Evaluation of Cough Medication Use Patterns in Ambulatory Care Settings in the United States: 2003-2018

Using 2003-2018 National Ambulatory Medical Care Survey data for office-based visits and 2003-2018 National Hospital Ambulatory Medical Care Survey data for emergency department (ED) visits, we conducted cross-sectional analyses to examine cough medication (CM) use trends in the United States (US) ambulatory care settings. We included adult (>= 18 years) patient visits with respiratory-infection-related or non-infection-related cough as reason-for-visit or diagnosis without malignant cancer or benign respiratory tumor diagnoses. Using multivariable logistic regressions, we examined opioid antitussive, benzonatate, dextromethorphan-containing antitussive, and gabapentinoid use trends. From 2003-2005 to 2015-2018, opioid antitussive use decreased in office-based visits (8.8% to 6.4%, P-trend = 0.03) but remained stable in ED visits (6.3% to 5.9%, P-trend = 0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. Benzonatate use more than tripled (office-based:1.6% to 4.8%; ED:1.5% to 8.0%; both P-trend < 0.001). Dextromethorphan-containing antitussive use increased in ED visits (1.8% to 2.6%, P-trend = 0.003) but stayed unchanged in office-based visits (3.8% to 2.7%; P-trend = 0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006-2008 to 2.4% in 2015-2018, P-trend < 0.001) but was negligible in ED visits. In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan-containing antitussive and gabapentinoid use remained low (<3%).