Volume 152, Issue 3, Pages 547-562 (September 2017) Change in Psychological, Physiological, and Situational Factors in Adults After Treatment of Chronic Cough  Cynthia L. French, PhD, ANP-BC, FCCP, Sybil L. Crawford, PhD, Carol Bova, PhD, ANP-BC, Richard S. Irwin, MD, Master FCCP  CHEST  Volume 152, Issue 3, Pages 547-562 (September 2017) DOI: 10.1016/j.chest.2017.06.024 Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 1 Schematic representation of the theory of unpleasant symptoms. See text for a discussion of the meaning of the theory. (Reproduced with the permission of Wolters Kluwer Health Inc. from “The middle-range theory of unpleasant symptoms: an update,” by E. R. Lenz, L. C. Pugh, R. A. Milligan, A. Gift, and F. Suppe, (1997), Advances in Nursing Science, 19(3), p. 14-27.21 Copyright 2008 by Aspen Publishers, Incorporated. http://journals.lww.com/advancesinnursingscience/Pages/default.aspx) CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 2 Chronic cough algorithm for the management of patients ≥ 15 years of age with cough lasting > 8 weeks. ACE-I = ACE inhibitor; BD = bronchodilator; LTRA = leukotriene-receptor antagonist; PPI = proton pump inhibitor. (Reproduced with the permission of Elsevier from “Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines,” by R. S. Irwin, M. H. Baumann, D. C. Bolser, L. P. Boulet, S. S. Braman, C. E. Brightling, et al, 2006, Chest, 129 (1 Suppl), p. 4S.23 Copyright 2006. http://journal.chestnet.org/) CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 3 Subject flow diagram. This diagram summarizes the flow of study subjects from screening for eligibility through 6 months post-initial treatment. Eighty subjects were initially enrolled at baseline, 65 completed the 3-month follow-up, and 60 completed the 6-month follow-up. (Adapted from Vandenbroucke et al.25) CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 4 Significant relationships at baseline with cough severity. Using multivariate analysis of covariance, statistically significant associations that persisted after adjustment were education, ability to speak bothered by cough, and urge to cough. Worse cough severity at baseline (mean ± SE) was associated with less than a college education, worse ability to speak, and worse urge to cough. CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 5 Significant relationships at baseline with cough-related quality of life (CQOL). Using multivariate analysis of covariance, statistically significant associations that persisted after adjustment were age, UI, ability to speak bothered by cough, use of self-prescribed remedies, and depression symptoms. Worse CQOL at baseline (mean ± SE) was associated with younger age, worse UI, worse ability to speak bothered by cough, use of self-prescribed remedies, and worse depression symptoms. QOL = quality of life; RX = self-prescribed remedies; UI = urinary incontinence. CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 6 Significant relationships since baseline in cough severity. Using multivariate analysis of covariance, significant associations that persisted after adjustment were education, sex, ability to speak bothered by cough, and urge to cough. Greater improvement in cough severity since baseline (mean ± SE) was associated with less than a college education, male sex, greater improvement in ability to speak, and greater improvement in urge to cough. Negative scores reflect improvement. CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 7 Significant relationships since baseline in cough quality of life (CQOL). Using linear mixed models, significant associations that persisted after adjustment were use of self-prescribed remedies, UI, urge to cough, and anxiety symptoms. Greater improvement in CQOL since baseline (mean ± SE) was associated with the use of self-prescribed remedies, greater improvement in UI (most improvement = better), greater improvement in urge to cough, and greater improvement in anxiety symptoms. Negative scores reflect improvement. See Figure 5 legend for expansion of abbreviations. CHEST 2017 152, 547-562DOI: (10.1016/j.chest.2017.06.024) Copyright © 2017 American College of Chest Physicians Terms and Conditions