidence-based recommendations for assessing the efficacy of cough-modifying agents in clinical research. Ovid MEDLINE literature review (through March 2004) for all studies published in the English language since 1953 using the medical subject heading terms \"assessing the impact of cough,\" \"assessing the efficacy of cough treatments,\" \"tussigenic challenges,\" \"cough counting,\" \"character and timing of cough,\" \"visual analog scales,\" \"cough scoring systems,\" \"health related quality of life instruments,\" \"cough-specific health-related quality of life instruments,\" \"citric acid challenge,\" \"capsaicin challenge,\" \"flow-volume loops,\" \"assessing airway inflammation,\" \"lipid laden macrophages in sputum,\" and \"exhaled nitric oxide.\" To optimally evaluate the efficacy of cough-modifying agents, investigators should use both subjective and objective methods, because they have the potential to measure different things. A patient's subjective response is likely the only one that measures the impact of the intensity of cough. With respect to subjective methods, it is recommended that a cough-specific health-related quality-of-life instrument be utilized because valid and reliable instruments exist. Even though visual analog scales have not been psychometrically tested, they are recommended because they are commonly used and valid, and they are likely to yield different but complementary results. Because there are cough-specific health-related quality-of-life instruments that have been fully psychometrically tested, and the same cannot be said for visual analog scales, this is a reason to use cough-specific health-related quality-of-life instruments as the primary, subjective outcome measure of choice. With respect to objective methods, tussigenic challenges can be used before and after the intervention to assess the effect of therapy on cough sensitivity. They are most likely to be helpful in disease states in which cough reflex sensitivity is known to be heightened. Because the act of coughing has the potential to traumatize the upper airway (eg, vocal cords), assessing the presence of upper airway edema before and after therapy with flow-volume loops may be useful. Investigators must be cautious and not assume that observing changes suggestive of inflammation and edema of upper airway structures is specific for any particular disease. Cough counting is recommended with a computerized methodology that is reliable and accurate, noninvasive and portable, and easy to use in unattended, ambulatory real-life settings within a subject's home environment when it can be done over a 24-h period of time.

To review the literature on identifying cough and to make evidence-based recommendations for assessing the efficacy of cough-modifying agents in clinical research. Ovid MEDLINE literature review (through March 2004) for all studies published in the English language since 1953 using the medical subject heading terms “assessing the impact of cough,” “assessing the efficacy of cough treatments,” “tussigenic challenges,” “cough counting,” “character and timing of cough,” “visual analog scales,” “cough scoring systems,” “health related quality of life instruments,” “cough-specific health-related quality of life instruments,” “citric acid challenge,” “capsaicin challenge,” “flow-volume loops,” “assessing airway inflammation,” “lipid laden macrophages in sputum,” and “exhaled nitric oxide.” To optimally evaluate the efficacy of cough-modifying agents, investigators should use both subjective and objective methods, because they have the potential to measure different things. A patient's subjective response is likely the only one that measures the impact of the intensity of cough. With respect to subjective methods, it is recommended that a cough-specific health-related quality-of-life instrument be utilized because valid and reliable instruments exist. Even though visual analog scales have not been psychometrically tested, they are recommended because they are commonly used and valid, and they are likely to yield different but complementary results. Because there are cough-specific health-related quality-of-life instruments that have been fully psychometrically tested, and the same cannot be said for visual analog scales, this is a reason to use cough-specific health-related quality-of-life instruments as the primary, subjective outcome measure of choice. With respect to objective methods, tussigenic challenges can be used before and after the intervention to assess the effect of therapy on cough sensitivity. They are most likely to be helpful in disease states in which cough reflex sensitivity is known to be heightened. Because the act of coughing has the potential to traumatize the upper airway (eg, vocal cords), assessing the presence of upper airway edema before and after therapy with flow-volume loops may be useful. Investigators must be cautious and not assume that observing changes suggestive of inflammation and edema of upper airway structures is specific for any particular disease. Cough counting is recommended with a computerized methodology that is reliable and accurate, noninvasive and portable, and easy to use in unattended, ambulatory real-life settings within a subject's home environment when it can be done over a 24-h period of time.

Background: Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals’ lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies. Objectives: The primary objectives of this study were to assess respondents’ perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships. Design: Qualitative study. Methods: This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes. Results: A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0–24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents. Conclusion: RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals’ lived experiences may inform the development of RCC and UCC therapeutic strategies. Plain language summary Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis Chronic cough, particularly refractory and unexplained chronic cough, remain poorly managed in many individuals and are associated with a wide range of symptoms and cough triggers that hinder daily activities and reduce emotional well-being. Currently there are no US Food and Drug Administration-approved treatments for refractory or unexplained chronic cough. Understanding the experience and treatment preferences of individuals with these conditions may help inform the development of new therapies and clarify the potential impact of such therapies on the lives of individuals with chronic cough. Using in-depth interviews, the present study comprehensively evaluated individuals’ experience with refractory or unexplained chronic cough and treatment priorities, a research area that has not been well-studied. This study detailed broad-ranging physical, behavioral, and emotional impacts of chronic cough, which hindered individuals’ social well-being.

Background There is absence of literature related to cough prevalence and its characteristics in lung cancer patients, with information deriving only from broader symptoms occurrence studies. The aims of this study were to provide a snapshot of the prevalence of all-cause-cough in lung cancer patients and to characterise cough in terms of its impact and severity. Methods A cross-sectional study recruiting consecutive lung cancer patients over a pre-defined period of time and using cough-specific validated tools in a tertiary referral centre in the UK, including a cough severity VAS and the Manchester Cough in Lung Cancer scale (MCLCS). Results Data was collected from 202 patients. All-cause cough prevalence was 57% (through VAS) both in the screened ( N  = 223) and research ( N  = 202) population or 67% (through the MCLCS), and cough severity was moderate at a mean of 32 mm (in a 100 mm VAS). Age, sex, smoking status, lung cancer histology, stage and comorbidities were not associated with cough prevalence. The only variable associated with lower cough reports was being ‘on anticancer treatment’; fewer patients on treatment reported a cough (40%) compared to those off treatment (54%) ( p  = 0.04). The impact of cough (as measured by MCLCS) was also significant (mean score = 22). About 18% of patients felt moderate/severe distress from their cough and about 15% often or always reported disturbed sleep due to coughing. Half the patients felt their cough warranted treatment. Conclusions Cough is a common symptom in lung cancer with considerable impact on patients’ lives. Cough presence and severity should regularly be assessed in clinical practice. There is an urgent need to focus on developing more potent antitussive treatments and improve the management of this complex and distressing symptom.

Background Chronic cough is associated with reduced mental and physical health and increased health care resource use. The lack of nationwide data on chronic cough hinders our understanding of the prevalence, demographics, and impacts of chronic cough in China. The aim of this study was to estimate the lifetime and annual prevalence of chronic cough in mainland China and to describe the sociodemographic and health-related characteristics of adults with chronic cough. Methods This was a cross-sectional study using self-reported information from a nationally representative sample of 20,051 adults. Respondents with chronic cough (daily cough for ≥ 8 weeks) during the prior 12 months were matched to respondents without chronic cough. Results We estimated a lifetime prevalence of 7.0% and an annual prevalence of 4.1% for chronic cough among adult residents of mainland China. Affected individuals had a mean age of 43.5 years, and there were no significant differences in prevalence between men and women. Compared to matched controls, the chronic cough group had more comorbidities and included a higher proportion of individuals who had been diagnosed with respiratory and sleep-related conditions. Chronic cough was also associated with significantly worse depression and anxiety symptom severity and health-related quality of life, as well as increased impairment of work and other daily activities and higher rates of all-cause health care resource use. Conclusions Chinese adults with chronic cough show a middle age, equal gender distribution. Chronic cough affects an estimated 46.4 million adults in mainland China during their lifetime and is associated with significant individual and health care system burden. Take home message Chronic cough affects approximately 4.1% (27.2 million) of adults per year in mainland China and is associated with worse health and health-related quality of life, impairment of work productivity and other daily activities, and increased all-cause health care resource use.

Background Despite vaccine availability, Pertussis remains a global public health challenge, especially among infants. The Eastern Mediterranean Region (EMR) presents a diverse epidemiological landscape with varying vaccination coverages and healthcare infrastructures. This systematic review aimed to assess the burden of pertussis in infants < 1 year of age in the EMR and evaluate the use and impact of pertussis vaccination during pregnancy. Methods Following PRISMA guidelines, we conducted a systematic search of Scopus, Embase, CINAHL Ultimate, and PubMed from inception until April 30, 2024. Studies included reported on pertussis burden in infants or maternal vaccination. Data extraction and quality assessment were performed in duplicate, focusing on incidence, age distribution, disease severity, and vaccination uptake and impact when data were available. Results Thirty-six studies were included, the majority from Iran ( N  = 11), Morocco ( N  = 5), Tunisia ( N  = 5), and Oman ( N  = 3), with underrepresentation of other EMR countries. The incidence of PCR-confirmed pertussis among children with suspected pertussis varied significantly, from 6.7% to 8.9% (Morocco 2018–2019) to 50.4% and 51.6% (Palestine 2004–2008) among children < 12 and < 6 months, respectively, and between 16.3% (Tunisia 2007–2016) to 73.0% (Morocco 2013–2015) in children < 2 months. Age distribution data indicated the highest burden was in infants < 2 months regardless of the population studied. High hospitalization rates and severe complications, including seizures and the need for ventilatory support, were frequently reported in infants < 6 months of age. Only one study from Saudi Arabia addressed maternal pertussis vaccination, reflecting low vaccine uptake and awareness among pregnant women. Conclusions This review underscores the substantial burden of pertussis among infants in the EMR and the lack of data on maternal immunization. The findings emphasize the need for enhanced surveillance and targeted public health interventions to reduce disease incidence. Future research should prioritize underrepresented countries to ensure comprehensive data for informed public health strategies. Trial registration PROSPERO (CRD42024573471)