Survey: Smokers ignore chronic cough

The Canadian Lung Association has a message for anyone with a chronic cough: it’s not normal.

This so-called smoker’s cough is really chronic bronchitis and needs medical attention. But according to a recent national survey sponsored by the lung association, people go almost a decade before ever seeking treatment.

The survey says:

• Chronic bronchitis afflicts about two million Canadians
• Those ages 40 to 75 have the most severe symptoms.
• Sufferers with this chronic cough spend about $30 million dollars a year on over the counter remedies.

Yet a lung specialist says the cough syrups and other non-prescription treatments have no effect.

Smokers’ disease
“Chronic bronchitis is a disease of insults on your airways. The older you are, the more time you’ve had to insult your airways. And you can do that in different ways. The most common is smoking,” says Dr. Meyer Balter. He’s the director of the Asthma Education Clinic at Mount Sinai Hospital in Toronto who worked with the Canadian Lung Association on a national chronic bronchitis survey.

He says chronic bronchis is almost exclusively a disease you see in smokers-80 to 90 per cent of patients are either current or past smokers.

Costs to economy
Yet there’s also a broader cost carried by all Canadians, according to Alan McFarlane from the Canadian Lung Association. He says chronic bronchitis means:

• Economic costs of $4 billion dollars for health care and lost working days
• About 1.9 million days of lost productivity
• $30 million spent annually on over the counter medications (OTC)  
• $34 million spent on prescription medications per year.

These figures are based on an Ipsos-Reid national telephone survey done January 22 to February 4th. Alastair Cosby, Ipsos-Reid vice president told a media conference in Toronto that the survey contained two parts:

• 400 interviews with chronic bronchitis sufferers
• A random survey of 2000 Canadians over age 18.

He also said the survey error of margin is 2.2 per cent, 19 times out of 20.

Attitude to treatment
Cosby said the interviews revealed much about peoples’ attitudes to treatment:

• Only 31 per cent say they see a doctor regularly for the symptoms.
• 30 per cent say they see a doctor, but not every time they have an outbreak.
• 21 per cent say they’ve seen a doctor in the past, but no longer do so.
• 18 per cent never have seen a doctor for these symptoms.

“We asked those who never consult why they don’t so, and it seems they have a somewhat complacent attitude to their symptoms. They don’t seem to understand the potential long-term risks of this condition. They say it’s just a smoker’s cough, or the cough’s not that bad, they’ve stopped worrying about it, or they’ve learned to live with it. They’re somewhat resigned to this condition. And at a lower level, there’s a feeling that maybe doctors can’t do much for them. And more than half are adamant that they’re not going to see a doctor,” said Cosby.

Affects daily life
Dr. Balter says the survey showed that patients with a persistent long term cough with phlegm had their symptoms for almost 10 years before seeing a physician. In addition, he said:

• 40 per cent experienced shortness of breath with daily activities
• Over 50 per cent had regular wheezing in the chest
• The vast majority had shortness of breath with any speeded up activity. 

He says the first line of treatment is clear: quit smoking. In severe cases, a course of antibiotics may also be required.

“What you do with smoking cessation is slow down the damage to that of a normal person. So you can’t fix the damage done, but you prevent further damage. In terms of the chronic cough and sputum production, the vast majority of patients will have a marked decrease and even a disappearance of their cough with smoking cessation. It usually takes a month of longer for that to go away,” he says.

He defined chronic bronchitis as coughing on a daily basis, with phlegm, for at least three months.

Resist quitting
He admits he has many patients who resist any advice to quit. And even in the best programs, cessation rates are only 20 to 25 per cent. But he says the survey shows a 37 per cent cessation rate with physician advice.

“The importance of physician counseling cannot be underestimated. And most previous surveys have shown the same thing-that physician counseling and the suggestion to set a specific quit date is the most helpful thing we can do as health care professionals,” he says.