Knowledge, practices, and diagnostic barriers in chronic cough management among primary care doctors in Klang Valley, Malaysia: a cross-sectional survey

Chronic cough (CC), defined as a cough persisting for over eight weeks, presents diagnostic and management challenges in primary care, particularly in tuberculosis (TB)-endemic countries like Malaysia. This study aimed to assess the knowledge, practices and diagnostic barriers of primary care doctors in Klang Valley regarding CC. A cross-sectional online survey was conducted from October to December 2024 involving 170 primary care physicians from public and private clinics. The questionnaire covered sociodemographic, diagnostic tools, clinical strategies, perceived barriers, and training needs. Descriptive and inferential statistics, including regression analysis, were used to identify patterns and associations. Only 18·8% of participants correctly defined CC as lasting more than 8 weeks. Most emphasized environmental and occupational history-taking but underutilized spirometry (available to only 33·5% of clinics). While chest radiography was widely available (61·2%), high patient load was significantly associated with reduced medical history-taking and chest X-ray ordering (p = 0·011). Empirical treatments, including antihistamines and bronchodilators, were commonly used. Barriers included limited diagnostic tools (53·7%), unclear referral pathways (12·8%), lack of standardized guidelines (8·7%), and time constraints (16·8%). Primary care doctors in Malaysia face significant limitations in CC management, particularly in defining, diagnosing, and accessing diagnostic tools. There is an urgent need for national guidelines tailored to primary care, broader access to spirometry, and structured training. Addressing these issues can improve diagnostic accuracy and reduce unnecessary investigations and treatment delays in chronic cough care.