OBJECTIVES: Chronic cough (CC) can be debilitating and negatively affects patients’ quality-of-life. Opioid antitussives, dextromethorphan, and benzonatate are commonly used for symptomatic relief of cough despite a lack of proven efficacy and safety evidence for CC. We aimed to examine trajectories of prescription antitussive use in CC patients in real-world settings.

METHODS: In a retrospective cohort study using 2012−2021 statewide clinical data from the OneFlorida Clinical Research Consortium, we identified adult CC patients defined as having ≥3 cough events (a cough diagnosis or prescriptions for opioid antitussive, dextromethorphan or benzonatate) within 120 days, with the first and last of the 3 events ≥8 weeks apart and any 2 of the 3 events ≥3 weeks apart. Using data-driven group-based trajectory models, we identified antitussive use patterns based on monthly number of antitussive prescriptions within 12 months after the first qualifying cough event (index date). We compared baseline (6 months pre-index) characteristics across identified trajectories.

RESULTS: Among 15,566 CC patients (age≥65 years=27.7%, female=70.2%, White=62.3%), we identified three distinct antitussive use trajectories: (1) no use (72.1% of the cohort), (2) declining use within the first 5 months (26.4%), and (3) chronic use (1.5%). Compared to the other groups, CC patients in “chronic use” trajectory were more likely to have CC-related conditions (e.g., allergic rhinitis [no use=11.3%, declining use=12.7%, chronic use=16.3%], asthma [22.5%, 23.1%, 32.6%], chronic sinusitis [5.9%, 4.7%, 12.1%], and gastroesophageal reflux disease [26.7%, 26.5%, 34.7%]), and antitussive use and polypharmacy (≥3 different medications) at baseline (all p<0.05).

CONCLUSIONS: In Florida, over 70% of CC patients did not have any antitussive prescription, and CC patients with chronic antitussive use was low. CC patients with chronic antitussive use had a higher burden of CC-related comorbidities and medication use at baseline. Chronic antitussive use may indicate unmet or suboptimal management of CC in a subset of CC patients.