(27) Characteristics and Trends in Cough Medication Use Among Patients with Chronic Cough in Florida: 2013-2019

Publication Number: 358

Background: Chronic cough (CC), lasting for 8 weeks or more, can be caused by various respiratory/non-respiratory medical conditions and other factors. Emerging evidence suggests some CC may have a single disease entity with neural dysregulation. Limited evidence is available on patient characteristics among CC patients.

Objectives: To examine the trends in cough medication (CM) use and characteristics among CC patients.

Methods: We conducted repeated annual cross-sectional analyses using 2013-2019 statewide electronic health records from the One Florida Clinical Research Consortium database. Among patients without cancer or benign respiratory tumor diagnoses and with ≥2 medical encounters, we identified CC patients (aged ≥18 years) defined as having any 3 clinical cough events (i.e., a cough diagnosis, or a prescription of opioid antitussives, benzonatate, or dextromethorphan-containing medications) occurring within 120 days. We required the first and last of the 3 events to be ≥8 weeks apart and any 2 of the 3 events to be ≥3 weeks apart. We examined the trends in CM use among CC patients from 2013 to 2019 using multivariable generalized estimating equations and described patient characteristics in 2019.

Results: From 2013 to 2019, there were increasing trends in benzonatate use (16.3% to 23.7%) and gabapentinoid use (9.2% to 15.2%) among CC patients, while opioid-containing antitussive use has increased till 2015, and then decreased (11.3% in 2013, 16.3% in 2015, and 12.2% in 2019) (all p< 0.001). Dextromethorphan use remained stable (8.7% to11.1%; p=0.13). Of 1,966 CC patients in 2019 (aged ≥65 years=31.2%, female=68.7%, White=63.2% and Hispanic=12.5%), 92.6% resided in metropolitan counties, 38.4% had ≥1 hospitalization and 43.3% had 2 emergency department visits. Medicare was the most common primary payer for CC patients (39.9%), followed by Medicaid (33.6%) and commercial insurance (20.6%). The top 3 most frequently diagnosed respiratory comorbidities were chronic obstructive pulmonary disease (48.0%), acute upper respiratory tract infections (45.3%), and bronchitis (41.1%); whereas musculoskeletal disorders (71.9%), hypertension (66.5%), and gastroesophageal reflux disease (52.4%) as the most frequently diagnosed non-respiratory conditions. The top 3 frequently prescribed concomitant medications were antibiotics for respiratory infections (47.1%), inhaled short-acting beta-agonists (37.9%), and H1 antagonists (30.3%).

Conclusions: Among CC patients in Florida, there were increasing trends in benzonatate and gabapentinoid use and a decreasing trend in opioid-containing antitussive use. CC patients had substantial burdens of respiratory/non-respiratory comorbidities and healthcare and concomitant medication use.