Prevalence and Risk Factors for Refractory and Resolved Chronic Cough in the Canadian Longitudinal Study of Aging (CLSA)

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Background: Chronic cough (CC) affects 16% of individuals in the Canadian Longitudinal Study of Aging (CLSA), but the prevalence of either refractory chronic cough (RCC) or resolved chronic cough (ResCC), along with medication use, remains unclear. Understanding RCC burden is essential for identifying populations that may benefit from novel therapies. Objectives: To determine the prevalence, demographics, and factors for RCC and ResCC, with and without medication use. Methods: Participants reporting daily cough at baseline and follow-up 3 years later were analyzed. RCC was defined as persistent cough at both time points, while ResCC included those with baseline cough that resolved by follow-up. Medication use for CC was documented. Multivariate models assessed odds ratios (ORs) for RCC with or without medication at baseline. Results: Among 26,606 participants at follow-up, 834 (3%) had RCC with medication, 1,341 (5%) had RCC without treatment, 611 (2%) had ResCC with medication, and 1,273 (5%) had ResCC without medication. Common treatments included anti-acids (62%), inhalers (42%), neuromodulators (14%), nasal sprays (15%), and antihistamines (10%). Factors associated with RCC included persistent smoking, provincial location, wheeze, asthma, COPD, neurological conditions, anxiety, ACE-inhibitor use, and bowel disorders. Smoking cessation was associated with lower RCC risk. Conclusion: Many individuals with RCC remain untreated, while some with ResCC improve without therapy. Identifying key risk factors and the underutilization of treatments highlights the need for better RCC recognition and management.

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