D3.110 - Patterns of Opioid or Neuromodulator Use in Chronic Cough Patients with Newly Diagnosed Asthma

Chronic cough (CC) is a common reason for hospital visits and often shows suboptimal responses to standard treatments, leading to the use of opioid or neuromodulator therapy. Asthma is a frequent and potentially treatable trait in CC; however, cough may persist despite asthma treatment. This study aimed to investigate patterns of opioid or neuromodulator use and associated clinical characteristics among CC patients with newly diagnosed asthma in a real-world setting.

We analyzed data from the OMOP-Common Data Model (v5.3.0) of Pusan National University Hospital from 2011 to 2024. Adult patients presenting with CC for the first time and with at least one year of follow-up were included. Patients without prior asthma who were subsequently diagnosed with asthma and initiated inhaled corticosteroids (ICS) were classified as CC with newly diagnosed asthma (CC with BA), while those without asthma served as comparators (CC without BA). Opioid or neuromodulator use was defined as prescriptions lasting ≥28 days. Early initiation was defined as treatment initiation within 90 days of cohort entry. Baseline characteristics were compared using standardized mean differences (SMD).

Among 8,964 CC patients without prior asthma, 724 (8.1%) were newly diagnosed with asthma. Baseline age and sex distribution were comparable between CC with BA and CC without BA (mean age 57.01±15.48 vs. 56.92±15.73 years; female 67.27% vs. 63.15%). During one-year follow-up, opioid or neuromodulator use was more frequent in CC with BA than CC without BA (14.6% vs. 8.5%; SMD 0.13), with a higher incidence rate of use (135.3 vs. 81.9 per 1,000 person-years). Within the CC with BA group, patients requiring opioid or neuromodulator therapy were older and had higher prevalences of allergic rhinitis (AR) and gastroesophageal reflux disease (GERD), as well as more frequent oral corticosteroid (OCS) use. Early initiation of opioid or neuromodulator therapy was associated with recent OCS use.

A substantial proportion of CC with newly diagnosed asthma required opioid or neuromodulator therapy despite ICS-based treatment initiation. Older age, comorbid AR and GERD, and recent OCS use characterized this subgroup, suggesting a distinct chronic cough–asthma phenotype characterized by multimorbid treatable traits beyond airway inflammation.