Less than half of the healthcare providers correctly identified refractory chronic cough (RCC) as a cough lasting more than 8 weeks and not responding to treatment, based on survey data from more than 700 providers.

RCC is defined as a persistent cough unresponsive to the treatment of underlying conditions, including asthma, gastroesophageal reflux disease (GERD), or upper airway cough syndrome, wrote Kaiser G. Lim, MD, a pulmonologist and allergist-immunologist at the Mayo Clinic, Rochester, Minnesota, and colleagues in a study presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting.

The current state of practice in the US regarding RCC remains unclear, and the researchers conducted an internet-based, cross-sectional survey of 717 healthcare providers across seven specialties to examine knowledge and perceptions among providers who treat patients with RCC.

The survey respondents included 212 primary care providers, 104 pharmacists, 100 pulmonologists, 100 ENTs, 100 allergists/immunologists, 51 nurse practitioners, and 50 physician assistants. All respondents had seen at least one patient in the previous 6 months with chronic cough unrelated to a diagnosed condition.

Overall, 46% of the respondents correctly identified chronic cough. Of these, allergists/immunologists had the highest accuracy rate (56%), followed by nurse practitioners (55%) and pulmonologists (50%). Physician assistants had the lowest rate of accuracy (26%).

Although 70% of the respondents correctly identified asthma, GERD, and upper airway cough syndrome as the three most common causes of chronic cough, accuracy varied by specialty, ranging from 84% among allergists/immunologists to 56% of pharmacists.

Provider knowledge of RCC as a diagnosis of exclusion was high overall (88%), but knowledge of epidemiology and risk factors was lower. Approximately half (52%) of the respondents correctly noted that RCC is more common in women, with the highest awareness among pulmonologists and ENTs (68% and 65%, respectively) and the lowest awareness among primary care providers (41%).

In addition, 46% of respondents correctly identified adults aged 50 years or older as the highest-risk age group, with the highest accuracy among ENTs (61%) and physician assistants (60%) and the lowest among primary care providers (37%).

Most respondents (84%) reported managing patients with RCC over the course of three to six visits per year, with the most follow-up visits reported by pulmonologists and allergists/immunologists (91% and 88%, respectively). However, the respondents overall reported that RCC treatment was effective in a mean of 51% of their cases.

The findings were limited by the lack of data on specific treatments, the researchers noted.

However, the results suggest persistent knowledge gaps regarding clinical management of RCC, the researchers wrote. “Enhanced, targeted education efforts are essential to increase awareness and deepen understanding of RCC among HCPs [healthcare professionals] to ultimately improve clinical decision-making,” they concluded.

The findings also highlighted a potential unmet need for more effective treatments, given the low rate of perceived effectiveness of treatments and the frequent need for multiple visits per year to manage RCC, they said.

Challenges of Characterizing RCC

The current study is valuable given the evolving understanding of RCC and how it affects patients, said Sean P. Duffy, MD, associate professor of pulmonary and critical care medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia, in an interview.

“Chronic cough has traditionally been thought of as the result of a specific underlying condition, most commonly asthma, GERD, or upper airway cough syndrome,” said Duffy, who was not involved in the current study.

“Refractory chronic cough is often managed by primary care physicians along with multiple subspecialists simultaneously, and as a result, perspectives and understanding surrounding RCC are varied,” he said.

Medical literature has defined RCC as a diagnosis of exclusion, with varied clinical trials and observations, Duffy said. “To create an improved universal understanding, it is critically important to be informed of the current real-world clinical practice and awareness of healthcare providers,” he added.

Duffy, who treats a significant number of patients with RCC, viewed the findings as an accurate reflection of clinical practice.

“A lack of awareness and understanding of the epidemiology of this condition is reflected in the results, with only about half of healthcare providers noting that RCC is more common in women and individuals over 50 years of age,” he said. The findings that patients require several visits per year to manage RCC and that providers perceive treatments to be effective approximately half the time highlight the difficulty in establishing a diagnosis and the lack of available and effective treatment, Duffy added.

Additional research is needed to establish a more streamlined criterion for the definition of RCC so that patients can be identified and treated earlier in the disease course, Duffy told Medscape Medical News.

“There remains a great deal of heterogeneity in how these patients are treated in clinical practice,” Duffy noted. Additional areas for research include more trials to evaluate potentially effective therapies for RCC, he said.

The study received no outside funding. Lim had no financial conflicts to disclose. Several coauthors disclosed having relationships with GlaxoSmithKline and other pharmaceutical companies. Duffy disclosed having a consultant relationship with GlaxoSmithKline.