Real-World Patterns of Korean Medicine and Combined Korean–Western Medicine Use in Patients with Chronic Cough: A Nationwide Cohort Study

Real-World Patterns of Korean Medicine and Combined Korean–Western Medicine Use in Patients with Chronic Cough: A Nationwide Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Real-World Patterns of Korean Medicine and Combined Korean–Western Medicine Use in Patients with Chronic Cough: A Nationwide Cohort Study Man Young Park, Beom-Joon Lee, Kwan-Il Kim, Yee Ran Lyu, Sung-Woo Kang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7700795/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Chronic cough impairs quality of life and increases healthcare utilization, yet no pharmacological treatment is formally approved. Korea’s dual healthcare system, which fully integrates Western medicine (WM) and Korean medicine (KM) under national insurance, provides a unique setting to examine real-world treatment patterns. Objective To compare KM-only and integrative KM + WM care for chronic cough and describe the use of key KM modalities and multimodal treatment combinations. Methods This retrospective cohort study analyzed nationwide claims data from the Health Insurance Review and Assessment Service (HIRA), 2011–2020. Chronic cough was defined as ≥ 56 days with ≥ 3 outpatient visits. Patients diagnosed with cough (R05) in KM institutions were included and classified into KM-only or KM + WM groups based on WM encounters within ± 30 days of the index episode. KM modalities (acupuncture, moxibustion, cupping, herbal medicine) and WM prescriptions were assessed, with comorbidities evaluated using the Charlson Comorbidity Index (CCI). Results Among 14,223 patients (mean age 58.6 years), 74.8% received KM-only care and 25.2% sought KM + WM care. Despite overall declines in KM utilization, the proportion of chronic cough patients among KM outpatients increased from 1.15% in 2011 to 2.76% in 2020. The KM + WM group had higher comorbidity burden (CCI ≥ 1: 43.7% vs. 32.8%) and more GERD (50.1% vs. 31.3%), allergic rhinitis (51.0% vs. 30.1%), and asthma (26.8% vs. 14.4%). Acupuncture was nearly universal (98.6%; mean 19.8 sessions), with cupping (59.3%) and hot–cold meridian therapy (42.9%) as common adjuncts. Herbal use was led by Samso-eum (35.0%) and So-cheong-ryong-tang (23.3%), whereas GERD-targeted formulas were rarely prescribed (Ojeok-san 3.3%, Saengmaek-san 2.7%). Conclusions KM was the primary treatment option for chronic cough in Korea, while integrative KM + WM care was more common in patients with greater comorbidities. Acupuncture-centered multimodal approaches predominated, but the mismatch between GERD prevalence and GERD-targeted prescriptions highlights the need for standardized, evidence-based integrative guidelines. Findings reflect patients who initially sought KM care and should be interpreted within this context when informing policy and clinical practice. Figures Figure 1 Introduction Chronic cough is more than a mere nuisance; it is associated with impaired quality of life, sleep disturbance, social withdrawal, and reduced productivity, and is increasingly recognized as an important global public health concern ( 1 ). A recent systematic review reported that approximately 10% of adults worldwide experience chronic cough, with higher prevalence in Europe (12.7%) and North America (11.0%) compared to Asia (4.4%) ( 2 , 3 ). Nevertheless, substantial heterogeneity exists across Asian countries, and prevalence appears to be rising due to aging populations, environmental pollution, and lifestyle changes ( 4 , 5 ). Thus, chronic cough contributes significantly to disease burden through diminished quality of life, increased medical expenditures, and heightened healthcare utilization ( 6 , 7 ). Despite this burden, no pharmacological treatment has been formally approved, and gaps remain between guideline-recommended management and real-world clinical practice ( 8 – 10 ). The current treatment paradigm emphasizes identifying and addressing underlying etiologies (“cause-oriented treatment”). However, in up to 40–50% of patients, no clear cause can be determined, leading to empirical use of antihistamines, acid suppressants, neuromodulators, or complementary behavioral and physical therapies ( 11 – 13 ). In this context, interest in traditional therapies such as acupuncture, herbal medicine, moxibustion, and cupping has increased, particularly among patients who do not experience sufficient improvement with Western medicine alone. Several studies have suggested that such complementary and integrative approaches may provide symptomatic relief and improve quality of life ( 14 – 16 ). However, existing evidence is limited to small clinical trials or single-center studies, and there remains a lack of large-scale, nationwide data reflecting real-world treatment patterns. Korea provides a unique research setting as one of the few countries worldwide where both Western medicine (WM) and traditional Korean medicine (KM) are fully integrated into the National Health Insurance system ( 17 , 18 ). Patients can freely choose between, or combine, these two systems under a single coverage framework. This dual healthcare structure offers an exceptional opportunity to directly compare KM-only care with integrative KM–WM care in routine clinical practice ( 19 ). Therefore, the present study analyzed nationwide claims data from 2011 to 2020 to investigate treatment patterns among patients with chronic cough. Specifically, we aimed to: ( 1 ) compare patient characteristics between KM-only and KM + WM groups; ( 2 ) examine utilization of key KM modalities such as acupuncture, herbal medicine, moxibustion, and cupping alongside WM prescriptions; and ( 3 ) explore the patterns of multimodal treatment combinations in real-world practice. By doing so, this study provides evidence to inform clinical and policy decision-making regarding complementary and integrative approaches to chronic cough management. Methods Data Source and Study Population This retrospective cohort study was conducted using nationwide outpatient claims data from the Health Insurance Review and Assessment Service (HIRA) between January 1, 2011, and December 31, 2020. Given the limitations of extracting data for all cough patients, we identified all patients who received a cough-related diagnosis code (R05) at Korean Medicine (KM) institutions. For each patient, medical encounters were chronologically ordered by patient identifier and visit date, and repeated consultations for cough were grouped to define chronic cough episodes. No exclusions were made based on underlying diseases, in order to capture the comprehensive clinical spectrum of chronic cough and to reflect real-world treatment utilization. The study used customized research data from HIRA (project ID: M20230131001). As the dataset contained de-identified secondary data, the Institutional Review Board (IRB) granted an exemption from ethical review (IRB No. I-2301/001–002). Clinical trial number: not applicable. Definition of Chronic Cough Episodes Cough episodes were reconstructed from claims records, with the start defined as the first visit date for a cough diagnosis. A sequence of visits was classified as a single episode if consecutive consultations were recorded without a gap exceeding 30 days. If no cough-related visits occurred for ≥ 30 days, the episode was considered terminated, and any subsequent visits were treated as a new episode. Chronic cough was defined as an episode lasting ≥ 56 days with at least three outpatient visits during that period. This operational definition is consistent with international clinical guidelines that define chronic cough as lasting ≥ 8 weeks ( 20 , 21 ) and aligns with prior electronic medical record-based studies adopting a 56-day duration and ≥ 3 visits as a validated definition ( 22 ). Classification of Treatment Groups Healthcare provider type was classified using institutional codes in the claims database, distinguishing Korean Medicine (KM) institutions from Western Medicine (WM) institutions. For each patient, the observation window extended from 30 days before the index date (start of the representative episode) to 30 days after the end date. Patients with WM encounters within this window were categorized into the KM + WM (integrative care) group, while those without such encounters were assigned to the KM-only group. The ± 30-day window was chosen to capture clinically relevant patterns of concurrent or overlapping use of KM and WM, thereby reflecting real-world integrative care behaviors. Because the cohort was constructed from patients who received cough diagnoses in KM institutions, the KM-only group represents the primary population, with the KM + WM group being a subset the cohort. Treatment and Medication Data Treatment data were linked across claims tables to identify both KM and WM interventions during chronic cough episodes. KM modalities included acupuncture, moxibustion, cupping, and herbal medicine, while WM prescriptions included antibiotics, antitussives/expectorants, antihistamines, and other medications. Only treatment and prescription records within the defined episode window were included for analysis. Comorbidity Assessment The Charlson Comorbidity Index (CCI) was calculated to evaluate the burden of comorbidities ( 23 ). The CCI is a weighted index ranging from 1 to 6 points for 19 disease categories, widely used for mortality risk adjustment. We assessed each patient’s CCI based on diagnoses recorded during the two years prior to the index date. Statistical Analysis Eligible patients were adults (≥ 18 years) with chronic cough episodes and at least one treatment or prescription record. The proportion of chronic cough patients among all KM outpatient visits was calculated annually to assess temporal trends. Demographic characteristics (age, sex) and clinical features (CCI, visit frequency, episode duration, treatment type) were compared between the KM-only and KM + WM groups. Descriptive statistics were presented as means with standard deviations (SD) for continuous variables and counts with percentages for categorical variables. Group comparisons were performed using chi-square tests or t-tests, as appropriate. All analyses were conducted using SAS (SAS Institute, Cary, NC, USA) and R (R Foundation for Statistical Computing, Vienna, Austria). Results Utilization of Korean Medicine and Trends in the Proportion of Chronic Cough Patients Between 2011 and 2020, overall utilization of Korean Medicine (KM) services showed a consistent decline. The total number of KM outpatient visits decreased from 229,655 in 2011 to 123,986 in 2020, representing a reduction of approximately 46%. Similarly, the number of unique patients declined by about 60%, from 96,552 in 2011 to 39,031 in 2020. These findings indicate a steady contraction in the overall scale of KM utilization over the past decade. In contrast, the proportion of chronic cough patients among all KM outpatients demonstrated a clear upward trend. The prevalence of chronic cough within the KM population was only 1.15% in 2011 but increased steadily each year, surpassing 2.0% in 2016 and reaching 2.76% by 2020. Notably, since 2017, the proportion has remained consistently above 2%, suggesting that the relative burden of chronic cough within KM practice has expanded, even as the overall patient population declined (Fig. 1 ). Baseline Characteristics of Patients with Chronic Cough A total of 14,223 patients met the inclusion criteria, of whom 10,638 (74.8%) were classified as the KM-only group and 3,585 (25.2%) as the KM + WM group (Table 1 ). The mean age of the overall cohort was 58.6 years, with more than half of the patients in both groups aged ≥ 50 years. The proportion of older patients was higher in the KM + WM group, in which 55.7% were aged ≥ 60 years, compared with 45.3% in the KM-only group (p < 0.001). Female patients predominated in both groups; however, the proportion of male patients was significantly higher in the KM-only group (30.2%) than in the KM + WM group (26.6%, p < 0.001). Patterns of healthcare utilization also differed between groups. The KM-only group had a higher mean number of outpatient visits (20.4 vs. 9.3) and a longer episode duration (101.9 vs. 84.4 days, p < 0.001) compared with the KM + WM group. With regard to comorbidity burden, patients with a Charlson Comorbidity Index (CCI) score ≥ 1 accounted for 43.7% of the KM + WM group, compared with 32.8% in the KM-only group. These findings indicate that patients receiving combined KM and WM care tended to have more comorbidities and a more complex clinical profile than those receiving KM care alone. Table 1 Baseline characteristics of chronic cough patients by treatment group Characteristics KM only (N = 10,638) KM + WM (N = 3,585) Total (N = 14,223) p-value Age, mean ± SD 58.4 ± 15.4 59.3 ± 14.6 58.6 ± 15.2 0.001 Male sex, n (%) 3,209 (30.2) 952 (26.6) 4,161 (29.3) < 0.001 Age group, n (%) < 0.001 − 20–39 yrs 1,514 (14.2) 440 (12.2) 1,954 (13.7) − 40–59 yrs 3,635 (34.2) 1,148 (32.0) 4,783 (33.6) − 60–79 yrs 4,814 (45.3) 1,800 (50.2) 6,614 (46.5) - ≥80 yrs 675 (6.3) 197 (5.5) 872 (6.1) Visit count, mean ± SD 20.4 ± 21.8 9.3 ± 10.2 17.6 ± 20.1 < 0.001 Episode duration (days), mean ± SD 101.9 ± 78.1 84.4 ± 47.0 97.5 ± 72.0 < 0.001 Charlson comorbidity index, mean ± SD 0.5 ± 0.9 0.7 ± 1.0 0.5 ± 0.9 < 0.001 CCI category, n (%) < 0.001 − 0 7,152 (67.2) 2,018 (56.3) 9,170 (64.5) − 1–2 3,082 (29.0) 1,364 (38.0) 4,446 (31.3) − 3–4 358 (3.4) 183 (5.1) 541 (3.8) - ≥5 46 (0.4) 20 (0.6) 66 (0.5) Comorbidities and Medication Use in the Three Years Prior to Index Date Medication use during the three years prior to the index date showed markedly higher rates in the KM + WM group compared with the KM-only group (Table 2 ). Prescriptions for respiratory and allergy-related drugs were consistently more frequent in the KM + WM group, including corticosteroids (36.4% vs. 24.4%), antihistamines (31.4% vs. 19.0%), bronchodilators (34.5% vs. 21.5%), and expectorants/mucolytics (18.0% vs. 13.2%; all p < 0.001). Gastroprotective agents (41.3% vs. 29.3%) and antihypertensive medications (11.2% vs. 7.1%) were also more commonly prescribed in the KM + WM group, and use of antiallergic or immunomodulatory agents was nearly twice as high (7.1% vs. 3.6%). Comorbidity profiles, evaluated based on diagnostic records during the same three-year period, likewise indicated a greater burden among KM + WM patients. Allergic rhinitis (51.0% vs. 30.1%), asthma (26.8% vs. 14.4%), chronic bronchitis (20.7% vs. 11.0%), and chronic sinusitis (16.7% vs. 8.0%) were all significantly more prevalent in the KM + WM group (all p < 0.001). Gastroesophageal reflux disease (GERD) was diagnosed in more than half of KM + WM patients (50.1%) compared with 31.3% in the KM-only group (p < 0.001). In addition, major chronic conditions such as hypertension (27.3% vs. 21.1%) and diabetes mellitus (18.4% vs. 13.6%) were more common in the KM + WM group. By contrast, no significant between-group differences were observed for relatively rare conditions such as bronchiectasis, pulmonary fibrosis, or tuberculosis. Table 2 Medication use and comorbidities within 3 years prior to the index date among chronic cough patients Variables KM only (N = 10,638) KM + WM (N = 3,585) Total (N = 14,223) p-value Medications Adrenal corticosteroids 2,600 (24.4) 1,305 (36.4) 3,905 (27.5) < 0.001 Antihistamines 2,019 (19.0) 1,125 (31.4) 3,144 (22.1) < 0.001 Bronchodilators 2,287 (21.5) 1,236 (34.5) 3,523 (24.8) < 0.001 Expectorants & mucolytics 1,400 (13.2) 647 (18.0) 2,047 (14.4) < 0.001 Anti-ulcer agents 3,113 (29.3) 1,481 (41.3) 4,594 (32.3) < 0.001 Antihypertensives 752 (7.1) 401 (11.2) 1,153 (8.1) < 0.001 Other allergy & immunology drugs 378 (3.6) 255 (7.1) 633 (4.5) < 0.001 Comorbidities Allergic rhinitis 3,197 (30.1) 1,830 (51.0) 5,027 (35.3) < 0.001 Asthma 1,536 (14.4) 960 (26.8) 2,496 (17.5) < 0.001 Chronic bronchitis 1,166 (11.0) 743 (20.7) 1,909 (13.4) < 0.001 Chronic sinusitis 847 (8.0) 598 (16.7) 1,445 (10.2) < 0.001 GERD 3,327 (31.3) 1,797 (50.1) 5,124 (36.0) < 0.001 Hypertension 2,241 (21.1) 978 (27.3) 3,219 (22.6) < 0.001 Diabetes mellitus 1,443 (13.6) 660 (18.4) 2,103 (14.8) < 0.001 Pneumonia 959 (9.0) 480 (13.4) 1,439 (10.1) < 0.001 Heart failure 320 (3.0) 153 (4.3) 473 (3.3) 0.002 Values are expressed as mean ± standard deviation or number (%). Medication use and comorbidities were identified from claims records during the 3 years prior to the index date, including the index date. KM only = Korean Medicine only; KM + WM = Korean Medicine combined with Western Medicine. p-values were obtained using t-tests for continuous variables and chi-square tests for categorical variables. GERD = gastroesophageal reflux disease. Most Frequently Prescribed Medications During the Chronic Cough Period (Western Medicine) During the chronic cough period, the most frequently prescribed Western medicine was expectorants/antitussives, which were used in 88.2% of patients, with an average of 6.3 prescriptions per patient (Table 3 ). Antihistamines were the second most common, prescribed to 66.9% of patients with a mean of 3.7 prescriptions. Gastroprotective agents (60.8%) and other antiallergic drugs (49.2%) were also prescribed in nearly half of the cohort. Other frequently used medications included opioid alkaloid antitussives (29.2%), bronchodilators and other respiratory agents (approximately 25%), otolaryngologic medications (28.2%), other gastrointestinal drugs (21.7%), and corticosteroids (25.4%). Psychotropic medications were prescribed to a smaller proportion of patients (8.4%), yet among those prescribed, the average number of prescriptions per patient was relatively high (4.6). Additional, less frequently used prescriptions are presented in Supplementary Table S1 . Table 3 Most frequently prescribed medications during chronic cough period (Western medicine) Medication class Total prescriptions Unique patients (N = 3,325) % of patients Avg. per patient Expectorants & mucolytics 18,373 2,933 88.20% 6.26 Antihistamines 8,297 2,225 66.90% 3.73 Anti-ulcer agents 6,648 2,020 60.80% 3.29 Other antiallergy drugs 5,416 1,635 49.20% 3.31 Opioid alkaloid antitussives 2,516 972 29.20% 2.59 Other respiratory drugs 2,097 849 25.50% 2.47 ENT preparations 1,980 938 28.20% 2.11 Other gastrointestinal drugs 1,979 721 21.70% 2.74 Adrenal corticosteroids 1,919 845 25.40% 2.27 Psychotropic agents 1,284 279 8.40% 4.6 Values are expressed as number or number (%). Data represent medications prescribed during the chronic cough period in Western medicine settings. The table shows the top 10 medication classes based on the proportion of patients who received each medication. Additional medications prescribed in fewer than 8% of patients are provided in Supplementary Table S1 . Utilization Patterns of Korean Medicine Procedures During the Chronic Cough Period During the chronic cough period, acupuncture was by far the most frequently utilized Korean Medicine procedure. A total of 98.6% of patients received acupuncture, with an average of 19.8 sessions per patient, underscoring its role as the central therapeutic strategy (Table 4 ). Cupping therapy was performed in 59.3% of patients, with an average of 16.1 sessions per patient, making it the second most common modality. Hot and cold meridian therapy (a traditional Korean physical therapy modality involving thermal stimulation along meridian pathways) was administered to 42.9% of patients, with an average of 13.4 sessions, indicating its substantial use as an adjunctive treatment. In contrast, Chuna manual therapy (a traditional Korean manual therapy that combines spinal manipulation techniques with meridian theory, similar to chiropractic but based on traditional East Asian medicine principles) was rarely applied, being utilized in only 0.7% of patients. Overall, these findings demonstrate that acupuncture constituted the cornerstone of Korean Medicine management for chronic cough, while cupping and hot/cold meridian therapy were commonly used as complementary approaches, and Chuna was infrequently employed. Table 4 Utilization patterns of Korean Medicine procedures during the chronic cough period Treatment group Total treatments Unique patients (N = 11,151) % of patients Avg. per patient Acupuncture 217,615 10,996 98.60% 19.8 Cupping 106,496 6,609 59.30% 16.1 Hot and cold meridian therapy 64,361 4,788 42.90% 13.4 Chuna 521 76 0.70% 6.9 This table summarizes the utilization patterns of Korean Medicine-based procedures among 11,151 patients with chronic cough. “Total procedures” indicates the overall number of sessions provided in each category. “Unique patients” refers to the number of patients who received the respective procedure at least once. “% of patients” represents the proportion of those patients out of the total cohort. “Avg. per patient” is calculated as the total number of procedures divided by the number of treated patients Most Frequently Prescribed Herbal Formulas During the Chronic Cough Period Analysis of herbal prescriptions during the chronic cough period revealed that a small number of formulas were used with notably high frequency. The most commonly prescribed formula was Samso-eum, which was given to 35.0% of patients, with an average of 8.3 prescriptions per patient (Table 5 ). This was followed by So-cheong-ryong-tang (23.3%), Ja-eum-ganghwa-tang (12.5%), and Haengso-tang (9.8%). Other frequently used prescriptions included Bojung-ikgi-tang, Ijin-tang, Yeongyo-paedok-san, and Gung-ha-tang. Interestingly, certain prescriptions such as Gung-ha-tang, Gamcho, and Jakyak were used in a relatively small proportion of patients, but those who received them had more than 15 prescriptions on average, indicating intensive use within specific patient subgroups. By contrast, many other herbal formulas were prescribed to less than 1% of patients and had minimal impact on overall frequency; these less common formulas are presented in Supplementary Table S2. Overall, the pattern of herbal prescriptions in chronic cough patients was characterized by predominant use of Samso-eum and So-cheong-ryong-tang, supplemented by a variety of traditional formulas tailored to individual clinical contexts. Table 5 Top 15 herbal prescriptions used during the chronic cough period (Korean Medicine) Prescription Total prescription Unique patients (N = 5,001) % of patients Avg. per patient Samso-eum 14,576 1,750 35.00% 8.33 So-cheong-ryong-tang 9,493 1,167 23.30% 8.13 Ja-eum-ganghwa-tang 5,373 623 12.50% 8.62 Haengso-tang 3,709 490 9.80% 7.57 Bojung-ikgi-tang 2,409 263 5.30% 9.16 Ijin-tang 2,337 227 4.50% 10.3 Yeongyo-paedok-san 2,320 389 7.80% 5.96 Gung-ha-tang 2,191 145 2.90% 15.11 Gumi-ganghwal-tang 1,724 241 4.80% 7.15 Insam-paedok-san 1,433 243 4.90% 5.9 Gamcho (Glycyrrhizae Radix) 1,415 93 1.90% 15.22 Jakyak (Paeoniae Radix) 1,330 83 1.70% 16.02 Pyeongwi-san 1,323 191 3.80% 6.93 Ojeok-san 1,260 165 3.30% 7.64 Hyeonggae-yeongyo-tang 1,182 271 5.40% 4.36 This table presents the 15 most frequently prescribed herbal medicines during the chronic cough period among 5,001 patients. “Total prescriptions” indicates the total number of prescriptions for each formula. “Unique patients” refers to the number of patients who received the prescription at least once. “% of patients” represents the proportion of those patients out of the total cohort. “Avg. per patient” is calculated as the number of prescriptions divided by the number of treated patients. Additional prescriptions beyond the top 15 are provided in Supplementary Table S2. Patterns of Treatment Combinations During the Chronic Cough Period During the chronic cough period, the most frequently observed treatment combination was acupuncture alone, accounting for 82,732 sessions among 4,536 patients (31.9% of the cohort), with an average of 18.2 sessions per patient (Table 6 ). The second most common pattern was acupuncture combined with cupping therapy, delivered in 42,503 sessions to 3,324 patients (23.4%), followed by acupuncture combined with cupping and hot and cold meridian therapy (28,723 sessions, 2,551 patients, 17.9%). Other frequently utilized multimodal regimens included acupuncture + cupping + herbal medicine (12.8% of patients) and acupuncture + hot and cold meridian therapy (10.5%). Notably, Western medicine alone was administered to 3,308 patients (23.3%), with a comparatively lower intensity (13,945 sessions, mean 4.2 sessions per patient). Pure herbal medicine prescriptions without procedures were observed in 1,607 patients (11.3%), with 10,568 sessions (mean 6.6 per patient). In addition, integrative regimens combining acupuncture, cupping, hot and cold meridian therapy, and herbal medicine were delivered to 1,362 patients (9.6%, 12,261 sessions). Overall, the findings indicate that while acupuncture formed the backbone of chronic cough management in Korean Medicine, it was frequently combined with cupping and other KM modalities, and in some cases integrated with herbal medicine or Western medicine. Table 6 Treatment combinations including procedures, herbal medicine, and Western medicine during the chronic cough period5 Treatment combination Total sessions Unique patients (N = 14,223) % of patients Avg. sessions per patient Acupuncture 82,732 4,536 31.90% 18.2 Acupuncture + Cupping 42,503 3,324 23.40% 12.8 Acupuncture + Cupping + Hot and cold meridian therapy 28,723 2,551 17.90% 11.3 Acupuncture + Cupping + Herbal medicine 19,365 1,824 12.80% 10.6 Acupuncture + Hot and cold meridian therapy 16,277 1,486 10.50% 11 Western medicine 13,945 3,308 23.30% 4.2 Acupuncture + Cupping + Hot and cold meridian therapy + Herbal medicine 12,261 1,362 9.60% 9 Herbal medicine 10,568 1,607 11.30% 6.6 Acupuncture + Herbal medicine 9,834 1,363 9.60% 7.2 Acupuncture + Hot and cold meridian therapy + Herbal medicine 5,304 783 5.50% 6.8 Values represent the most common treatment combinations. Less frequent combinations are presented in Supplementary Table S3. Discussion This large-scale retrospective cohort study analyzed 14,223 patients with chronic cough using nationwide claims data from the Korean National Health Insurance Service between 2011 and 2020. The key findings are as follows: First, the proportion of patients with chronic cough seeking Korean Medicine (KM) care increased steadily over the past decade, rising from 1.15% in 2011 to 2.76% in 2020, representing approximately a 2.4-fold increase. This trend highlights the expanding role of KM in the management of chronic cough within the national healthcare system. Second, while the majority of patients (74.8%) received KM-only treatment, one-quarter (25.2%) sought combined care with Western Medicine (KM + WM). This pattern underscores the continued reliance on KM as a primary treatment option and reflects the unique dual healthcare system in Korea, which allows patients to freely choose between, or combine, KM and WM within the same insurance framework. Third, patients in the KM + WM group exhibited a higher prevalence of comorbidities and greater medication use compared to those in the KM-only group. Notably, the prevalence of gastroesophageal reflux disease (GERD) was 50.1% in the KM + WM group versus 31.3% in the KM-only group, a statistically significant difference. These findings suggest that patients with greater disease complexity or comorbidity burden are more likely to seek integrative care. Fourth, acupuncture was almost universally utilized, with 98.6% of patients receiving it at least once, confirming its role as the cornerstone of KM-based interventions for chronic cough. In contrast, adjunctive therapies such as moxibustion (42.9%) and cupping (59.3%) were used less frequently, indicating their role as complementary rather than primary interventions. Finally, the analysis of treatment combinations (Table 6 ) revealed that greater diversity of therapies did not necessarily translate into more frequent visits. In some cases—such as the combination of acupuncture, cupping, and herbal medicine—the average number of treatments per patient was lower than that observed with single therapies. This finding suggests that treatment frequency in clinical practice is tailored according to patient symptomatology and therapeutic strategies, rather than being uniformly additive across modalities. Implications of the Increasing Prevalence of Chronic Cough The persistent increase in the prevalence of chronic cough observed over the 10-year study period (from 1.15% in 2011 to 2.76% in 2020, approximately a 2.4-fold rise) is noteworthy when compared with domestic and international epidemiological studies. A recent systematic review estimated the average prevalence of chronic cough in Asia at 4.4%, lower than in Europe (12.7%) or North America (11.0%) ( 2 ). Although the 2020 prevalence in this study (2.76%) remained below the Asian average, it represented a clear upward trend relative to 2011. This suggests that the prevalence of chronic cough in Korea is gradually increasing. A previous study using the Korea National Health and Nutrition Examination Survey (KNHANES) reported a prevalence of 2.6% in 2010–2012 ( 24 ), which was higher than our estimates for the corresponding years (1.15–1.57%). While methodological differences and definitions must be considered, the overall trend of rising prevalence remains consistent. A recent comparative study between Korea and Taiwan also reported a 12-month prevalence of 4.34% in Korea ( 25 ), further supporting the long-term trajectory observed in our data. Several factors may contribute to this upward trend. First, chronic cough is strongly associated with aging, and Korea’s rapidly aging population is likely an important driver of prevalence growth. Second, worsening air pollution and other environmental factors may have exacerbated respiratory symptoms. Air pollution has previously been identified as a major risk factor for chronic cough in Korea ( 26 ). Third, the rising prevalence of gastroesophageal reflux disease (GERD) may also play a role; in Korea, GERD prevalence increased from 7.1% in 2002 to 7.9% in 2007 ( 27 ), likely reflecting Westernized dietary and lifestyle changes. Fourth, improved access to healthcare and greater disease awareness may have led to higher diagnosis rates. Importantly, the COVID-19 pandemic in 2020 marked an exceptional turning point. Although overall healthcare utilization declined during the pandemic, the prevalence of chronic cough peaked at 2.76%. This could partly be explained by the high prevalence of post-COVID cough (estimated at ~ 18%) ( 28 ), indicating a possible influence of COVID-19 on cough epidemiology. In addition, lifestyle changes such as mask wearing, social distancing, and elevated stress levels could have contributed to symptom exacerbation.. High Proportion of Korean Medicine-Only Utilization and Its Implications This cohort was constructed from patients diagnosed with cough (R05) in Korean Medicine (KM) clinics, and 85.7% of the study population received KM-only treatment. This finding indicates that a substantial proportion of chronic cough patients who initially sought KM care continued to rely exclusively on this system. Thus, the results should not be generalized to all chronic cough patients, but rather interpreted as reflecting the characteristics of those who selected KM care. Given the relatively older mean age of the study population (~ 60 years), the higher KM utilization may partly reflect the treatment preferences of older adults, who are known to favor KM. Furthermore, KM’s holistic approach and perceived lower risk of adverse effects likely make it an attractive option for patients with complex, multifactorial symptoms. However, as this study relied on claims data, non-reimbursed KM treatments and over-the-counter medications were not captured. Therefore, some patients categorized as KM-only users may in fact have received WM in parallel, and this should be taken into account when interpreting the findings. Future studies incorporating survey data or qualitative approaches will be valuable in more accurately characterizing real-world treatment behaviors. Differences in Patient Characteristics Between Treatment Groups Clear differences were observed between the KM-only and KM + WM groups, reflecting distinct levels of clinical complexity. Patients in the KM + WM group had higher prevalences of major comorbidities (GERD 50.1% vs. 31.3%, allergic rhinitis 51.0% vs. 30.1%, asthma 26.8% vs. 14.4%), greater prescription rates for key medications, and higher CCI scores. Conversely, KM-only patients had longer episode durations (101.9 vs. 84.4 days) and more frequent visits (20.4 vs. 9.3), suggesting sustained KM utilization in less complex cases. This pattern may indicate that patients with milder or less complicated disease profiles tend to rely on KM for long-term symptom management, where repeated visits are intended to maintain or gradually improve symptoms rather than to address acute exacerbations. Overall, these findings suggest that patients with greater clinical complexity were more likely to seek integrative care, whereas those with milder presentations tended to rely on KM alone. Notably, the markedly higher prevalence of GERD in the KM + WM group (50.1% vs. 31.3%) highlights the importance of GERD as a common comorbidity in chronic cough. Because GERD-related cough often requires pharmacological therapy and remains challenging to manage effectively, this observation underscores a potential treatment gap in which KM interventions alone may be insufficient, thereby driving patients toward integrative KM–WM care. Patterns and Clinical Implications of Korean Medicine and Integrative Interventions Acupuncture was administered to nearly all patients (98.6%), confirming its role as the cornerstone of KM-based treatment for chronic cough. The average of 19.8 sessions per patient, spanning approximately 3–4 months based on typical treatment schedules, suggests that chronic cough requires sustained neuromodulatory intervention rather than short-term symptomatic relief. This finding aligns with systematic reviews and meta-analyses reporting that acupuncture-related therapies significantly improve cough severity and quality of life through cumulative therapeutic effects (30). Cupping therapy (59.3%) and hot–cold meridian therapy (42.9%) were frequently applied as adjunctive modalities, with average session counts of 16.1 and 13.4 respectively, reflecting the multimodal approach characteristic of KM practice. In contrast, Chuna manual therapy was rarely utilized (0.7%), indicating its selective application in specific clinical contexts rather than routine use for chronic cough management. Herbal medicine prescriptions were dominated by Samso-eum (35.0%) and So-cheong-ryong-tang (23.3%), both traditionally indicated for cough-related conditions. The frequent use of So-cheong-ryong-tang is particularly noteworthy given the high prevalence of allergic rhinitis in our cohort (51.0% in KM + WM group, 30.1% in KM-only group), as this formula has documented efficacy in allergic respiratory conditions (31). Other commonly prescribed formulas included Ja-eum-ganghwa-tang (12.5%) and Haengso-tang (9.8%), reflecting the heterogeneous clinical presentations requiring individualized treatment approaches. A notable finding was the infrequent prescription of formulas specifically indicated for GERD-related cough, such as Ojeok-san (3.3%) and Saengmaek-san (2.7%), despite GERD being present in 50.1% of the KM + WM group and 31.3% of the KM-only group. This discrepancy suggests either underutilization of targeted therapies or the absence of well-established, evidence-based KM protocols for GERD-associated chronic cough, highlighting an area for future clinical guideline development. Analysis of treatment combinations revealed that acupuncture alone accounted for the largest proportion of patients (31.9%), followed by acupuncture with cupping (23.4%) and acupuncture combined with cupping plus hot–cold meridian therapy (17.9%). However, these patterns should be interpreted with caution, as the claims database captures only reimbursed treatments. Non-reimbursed herbal prescriptions, commonly used in routine KM practice, were not included, potentially leading to misclassification of some patients as receiving "acupuncture alone" when they may have received comprehensive integrative care. This limitation underscores a broader methodological challenge in KM research and highlights the need for data collection systems that can capture the full spectrum of integrative therapeutic approaches. Strengths and Limitations This study has several notable strengths. First, it is a large-scale, nationwide cohort study utilizing the comprehensive claims database of the Korean National Health Insurance Service, ensuring adequate sample size and representativeness. Data collected within a single-payer system minimize selection bias and provide a realistic reflection of healthcare utilization patterns. Second, unlike most previous studies that primarily focused on Western Medicine (WM) institutions, this study uniquely constructed its cohort based on patients utilizing Korean Medicine (KM) institutions. This methodological distinctiveness allowed us to illuminate clinical behaviors within KM settings, which have been underexplored in Korea’s dual healthcare system, thereby contributing novel academic value. Third, by examining a decade-long period, this study captured temporal changes in the prevalence of chronic cough while also considering the impact of the COVID-19 pandemic, offering an integrated understanding of disease epidemiology. Fourth, beyond descriptive frequency analysis, we systematically compared patient characteristics, comorbidities, and treatment patterns, thereby clarifying differences between the KM-only and KM + WM groups, which enhances the clinical relevance of our findings. However, this study also has limitations. First, owing to the nature of claims data, non-reimbursed treatments were not captured. As a result, patients who actually received both acupuncture and herbal medicine might have been misclassified as having received “acupuncture only,” potentially leading to an underestimation of KM treatment utilization. Second, over-the-counter medications purchased at pharmacies and the use of dietary supplements were not included, which may have resulted in an overestimation of KM-only utilization. Third, inherent to claims-based research, coding errors or under-reporting cannot be completely ruled out. Fourth, because the cohort was constructed from patients who received a cough diagnosis (R05) at KM institutions, our findings primarily reflect the characteristics of this population. Some of these patients subsequently sought WM care, but patients who received their initial cough diagnosis exclusively in WM institutions were not included, which may limit generalizability. Finally, as a retrospective analysis, this study could not assess patient-centered outcomes such as treatment effectiveness, symptom severity, quality of life, or satisfaction. Nor could it capture qualitative factors such as patients’ motivations and preferences for treatment choice, limiting the ability to fully explain the underlying drivers of healthcare utilization. Conclusion In this nationwide cohort of over 14,000 patients with chronic cough, nearly three-quarters received Korean Medicine (KM) alone, underscoring KM’s role as a primary treatment option. Patients who sought combined KM and Western Medicine (WM) care had greater comorbidity burdens and more complex medication profiles, reflecting the clinical need for integrative approaches. Acupuncture was almost universally used, while cupping, hot–cold meridian therapy, and herbal prescriptions were frequent adjuncts. These findings highlight the real-world significance of KM in chronic cough management and suggest future policies and guidelines should better integrate KM within comprehensive care pathways, especially for patients with persistent or unexplained chronic cough Declarations Author contributions statement M.Y.P. conceived the study, designed the analysis, and drafted the manuscript. B.J.L. and K.I.K. contributed to clinical interpretation and provided domain expertise on chronic cough and comorbid respiratory conditions. Y.R.L. and B.L. curated the data and performed statistical analyses. S.W.K. assisted with data interpretation and critically revised the manuscript for important intellectual content. J.H.L. supervised the overall study, provided methodological guidance, and served as corresponding author. All authors reviewed, edited, and approved the final version of the manuscript. Conflict of interest The authors have no conflicts of interest to declare. Ethical statement This study was approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (IRB No. I-2301/001–002). The requirement for informed consent was waived due to the retrospective nature of the study using anonymized data. Funding This study was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Nos. RS-2022-KH127, RS-2023-KH139021). Author Contribution M.Y.P. conceived the study, designed the analysis, and drafted the manuscript.B.J.L. and K.I.K. contributed to clinical interpretation and provided domain expertise on chronic cough and comorbid respiratory conditions.Y.R.L. and B.L. curated the data and performed statistical analyses.S.W.K. assisted with data interpretation and critically revised the manuscript for important intellectual content.J.H.L. supervised the overall study, provided methodological guidance, and served as corresponding author.All authors reviewed, edited, and approved the final version of the manuscript. Acknowledgments This study was supported by the Ministry of Health and Welfare, Republic of Korea (Grant Nos. RS-2022-KH127, RS-2023-KH139021). The data used in this study were obtained from the Health Insurance Review and Assessment Service (HIRA) under project number M20250121001. We also thank our colleagues at the Korea Institute of Oriental Medicine for their administrative and technical support throughout the study. Data Availability The data underlying this article are not publicly available due to restrictions from the Health Insurance Review and Assessment Service (HIRA). Access to these data requires approval from HIRA (https://opendata.hira.or.kr), and the authors are not permitted to share the data directly. References Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, et al. Cough hypersensitivity and chronic cough. Nat Rev Dis Primer. 2022 June;30(1):45. Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, et al. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J. 2015;45(5):1479–81. Abozid H, Patel J, Burney P, Hartl S, Breyer-Kohansal R, Mortimer K et al. Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study. eClinicalMedicine [Internet]. 2024 Feb 1 [cited 2025 Sept 12];68. Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00002-6/fulltext?uuid=uuid%3Acf496d95-4ed4-4b60-aab9-d6faab93b890 Liang H, Zhi H, Ye W, Wang Z, Liang J, Yi F, et al. Risk factors of chronic cough in China: a systematic review and meta-analysis. Expert Rev Respir Med. 2022;16(5):575–86. Yang X, Chung KF, Huang K. Worldwide prevalence, risk factors and burden of chronic cough in the general population: a narrative review. J Thorac Dis. 2023;15(4):2300–13. Bali V, Adriano A, Byrne A, Akers KG, Frederickson A, Schelfhout J. Understanding the economic burden of chronic cough: a systematic literature review. BMC Pulm Med. 2023;23(1):416. Morice A, Dicpinigaitis P, McGarvey L, Birring SS. Chronic cough: new insights and future prospects. Eur Respir Rev. 2021;30(162):210127. Demirjian NL, Lever A, Yip H. Identifying Practice Gaps Among Otolaryngology Providers for the Treatment of Chronic Cough. OTO Open. 2024;8(2):e143. Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. Antonelli Incalzi R, De Vincentis A, Li VW, Martin A, Di Laura D, Fonseca E, et al. Prevalence, clinical characteristics, and disease burden of chronic cough in Italy: a cross-sectional study. BMC Pulm Med. 2024 June;20(1):288. Arinze JT, Van Der Veer T, Bos D, Stricker B, Verhamme KMC, Brusselle G. Epidemiology of unexplained chronic cough in adults: a population-based study. ERJ Open Res. 2023;9(3):00739–2022. Bali V, Schelfhout J, Sher MR, Tripathi Peters A, Patel GB, Mayorga M, et al. Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis. Ther Adv Respir Dis. 2024;18:17534666241236025. Kukiełka P, Moliszewska K, Białek-Gosk K, Grabczak EM, Dąbrowska M. Prevalence of refractory and unexplained chronic cough in adults treated in cough centre. ERJ Open Res 2024 Sept;10(5):00254–2024. Lee B, Kwon CY, Jeong YK, Ha NY, Kim KI, Lee BJ, et al. Acupuncture-related therapy for chronic cough: A systematic review and meta-analysis. Integr Med Res. 2025;14(1):101121. Lee B, Kwon CY, Kim YJ, Kim JH, Kim KI, Lee BJ et al. Research status of east Asian traditional medicine treatment for chronic cough: A scoping review. Chen TH, editor. PLOS ONE. 2024;19(2):e0296898. Lee B, Kwon CY, Suh HW, Kim YJ, Kim KI, Lee BJ, et al. Herbal medicine for the treatment of chronic cough: a systematic review and meta-analysis. Front Pharmacol. 2023;14:1230604. Lim B. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues. Integr Med Res. 2013 Sept 1;2(3):81–8. Park J, Yi E, Yi J. The Provision and Utilization of Traditional Korean Medicine in South Korea: Implications on Integration of Traditional Medicine in a Developed Country. Healthcare. 2021;9(10):1379. Sasaki Y, Park JS, Park S, Cheon C, Shin YC, Ko SG, et al. Factors influencing use of conventional and traditional Korean medicine-based health services: a nationwide cross-sectional study. BMC Complement Med Ther. 2022 June;20(1):162. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and Management of Cough Executive Summary. Chest. 2006;129(1):S1–23. Pratter MR. Overview of Common Causes of Chronic Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(1, Supplement):S59–62. Bali V, Weaver J, Turzhitsky V, Schelfhout J, Paudel ML, Hulbert E, et al. Development of a natural language processing algorithm to detect chronic cough in electronic health records. BMC Pulm Med. 2022 June;28(1):256. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373–83. Kang MG, Song WJ, Kim HJ, Won HK, Sohn KH, Kang SY, et al. Point prevalence and epidemiological characteristics of chronic cough in the general adult population: The Korean National Health and Nutrition Examination Survey 2010–2012. Med (Baltim). 2017;96(13):e6486. Yu CJ, Song WJ, Kang SH. The disease burden and quality of life of chronic cough patients in South Korea and Taiwan. World Allergy Organ J. 2022 Sept 1;15(9):100681. Lee JH, Song WJ. Perspectives on chronic cough in Korea. J Thorac Dis. 2020 Sept;12(9):5194–206. Cho SC, Lee OY, Ha NR, Shim SG, Lee KN, Yoon JH, et al. Original Articles: The Change in the Prevalence of Typical Gastroesophageal Reflux Symptoms During the Past 5 Years in Korea: A Population-based Study. Kor J Neurogastroenterol Motil. 2008;14(2):96–102. Confronting COVID-. 19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses - The Lancet Respiratory Medicine [Internet]. [cited 2025 June 30]. Available from: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00125-9/fulltext Lee B, Kwon CY, Jeong YK, Ha NY, Kim KI, Lee BJ, et al. Acupuncture-related therapy for chronic cough: A systematic review and meta-analysis. Integr Med Res. 2025;14(1):101121. Additional Declarations No competing interests reported. Supplementary Files 5.SupplementaryTables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Jan, 2026 Reviews received at journal 18 Jan, 2026 Reviews received at journal 15 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers invited by journal 08 Jan, 2026 Editor invited by journal 19 Dec, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 13 Oct, 2025 First submitted to journal 24 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic cough is more than a mere nuisance; it is associated with impaired quality of life, sleep disturbance, social withdrawal, and reduced productivity, and is increasingly recognized as an important global public health concern (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A recent systematic review reported that approximately 10% of adults worldwide experience chronic cough, with higher prevalence in Europe (12.7%) and North America (11.0%) compared to Asia (4.4%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Nevertheless, substantial heterogeneity exists across Asian countries, and prevalence appears to be rising due to aging populations, environmental pollution, and lifestyle changes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Thus, chronic cough contributes significantly to disease burden through diminished quality of life, increased medical expenditures, and heightened healthcare utilization (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite this burden, no pharmacological treatment has been formally approved, and gaps remain between guideline-recommended management and real-world clinical practice (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current treatment paradigm emphasizes identifying and addressing underlying etiologies (\u0026ldquo;cause-oriented treatment\u0026rdquo;). However, in up to 40\u0026ndash;50% of patients, no clear cause can be determined, leading to empirical use of antihistamines, acid suppressants, neuromodulators, or complementary behavioral and physical therapies (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In this context, interest in traditional therapies such as acupuncture, herbal medicine, moxibustion, and cupping has increased, particularly among patients who do not experience sufficient improvement with Western medicine alone. Several studies have suggested that such complementary and integrative approaches may provide symptomatic relief and improve quality of life (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, existing evidence is limited to small clinical trials or single-center studies, and there remains a lack of large-scale, nationwide data reflecting real-world treatment patterns.\u003c/p\u003e \u003cp\u003eKorea provides a unique research setting as one of the few countries worldwide where both Western medicine (WM) and traditional Korean medicine (KM) are fully integrated into the National Health Insurance system (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Patients can freely choose between, or combine, these two systems under a single coverage framework. This dual healthcare structure offers an exceptional opportunity to directly compare KM-only care with integrative KM\u0026ndash;WM care in routine clinical practice (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the present study analyzed nationwide claims data from 2011 to 2020 to investigate treatment patterns among patients with chronic cough. Specifically, we aimed to: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) compare patient characteristics between KM-only and KM\u0026thinsp;+\u0026thinsp;WM groups; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) examine utilization of key KM modalities such as acupuncture, herbal medicine, moxibustion, and cupping alongside WM prescriptions; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) explore the patterns of multimodal treatment combinations in real-world practice. By doing so, this study provides evidence to inform clinical and policy decision-making regarding complementary and integrative approaches to chronic cough management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Source and Study Population\u003c/h2\u003e \u003cp\u003e This retrospective cohort study was conducted using nationwide outpatient claims data from the Health Insurance Review and Assessment Service (HIRA) between January 1, 2011, and December 31, 2020. Given the limitations of extracting data for all cough patients, we identified all patients who received a cough-related diagnosis code (R05) at Korean Medicine (KM) institutions. For each patient, medical encounters were chronologically ordered by patient identifier and visit date, and repeated consultations for cough were grouped to define chronic cough episodes. No exclusions were made based on underlying diseases, in order to capture the comprehensive clinical spectrum of chronic cough and to reflect real-world treatment utilization.\u003c/p\u003e \u003cp\u003eThe study used customized research data from HIRA (project ID: M20230131001). As the dataset contained de-identified secondary data, the Institutional Review Board (IRB) granted an exemption from ethical review (IRB No. I-2301/001\u0026ndash;002). Clinical trial number: not applicable.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinition of Chronic Cough Episodes\u003c/h3\u003e\n\u003cp\u003eCough episodes were reconstructed from claims records, with the start defined as the first visit date for a cough diagnosis. A sequence of visits was classified as a single episode if consecutive consultations were recorded without a gap exceeding 30 days. If no cough-related visits occurred for \u0026ge;\u0026thinsp;30 days, the episode was considered terminated, and any subsequent visits were treated as a new episode.\u003c/p\u003e \u003cp\u003eChronic cough was defined as an episode lasting\u0026thinsp;\u0026ge;\u0026thinsp;56 days with at least three outpatient visits during that period. This operational definition is consistent with international clinical guidelines that define chronic cough as lasting\u0026thinsp;\u0026ge;\u0026thinsp;8 weeks (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and aligns with prior electronic medical record-based studies adopting a 56-day duration and \u0026ge;\u0026thinsp;3 visits as a validated definition (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eClassification of Treatment Groups\u003c/h3\u003e\n\u003cp\u003eHealthcare provider type was classified using institutional codes in the claims database, distinguishing Korean Medicine (KM) institutions from Western Medicine (WM) institutions. For each patient, the observation window extended from 30 days before the index date (start of the representative episode) to 30 days after the end date. Patients with WM encounters within this window were categorized into the KM\u0026thinsp;+\u0026thinsp;WM (integrative care) group, while those without such encounters were assigned to the KM-only group. The \u0026plusmn;\u0026thinsp;30-day window was chosen to capture clinically relevant patterns of concurrent or overlapping use of KM and WM, thereby reflecting real-world integrative care behaviors. Because the cohort was constructed from patients who received cough diagnoses in KM institutions, the KM-only group represents the primary population, with the KM\u0026thinsp;+\u0026thinsp;WM group being a subset the cohort.\u003c/p\u003e\n\u003ch3\u003eTreatment and Medication Data\u003c/h3\u003e\n\u003cp\u003eTreatment data were linked across claims tables to identify both KM and WM interventions during chronic cough episodes. KM modalities included acupuncture, moxibustion, cupping, and herbal medicine, while WM prescriptions included antibiotics, antitussives/expectorants, antihistamines, and other medications. Only treatment and prescription records within the defined episode window were included for analysis.\u003c/p\u003e\n\u003ch3\u003eComorbidity Assessment\u003c/h3\u003e\n\u003cp\u003eThe Charlson Comorbidity Index (CCI) was calculated to evaluate the burden of comorbidities (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The CCI is a weighted index ranging from 1 to 6 points for 19 disease categories, widely used for mortality risk adjustment. We assessed each patient\u0026rsquo;s CCI based on diagnoses recorded during the two years prior to the index date.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eEligible patients were adults (\u0026ge;\u0026thinsp;18 years) with chronic cough episodes and at least one treatment or prescription record. The proportion of chronic cough patients among all KM outpatient visits was calculated annually to assess temporal trends. Demographic characteristics (age, sex) and clinical features (CCI, visit frequency, episode duration, treatment type) were compared between the KM-only and KM\u0026thinsp;+\u0026thinsp;WM groups. Descriptive statistics were presented as means with standard deviations (SD) for continuous variables and counts with percentages for categorical variables. Group comparisons were performed using chi-square tests or t-tests, as appropriate.\u003c/p\u003e \u003cp\u003eAll analyses were conducted using SAS (SAS Institute, Cary, NC, USA) and R (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eUtilization of Korean Medicine and Trends in the Proportion of Chronic Cough Patients\u003c/h2\u003e \u003cp\u003eBetween 2011 and 2020, overall utilization of Korean Medicine (KM) services showed a consistent decline. The total number of KM outpatient visits decreased from 229,655 in 2011 to 123,986 in 2020, representing a reduction of approximately 46%. Similarly, the number of unique patients declined by about 60%, from 96,552 in 2011 to 39,031 in 2020. These findings indicate a steady contraction in the overall scale of KM utilization over the past decade.\u003c/p\u003e \u003cp\u003eIn contrast, the proportion of chronic cough patients among all KM outpatients demonstrated a clear upward trend. The prevalence of chronic cough within the KM population was only 1.15% in 2011 but increased steadily each year, surpassing 2.0% in 2016 and reaching 2.76% by 2020. Notably, since 2017, the proportion has remained consistently above 2%, suggesting that the relative burden of chronic cough within KM practice has expanded, even as the overall patient population declined (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics of Patients with Chronic Cough\u003c/h2\u003e \u003cp\u003eA total of 14,223 patients met the inclusion criteria, of whom 10,638 (74.8%) were classified as the KM-only group and 3,585 (25.2%) as the KM\u0026thinsp;+\u0026thinsp;WM group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the overall cohort was 58.6 years, with more than half of the patients in both groups aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years. The proportion of older patients was higher in the KM\u0026thinsp;+\u0026thinsp;WM group, in which 55.7% were aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years, compared with 45.3% in the KM-only group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFemale patients predominated in both groups; however, the proportion of male patients was significantly higher in the KM-only group (30.2%) than in the KM\u0026thinsp;+\u0026thinsp;WM group (26.6%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003ePatterns of healthcare utilization also differed between groups. The KM-only group had a higher mean number of outpatient visits (20.4 vs. 9.3) and a longer episode duration (101.9 vs. 84.4 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with the KM\u0026thinsp;+\u0026thinsp;WM group.\u003c/p\u003e \u003cp\u003eWith regard to comorbidity burden, patients with a Charlson Comorbidity Index (CCI) score\u0026thinsp;\u0026ge;\u0026thinsp;1 accounted for 43.7% of the KM\u0026thinsp;+\u0026thinsp;WM group, compared with 32.8% in the KM-only group. These findings indicate that patients receiving combined KM and WM care tended to have more comorbidities and a more complex clinical profile than those receiving KM care alone.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of chronic cough patients by treatment group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKM only \u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;10,638)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKM\u0026thinsp;+\u0026thinsp;WM \u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3,585)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;14,223)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,209 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e952 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,161 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;20\u0026ndash;39 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,514 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e440 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,954 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;40\u0026ndash;59 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,635 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,148 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,783 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;60\u0026ndash;79 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,814 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,800 (50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,614 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- \u0026ge;80 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e675 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e872 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisit count, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpisode duration (days), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101.9\u0026thinsp;\u0026plusmn;\u0026thinsp;78.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.4\u0026thinsp;\u0026plusmn;\u0026thinsp;47.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.5\u0026thinsp;\u0026plusmn;\u0026thinsp;72.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson comorbidity index, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI category, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7,152 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,018 (56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9,170 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,082 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,364 (38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,446 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e358 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e541 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- \u0026ge;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComorbidities and Medication Use in the Three Years Prior to Index Date\u003c/h2\u003e \u003cp\u003eMedication use during the three years prior to the index date showed markedly higher rates in the KM\u0026thinsp;+\u0026thinsp;WM group compared with the KM-only group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Prescriptions for respiratory and allergy-related drugs were consistently more frequent in the KM\u0026thinsp;+\u0026thinsp;WM group, including corticosteroids (36.4% vs. 24.4%), antihistamines (31.4% vs. 19.0%), bronchodilators (34.5% vs. 21.5%), and expectorants/mucolytics (18.0% vs. 13.2%; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gastroprotective agents (41.3% vs. 29.3%) and antihypertensive medications (11.2% vs. 7.1%) were also more commonly prescribed in the KM\u0026thinsp;+\u0026thinsp;WM group, and use of antiallergic or immunomodulatory agents was nearly twice as high (7.1% vs. 3.6%).\u003c/p\u003e \u003cp\u003eComorbidity profiles, evaluated based on diagnostic records during the same three-year period, likewise indicated a greater burden among KM\u0026thinsp;+\u0026thinsp;WM patients. Allergic rhinitis (51.0% vs. 30.1%), asthma (26.8% vs. 14.4%), chronic bronchitis (20.7% vs. 11.0%), and chronic sinusitis (16.7% vs. 8.0%) were all significantly more prevalent in the KM\u0026thinsp;+\u0026thinsp;WM group (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gastroesophageal reflux disease (GERD) was diagnosed in more than half of KM\u0026thinsp;+\u0026thinsp;WM patients (50.1%) compared with 31.3% in the KM-only group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, major chronic conditions such as hypertension (27.3% vs. 21.1%) and diabetes mellitus (18.4% vs. 13.6%) were more common in the KM\u0026thinsp;+\u0026thinsp;WM group. By contrast, no significant between-group differences were observed for relatively rare conditions such as bronchiectasis, pulmonary fibrosis, or tuberculosis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedication use and comorbidities within 3 years prior to the index date among chronic cough patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKM only (N\u0026thinsp;=\u0026thinsp;10,638)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKM\u0026thinsp;+\u0026thinsp;WM (N\u0026thinsp;=\u0026thinsp;3,585)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;14,223)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdrenal corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,600 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,305 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,905 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntihistamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,019 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,125 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,144 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchodilators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,287 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,236 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,523 (24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpectorants \u0026amp; mucolytics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,400 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e647 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,047 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-ulcer agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,113 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,481 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,594 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntihypertensives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e752 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e401 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,153 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther allergy \u0026amp; immunology drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e378 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e255 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e633 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllergic rhinitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,197 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,830 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,027 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,536 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e960 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,496 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic bronchitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,166 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e743 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,909 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic sinusitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e847 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e598 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,445 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGERD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,327 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,797 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,124 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,241 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e978 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,219 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,443 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e660 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,103 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e959 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e480 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,439 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e320 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e473 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number (%). Medication use and comorbidities were identified from claims records during the 3 years prior to the index date, including the index date. KM only\u0026thinsp;=\u0026thinsp;Korean Medicine only; KM\u0026thinsp;+\u0026thinsp;WM\u0026thinsp;=\u0026thinsp;Korean Medicine combined with Western Medicine. p-values were obtained using t-tests for continuous variables and chi-square tests for categorical variables. GERD\u0026thinsp;=\u0026thinsp;gastroesophageal reflux disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMost Frequently Prescribed Medications During the Chronic Cough Period (Western Medicine)\u003c/h2\u003e \u003cp\u003eDuring the chronic cough period, the most frequently prescribed Western medicine was expectorants/antitussives, which were used in 88.2% of patients, with an average of 6.3 prescriptions per patient (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Antihistamines were the second most common, prescribed to 66.9% of patients with a mean of 3.7 prescriptions. Gastroprotective agents (60.8%) and other antiallergic drugs (49.2%) were also prescribed in nearly half of the cohort.\u003c/p\u003e \u003cp\u003eOther frequently used medications included opioid alkaloid antitussives (29.2%), bronchodilators and other respiratory agents (approximately 25%), otolaryngologic medications (28.2%), other gastrointestinal drugs (21.7%), and corticosteroids (25.4%). Psychotropic medications were prescribed to a smaller proportion of patients (8.4%), yet among those prescribed, the average number of prescriptions per patient was relatively high (4.6). Additional, less frequently used prescriptions are presented in Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMost frequently prescribed medications during chronic cough period (Western medicine)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication class\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal prescriptions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnique patients \u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3,325)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAvg. per patient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpectorants \u0026amp; mucolytics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18,373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntihistamines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-ulcer agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6,648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther antiallergy drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpioid alkaloid antitussives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther respiratory drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eENT preparations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther gastrointestinal drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdrenal corticosteroids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychotropic agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues are expressed as number or number (%). Data represent medications prescribed during the chronic cough period in Western medicine settings. The table shows the top 10 medication classes based on the proportion of patients who received each medication. Additional medications prescribed in fewer than 8% of patients are provided in Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eUtilization Patterns of Korean Medicine Procedures During the Chronic Cough Period\u003c/h2\u003e \u003cp\u003eDuring the chronic cough period, acupuncture was by far the most frequently utilized Korean Medicine procedure. A total of 98.6% of patients received acupuncture, with an average of 19.8 sessions per patient, underscoring its role as the central therapeutic strategy (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Cupping therapy was performed in 59.3% of patients, with an average of 16.1 sessions per patient, making it the second most common modality. Hot and cold meridian therapy (a traditional Korean physical therapy modality involving thermal stimulation along meridian pathways) was administered to 42.9% of patients, with an average of 13.4 sessions, indicating its substantial use as an adjunctive treatment. In contrast, Chuna manual therapy (a traditional Korean manual therapy that combines spinal manipulation techniques with meridian theory, similar to chiropractic but based on traditional East Asian medicine principles) was rarely applied, being utilized in only 0.7% of patients.\u003c/p\u003e \u003cp\u003eOverall, these findings demonstrate that acupuncture constituted the cornerstone of Korean Medicine management for chronic cough, while cupping and hot/cold meridian therapy were commonly used as complementary approaches, and Chuna was infrequently employed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUtilization patterns of Korean Medicine procedures during the chronic cough period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal treatments\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnique patients\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;11,151)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAvg. per patient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217,615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10,996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCupping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106,496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHot and cold meridian therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChuna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis table summarizes the utilization patterns of Korean Medicine-based procedures among 11,151 patients with chronic cough. \u0026ldquo;Total procedures\u0026rdquo; indicates the overall number of sessions provided in each category. \u0026ldquo;Unique patients\u0026rdquo; refers to the number of patients who received the respective procedure at least once. \u0026ldquo;% of patients\u0026rdquo; represents the proportion of those patients out of the total cohort. \u0026ldquo;Avg. per patient\u0026rdquo; is calculated as the total number of procedures divided by the number of treated patients\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMost Frequently Prescribed Herbal Formulas During the Chronic Cough Period\u003c/h2\u003e \u003cp\u003eAnalysis of herbal prescriptions during the chronic cough period revealed that a small number of formulas were used with notably high frequency. The most commonly prescribed formula was Samso-eum, which was given to 35.0% of patients, with an average of 8.3 prescriptions per patient (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This was followed by So-cheong-ryong-tang (23.3%), Ja-eum-ganghwa-tang (12.5%), and Haengso-tang (9.8%). Other frequently used prescriptions included Bojung-ikgi-tang, Ijin-tang, Yeongyo-paedok-san, and Gung-ha-tang.\u003c/p\u003e \u003cp\u003eInterestingly, certain prescriptions such as Gung-ha-tang, Gamcho, and Jakyak were used in a relatively small proportion of patients, but those who received them had more than 15 prescriptions on average, indicating intensive use within specific patient subgroups. By contrast, many other herbal formulas were prescribed to less than 1% of patients and had minimal impact on overall frequency; these less common formulas are presented in Supplementary Table S2.\u003c/p\u003e \u003cp\u003eOverall, the pattern of herbal prescriptions in chronic cough patients was characterized by predominant use of Samso-eum and So-cheong-ryong-tang, supplemented by a variety of traditional formulas tailored to individual clinical contexts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 15 herbal prescriptions used during the chronic cough period (Korean Medicine)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal prescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnique patients \u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;5,001)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAvg. per patient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSamso-eum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14,576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSo-cheong-ryong-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJa-eum-ganghwa-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaengso-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBojung-ikgi-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIjin-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYeongyo-paedok-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGung-ha-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGumi-ganghwal-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsam-paedok-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGamcho (Glycyrrhizae Radix)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJakyak (Paeoniae Radix)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePyeongwi-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOjeok-san\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyeonggae-yeongyo-tang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis table presents the 15 most frequently prescribed herbal medicines during the chronic cough period among 5,001 patients. \u0026ldquo;Total prescriptions\u0026rdquo; indicates the total number of prescriptions for each formula. \u0026ldquo;Unique patients\u0026rdquo; refers to the number of patients who received the prescription at least once. \u0026ldquo;% of patients\u0026rdquo; represents the proportion of those patients out of the total cohort. \u0026ldquo;Avg. per patient\u0026rdquo; is calculated as the number of prescriptions divided by the number of treated patients. Additional prescriptions beyond the top 15 are provided in Supplementary Table S2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePatterns of Treatment Combinations During the Chronic Cough Period\u003c/h2\u003e \u003cp\u003eDuring the chronic cough period, the most frequently observed treatment combination was acupuncture alone, accounting for 82,732 sessions among 4,536 patients (31.9% of the cohort), with an average of 18.2 sessions per patient (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The second most common pattern was acupuncture combined with cupping therapy, delivered in 42,503 sessions to 3,324 patients (23.4%), followed by acupuncture combined with cupping and hot and cold meridian therapy (28,723 sessions, 2,551 patients, 17.9%). Other frequently utilized multimodal regimens included acupuncture\u0026thinsp;+\u0026thinsp;cupping\u0026thinsp;+\u0026thinsp;herbal medicine (12.8% of patients) and acupuncture\u0026thinsp;+\u0026thinsp;hot and cold meridian therapy (10.5%). Notably, Western medicine alone was administered to 3,308 patients (23.3%), with a comparatively lower intensity (13,945 sessions, mean 4.2 sessions per patient). Pure herbal medicine prescriptions without procedures were observed in 1,607 patients (11.3%), with 10,568 sessions (mean 6.6 per patient). In addition, integrative regimens combining acupuncture, cupping, hot and cold meridian therapy, and herbal medicine were delivered to 1,362 patients (9.6%, 12,261 sessions). Overall, the findings indicate that while acupuncture formed the backbone of chronic cough management in Korean Medicine, it was frequently combined with cupping and other KM modalities, and in some cases integrated with herbal medicine or Western medicine.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTreatment combinations including procedures, herbal medicine, and Western medicine during the chronic cough period5\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment combination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal sessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnique patients (N\u0026thinsp;=\u0026thinsp;14,223)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAvg. sessions per patient\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82,732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Cupping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42,503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Cupping\u0026thinsp;+\u0026thinsp;Hot and cold meridian therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28,723\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Cupping\u0026thinsp;+\u0026thinsp;Herbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19,365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Hot and cold meridian therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16,277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWestern medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Cupping\u0026thinsp;+\u0026thinsp;Hot and cold meridian therapy\u0026thinsp;+\u0026thinsp;Herbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12,261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHerbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Herbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcupuncture\u0026thinsp;+\u0026thinsp;Hot and cold meridian therapy\u0026thinsp;+\u0026thinsp;Herbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues represent the most common treatment combinations. Less frequent combinations are presented in Supplementary Table S3.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis large-scale retrospective cohort study analyzed 14,223 patients with chronic cough using nationwide claims data from the Korean National Health Insurance Service between 2011 and 2020. The key findings are as follows:\u003c/p\u003e \u003cp\u003eFirst, the proportion of patients with chronic cough seeking Korean Medicine (KM) care increased steadily over the past decade, rising from 1.15% in 2011 to 2.76% in 2020, representing approximately a 2.4-fold increase. This trend highlights the expanding role of KM in the management of chronic cough within the national healthcare system.\u003c/p\u003e \u003cp\u003eSecond, while the majority of patients (74.8%) received KM-only treatment, one-quarter (25.2%) sought combined care with Western Medicine (KM\u0026thinsp;+\u0026thinsp;WM). This pattern underscores the continued reliance on KM as a primary treatment option and reflects the unique dual healthcare system in Korea, which allows patients to freely choose between, or combine, KM and WM within the same insurance framework.\u003c/p\u003e \u003cp\u003eThird, patients in the KM\u0026thinsp;+\u0026thinsp;WM group exhibited a higher prevalence of comorbidities and greater medication use compared to those in the KM-only group. Notably, the prevalence of gastroesophageal reflux disease (GERD) was 50.1% in the KM\u0026thinsp;+\u0026thinsp;WM group versus 31.3% in the KM-only group, a statistically significant difference. These findings suggest that patients with greater disease complexity or comorbidity burden are more likely to seek integrative care.\u003c/p\u003e \u003cp\u003eFourth, acupuncture was almost universally utilized, with 98.6% of patients receiving it at least once, confirming its role as the cornerstone of KM-based interventions for chronic cough. In contrast, adjunctive therapies such as moxibustion (42.9%) and cupping (59.3%) were used less frequently, indicating their role as complementary rather than primary interventions.\u003c/p\u003e \u003cp\u003eFinally, the analysis of treatment combinations (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) revealed that greater diversity of therapies did not necessarily translate into more frequent visits. In some cases\u0026mdash;such as the combination of acupuncture, cupping, and herbal medicine\u0026mdash;the average number of treatments per patient was lower than that observed with single therapies. This finding suggests that treatment frequency in clinical practice is tailored according to patient symptomatology and therapeutic strategies, rather than being uniformly additive across modalities.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications of the Increasing Prevalence of Chronic Cough\u003c/h2\u003e \u003cp\u003eThe persistent increase in the prevalence of chronic cough observed over the 10-year study period (from \u003cb\u003e1.15%\u003c/b\u003e in 2011 to 2.76% in 2020, approximately a 2.4-fold rise) is noteworthy when compared with domestic and international epidemiological studies. A recent systematic review estimated the average prevalence of chronic cough in Asia at 4.4%, lower than in Europe (12.7%) or North America (11.0%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although the 2020 prevalence in this study (2.76%) remained below the Asian average, it represented a clear upward trend relative to 2011. This suggests that the prevalence of chronic cough in Korea is gradually increasing. A previous study using the Korea National Health and Nutrition Examination Survey (KNHANES) reported a prevalence of 2.6% in 2010\u0026ndash;2012 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), which was higher than our estimates for the corresponding years (1.15\u0026ndash;1.57%). While methodological differences and definitions must be considered, the overall trend of rising prevalence remains consistent. A recent comparative study between Korea and Taiwan also reported a 12-month prevalence of 4.34% in Korea (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), further supporting the long-term trajectory observed in our data.\u003c/p\u003e \u003cp\u003eSeveral factors may contribute to this upward trend. First, chronic cough is strongly associated with aging, and Korea\u0026rsquo;s rapidly aging population is likely an important driver of prevalence growth. Second, worsening air pollution and other environmental factors may have exacerbated respiratory symptoms. Air pollution has previously been identified as a major risk factor for chronic cough in Korea (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Third, the rising prevalence of gastroesophageal reflux disease (GERD) may also play a role; in Korea, GERD prevalence increased from 7.1% in 2002 to 7.9% in 2007 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), likely reflecting Westernized dietary and lifestyle changes. Fourth, improved access to healthcare and greater disease awareness may have led to higher diagnosis rates. Importantly, the COVID-19 pandemic in 2020 marked an exceptional turning point. Although overall healthcare utilization declined during the pandemic, the prevalence of chronic cough peaked at 2.76%. This could partly be explained by the high prevalence of post-COVID cough (estimated at ~\u0026thinsp;18%) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), indicating a possible influence of COVID-19 on cough epidemiology. In addition, lifestyle changes such as mask wearing, social distancing, and elevated stress levels could have contributed to symptom exacerbation..\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eHigh Proportion of Korean Medicine-Only Utilization and Its Implications\u003c/h2\u003e \u003cp\u003eThis cohort was constructed from patients diagnosed with cough (R05) in Korean Medicine (KM) clinics, and 85.7% of the study population received KM-only treatment. This finding indicates that a substantial proportion of chronic cough patients who initially sought KM care continued to rely exclusively on this system. Thus, the results should not be generalized to all chronic cough patients, but rather interpreted as reflecting the characteristics of those who selected KM care. Given the relatively older mean age of the study population (~\u0026thinsp;60 years), the higher KM utilization may partly reflect the treatment preferences of older adults, who are known to favor KM. Furthermore, KM\u0026rsquo;s holistic approach and perceived lower risk of adverse effects likely make it an attractive option for patients with complex, multifactorial symptoms.\u003c/p\u003e \u003cp\u003eHowever, as this study relied on claims data, non-reimbursed KM treatments and over-the-counter medications were not captured. Therefore, some patients categorized as KM-only users may in fact have received WM in parallel, and this should be taken into account when interpreting the findings. Future studies incorporating survey data or qualitative approaches will be valuable in more accurately characterizing real-world treatment behaviors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in Patient Characteristics Between Treatment Groups\u003c/h2\u003e \u003cp\u003eClear differences were observed between the KM-only and KM\u0026thinsp;+\u0026thinsp;WM groups, reflecting distinct levels of clinical complexity. Patients in the KM\u0026thinsp;+\u0026thinsp;WM group had higher prevalences of major comorbidities (GERD 50.1% vs. 31.3%, allergic rhinitis 51.0% vs. 30.1%, asthma 26.8% vs. 14.4%), greater prescription rates for key medications, and higher CCI scores. Conversely, KM-only patients had longer episode durations (101.9 vs. 84.4 days) and more frequent visits (20.4 vs. 9.3), suggesting sustained KM utilization in less complex cases. This pattern may indicate that patients with milder or less complicated disease profiles tend to rely on KM for long-term symptom management, where repeated visits are intended to maintain or gradually improve symptoms rather than to address acute exacerbations. Overall, these findings suggest that patients with greater clinical complexity were more likely to seek integrative care, whereas those with milder presentations tended to rely on KM alone. Notably, the markedly higher prevalence of GERD in the KM\u0026thinsp;+\u0026thinsp;WM group (50.1% vs. 31.3%) highlights the importance of GERD as a common comorbidity in chronic cough. Because GERD-related cough often requires pharmacological therapy and remains challenging to manage effectively, this observation underscores a potential treatment gap in which KM interventions alone may be insufficient, thereby driving patients toward integrative KM\u0026ndash;WM care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePatterns and Clinical Implications of Korean Medicine and Integrative Interventions\u003c/h2\u003e \u003cp\u003eAcupuncture was administered to nearly all patients (98.6%), confirming its role as the cornerstone of KM-based treatment for chronic cough. The average of 19.8 sessions per patient, spanning approximately 3\u0026ndash;4 months based on typical treatment schedules, suggests that chronic cough requires sustained neuromodulatory intervention rather than short-term symptomatic relief. This finding aligns with systematic reviews and meta-analyses reporting that acupuncture-related therapies significantly improve cough severity and quality of life through cumulative therapeutic effects (30).\u003c/p\u003e \u003cp\u003eCupping therapy (59.3%) and hot\u0026ndash;cold meridian therapy (42.9%) were frequently applied as adjunctive modalities, with average session counts of 16.1 and 13.4 respectively, reflecting the multimodal approach characteristic of KM practice. In contrast, Chuna manual therapy was rarely utilized (0.7%), indicating its selective application in specific clinical contexts rather than routine use for chronic cough management.\u003c/p\u003e \u003cp\u003eHerbal medicine prescriptions were dominated by Samso-eum (35.0%) and So-cheong-ryong-tang (23.3%), both traditionally indicated for cough-related conditions. The frequent use of So-cheong-ryong-tang is particularly noteworthy given the high prevalence of allergic rhinitis in our cohort (51.0% in KM\u0026thinsp;+\u0026thinsp;WM group, 30.1% in KM-only group), as this formula has documented efficacy in allergic respiratory conditions (31). Other commonly prescribed formulas included Ja-eum-ganghwa-tang (12.5%) and Haengso-tang (9.8%), reflecting the heterogeneous clinical presentations requiring individualized treatment approaches.\u003c/p\u003e \u003cp\u003eA notable finding was the infrequent prescription of formulas specifically indicated for GERD-related cough, such as Ojeok-san (3.3%) and Saengmaek-san (2.7%), despite GERD being present in 50.1% of the KM\u0026thinsp;+\u0026thinsp;WM group and 31.3% of the KM-only group. This discrepancy suggests either underutilization of targeted therapies or the absence of well-established, evidence-based KM protocols for GERD-associated chronic cough, highlighting an area for future clinical guideline development.\u003c/p\u003e \u003cp\u003eAnalysis of treatment combinations revealed that acupuncture alone accounted for the largest proportion of patients (31.9%), followed by acupuncture with cupping (23.4%) and acupuncture combined with cupping plus hot\u0026ndash;cold meridian therapy (17.9%). However, these patterns should be interpreted with caution, as the claims database captures only reimbursed treatments. Non-reimbursed herbal prescriptions, commonly used in routine KM practice, were not included, potentially leading to misclassification of some patients as receiving \"acupuncture alone\" when they may have received comprehensive integrative care. This limitation underscores a broader methodological challenge in KM research and highlights the need for data collection systems that can capture the full spectrum of integrative therapeutic approaches.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several notable strengths. First, it is a large-scale, nationwide cohort study utilizing the comprehensive claims database of the Korean National Health Insurance Service, ensuring adequate sample size and representativeness. Data collected within a single-payer system minimize selection bias and provide a realistic reflection of healthcare utilization patterns. Second, unlike most previous studies that primarily focused on Western Medicine (WM) institutions, this study uniquely constructed its cohort based on patients utilizing Korean Medicine (KM) institutions. This methodological distinctiveness allowed us to illuminate clinical behaviors within KM settings, which have been underexplored in Korea\u0026rsquo;s dual healthcare system, thereby contributing novel academic value. Third, by examining a decade-long period, this study captured temporal changes in the prevalence of chronic cough while also considering the impact of the COVID-19 pandemic, offering an integrated understanding of disease epidemiology. Fourth, beyond descriptive frequency analysis, we systematically compared patient characteristics, comorbidities, and treatment patterns, thereby clarifying differences between the KM-only and KM\u0026thinsp;+\u0026thinsp;WM groups, which enhances the clinical relevance of our findings.\u003c/p\u003e \u003cp\u003eHowever, this study also has limitations. First, owing to the nature of claims data, non-reimbursed treatments were not captured. As a result, patients who actually received both acupuncture and herbal medicine might have been misclassified as having received \u0026ldquo;acupuncture only,\u0026rdquo; potentially leading to an underestimation of KM treatment utilization. Second, over-the-counter medications purchased at pharmacies and the use of dietary supplements were not included, which may have resulted in an overestimation of KM-only utilization. Third, inherent to claims-based research, coding errors or under-reporting cannot be completely ruled out. Fourth, because the cohort was constructed from patients who received a cough diagnosis (R05) at KM institutions, our findings primarily reflect the characteristics of this population. Some of these patients subsequently sought WM care, but patients who received their initial cough diagnosis exclusively in WM institutions were not included, which may limit generalizability. Finally, as a retrospective analysis, this study could not assess patient-centered outcomes such as treatment effectiveness, symptom severity, quality of life, or satisfaction. Nor could it capture qualitative factors such as patients\u0026rsquo; motivations and preferences for treatment choice, limiting the ability to fully explain the underlying drivers of healthcare utilization.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this nationwide cohort of over 14,000 patients with chronic cough, nearly three-quarters received Korean Medicine (KM) alone, underscoring KM\u0026rsquo;s role as a primary treatment option. Patients who sought combined KM and Western Medicine (WM) care had greater comorbidity burdens and more complex medication profiles, reflecting the clinical need for integrative approaches. Acupuncture was almost universally used, while cupping, hot\u0026ndash;cold meridian therapy, and herbal prescriptions were frequent adjuncts. These findings highlight the real-world significance of KM in chronic cough management and suggest future policies and guidelines should better integrate KM within comprehensive care pathways, especially for patients with persistent or unexplained chronic cough\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor contributions statement\u003c/h2\u003e\n\u003cp\u003eM.Y.P. conceived the study, designed the analysis, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eB.J.L. and K.I.K. contributed to clinical interpretation and provided domain expertise on chronic cough and comorbid respiratory conditions.\u003c/p\u003e\n\u003cp\u003eY.R.L. and B.L. curated the data and performed statistical analyses.\u003c/p\u003e\n\u003cp\u003eS.W.K. assisted with data interpretation and critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eJ.H.L. supervised the overall study, provided methodological guidance, and served as corresponding author.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed, edited, and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003ch2\u003eEthical statement\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the Korea Institute of Oriental Medicine (IRB No. I-2301/001\u0026ndash;002). The requirement for informed consent was waived due to the retrospective nature of the study using anonymized data.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by grants from the Korea Health Technology R\u0026amp;D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Nos. RS-2022-KH127, RS-2023-KH139021).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eM.Y.P. conceived the study, designed the analysis, and drafted the manuscript.B.J.L. and K.I.K. contributed to clinical interpretation and provided domain expertise on chronic cough and comorbid respiratory conditions.Y.R.L. and B.L. curated the data and performed statistical analyses.S.W.K. assisted with data interpretation and critically revised the manuscript for important intellectual content.J.H.L. supervised the overall study, provided methodological guidance, and served as corresponding author.All authors reviewed, edited, and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThis study was supported by the Ministry of Health and Welfare, Republic of Korea (Grant Nos. RS-2022-KH127, RS-2023-KH139021). The data used in this study were obtained from the Health Insurance Review and Assessment Service (HIRA) under project number M20250121001. We also thank our colleagues at the Korea Institute of Oriental Medicine for their administrative and technical support throughout the study.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data underlying this article are not publicly available due to restrictions from the Health Insurance Review and Assessment Service (HIRA). Access to these data requires approval from HIRA (https://opendata.hira.or.kr), and the authors are not permitted to share the data directly.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, et al. Cough hypersensitivity and chronic cough. 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Herbal medicine for the treatment of chronic cough: a systematic review and meta-analysis. Front Pharmacol. 2023;14:1230604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim B. Korean medicine coverage in the National Health Insurance in Korea: present situation and critical issues. Integr Med Res. 2013 Sept 1;2(3):81\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark J, Yi E, Yi J. The Provision and Utilization of Traditional Korean Medicine in South Korea: Implications on Integration of Traditional Medicine in a Developed Country. Healthcare. 2021;9(10):1379.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki Y, Park JS, Park S, Cheon C, Shin YC, Ko SG, et al. Factors influencing use of conventional and traditional Korean medicine-based health services: a nationwide cross-sectional study. BMC Complement Med Ther. 2022 June;20(1):162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and Management of Cough Executive Summary. Chest. 2006;129(1):S1\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePratter MR. Overview of Common Causes of Chronic Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(1, Supplement):S59\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBali V, Weaver J, Turzhitsky V, Schelfhout J, Paudel ML, Hulbert E, et al. Development of a natural language processing algorithm to detect chronic cough in electronic health records. BMC Pulm Med. 2022 June;28(1):256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang MG, Song WJ, Kim HJ, Won HK, Sohn KH, Kang SY, et al. Point prevalence and epidemiological characteristics of chronic cough in the general adult population: The Korean National Health and Nutrition Examination Survey 2010\u0026ndash;2012. Med (Baltim). 2017;96(13):e6486.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu CJ, Song WJ, Kang SH. The disease burden and quality of life of chronic cough patients in South Korea and Taiwan. World Allergy Organ J. 2022 Sept 1;15(9):100681.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JH, Song WJ. Perspectives on chronic cough in Korea. J Thorac Dis. 2020 Sept;12(9):5194\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho SC, Lee OY, Ha NR, Shim SG, Lee KN, Yoon JH, et al. Original Articles: The Change in the Prevalence of Typical Gastroesophageal Reflux Symptoms During the Past 5 Years in Korea: A Population-based Study. Kor J Neurogastroenterol Motil. 2008;14(2):96\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConfronting COVID-. 19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses - The Lancet Respiratory Medicine [Internet]. [cited 2025 June 30]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00125-9/fulltext\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00125-9/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee B, Kwon CY, Jeong YK, Ha NY, Kim KI, Lee BJ, et al. Acupuncture-related therapy for chronic cough: A systematic review and meta-analysis. Integr Med Res. 2025;14(1):101121.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7700795/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7700795/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChronic cough impairs quality of life and increases healthcare utilization, yet no pharmacological treatment is formally approved. Korea\u0026rsquo;s dual healthcare system, which fully integrates Western medicine (WM) and Korean medicine (KM) under national insurance, provides a unique setting to examine real-world treatment patterns.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo compare KM-only and integrative KM\u0026thinsp;+\u0026thinsp;WM care for chronic cough and describe the use of key KM modalities and multimodal treatment combinations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study analyzed nationwide claims data from the Health Insurance Review and Assessment Service (HIRA), 2011\u0026ndash;2020. Chronic cough was defined as \u0026ge;\u0026thinsp;56 days with \u0026ge;\u0026thinsp;3 outpatient visits. Patients diagnosed with cough (R05) in KM institutions were included and classified into KM-only or KM\u0026thinsp;+\u0026thinsp;WM groups based on WM encounters within \u0026plusmn;\u0026thinsp;30 days of the index episode. KM modalities (acupuncture, moxibustion, cupping, herbal medicine) and WM prescriptions were assessed, with comorbidities evaluated using the Charlson Comorbidity Index (CCI).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 14,223 patients (mean age 58.6 years), 74.8% received KM-only care and 25.2% sought KM\u0026thinsp;+\u0026thinsp;WM care. Despite overall declines in KM utilization, the proportion of chronic cough patients among KM outpatients increased from 1.15% in 2011 to 2.76% in 2020. The KM\u0026thinsp;+\u0026thinsp;WM group had higher comorbidity burden (CCI\u0026thinsp;\u0026ge;\u0026thinsp;1: 43.7% vs. 32.8%) and more GERD (50.1% vs. 31.3%), allergic rhinitis (51.0% vs. 30.1%), and asthma (26.8% vs. 14.4%). Acupuncture was nearly universal (98.6%; mean 19.8 sessions), with cupping (59.3%) and hot\u0026ndash;cold meridian therapy (42.9%) as common adjuncts. Herbal use was led by Samso-eum (35.0%) and So-cheong-ryong-tang (23.3%), whereas GERD-targeted formulas were rarely prescribed (Ojeok-san 3.3%, Saengmaek-san 2.7%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eKM was the primary treatment option for chronic cough in Korea, while integrative KM\u0026thinsp;+\u0026thinsp;WM care was more common in patients with greater comorbidities. Acupuncture-centered multimodal approaches predominated, but the mismatch between GERD prevalence and GERD-targeted prescriptions highlights the need for standardized, evidence-based integrative guidelines. Findings reflect patients who initially sought KM care and should be interpreted within this context when informing policy and clinical practice.\u003c/p\u003e","manuscriptTitle":"Real-World Patterns of Korean Medicine and Combined Korean–Western Medicine Use in Patients with Chronic Cough: A Nationwide Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 09:22:41","doi":"10.21203/rs.3.rs-7700795/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-23T11:32:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T04:44:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-15T16:10:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158727920194753135964802550048020493831","date":"2026-01-10T12:06:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193474363335899211015142327343528830406","date":"2026-01-10T11:03:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6528770357991978817731239049885059537","date":"2026-01-10T08:46:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T10:37:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-19T09:33:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T11:19:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T11:17:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2025-09-24T07:38:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0843286-8595-432d-95b1-9f3e767fa0af","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T10:39:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 09:22:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7700795","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7700795","identity":"rs-7700795","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}