Real-world Insights on the Care and Management of Cough: A Physician Survey in India

Background and aim: The lack of comprehensive real-world data from physicians complicates the optimization of cough management strategies. Survey-based studies focusing on physician perspectives are particularly valuable to obtain insights on the management and care of cough in India. Methods: A cross-sectional, observational physician survey administered via a printed version to assess physician treatment patterns and the factors influencing their prescribing decisions, and to know physician perspectives on duration of cough, reasons for prolonged cough, most common type of cough at their clinics. Multiple-choice and rating scale questions were used. Results: Of the 190 physicians invited to complete the survey, 160 responded (120 general physicians and 40 pulmonologists). Cough duration >10 days was reported by 132 (82.5%) respondents and > 20 days by 24 (15%). Eighty-four (52.5%) physicians reported that 10–20% of patients experience the symptoms, such as congestion or cold along with cough. At least one physician identified the following reasons as contributing to the longer duration of cough: allergy, asthma, pollution, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), treatment non-compliance, COVID-19, smoking, and a history of nasal drip. Most respondents (90%) reported consider the presence of appropriate ingredients for the respective cough type, cooling and soothing effect, rational combination approved by drug authorities when prescribing. Complete relief from cough was reported by 43%, 55%, and 48% of physicians with syrups containing ambroxol + guaifenesin + terbutaline + menthol, levosalbutamol + ambroxol + guaifenesin, and dextromethorphan + chlorpheniramine, respectively. Most respondents preferred 10 mg (122/160) of dextromethorphan for the effective treatment of cough over higher doses (15 mg, 21/160; 30 mg, 13/160; other doses, 4/160). Conclusion: This survey highlights the diverse and known approaches physicians in India take toward managing cough, emphasizing the importance of personalized treatment strategies and syrups with multi-drug combinations. Keywords: Physician survey; real-world evidence; cough; ambroxol; guaifenesin; terbutaline; menthol; dextromethorphan