• Cynthia L French, Sybil L Crawford, Carol Bova, and Richard S Irwin.
• Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA. Electronic address: cynthia.french@umassmemorial.org.
• Chest. 2017 Sep 1; 152 (3): 547-562.

BackgroundWe hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL).MethodsMajor tenets of the theory of unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8 weeks' duration treated in our cough clinic. At baseline and 3 and 6 months, subjects completed 3 Punum Ladders rating cough severity, the CQOL Questionnaire, the Depression, Anxiety, and Stress Scales-21, and the Duke Functional Social Support Questionnaire. Cross-sectional baseline and longitudinal regression analyses were conducted.ResultsEighty subjects (55 women) with a mean age of 58.5 ± 11.1 years and a cough duration of 86.0 ± 123.7 months were enrolled. At baseline, worse cough severity was significantly associated with less education and worse ability to speak bothered by cough and the urge to cough. Worse CQOL was significantly associated with worse depression symptoms, urinary incontinence, and ability to speak; use of self-prescribed remedies; and younger age. Significant improvements in depression and stress symptoms occurred at 3 and 6 months. Anxiety symptoms improved, particularly in the first 3 months. Improvement in cough severity was significantly associated with less education, male sex, and improvement in ability to speak and urge to cough. Improvement in CQOL was significantly associated with improvement in urinary incontinence, urge to cough, anxiety symptoms, and use of self-prescribed remedies.ConclusionsUsing the theory of unpleasant symptoms, we have come to appreciate that managing psychological, physiological, and situational factors in addition to focusing on identifying the cause of cough is important to maximize improvement in CQOL.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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