Disparities in Cough Variant Asthma Management and Physician-Reported Pulmonary Function Testing Resources: A Cross-Sectional Survey of Respiratory Physicians Across Hospital Tiers in Zhejiang, China

Jiangying Guo,1,* Xi Zhang,1,* Jianxing Lai,1,* Jian Wang,2 Linfeng Shen,2 Yonghong Zhong,2 Huaqiong Huang11Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Zhejiang University School of Medicine Second Affiliated Hospital Linping Campus, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huaqiong Huang, Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China, Tel +86 15005818703, Email zr_hhq@zju.edu.cnPurpose: The study aimed to evaluate differences in cough variant asthma (CVA) management and physician-reported pulmonary function testing resources across hospital tiers in Zhejiang, China.Methods: From October 12 to November 15, 2025, a cross-sectional online questionnaire survey was conducted among physicians engaged in respiratory or chronic cough care in Zhejiang, China. The survey assessed physicians’ knowledge of CVA diagnosis and treatment, awareness of prognosis, and reported access to pulmonary function testing resources. Responses were compared across hospital tiers.Results: A total of 550 submitted questionnaires were received, and 522 valid responses were included after data cleaning. Physicians in tertiary hospitals were most accurate in diagnosing CVA according to guideline criteria (85.79%), compared with those in secondary (70.59%) and primary hospitals (51.53%). Reported access to key tests, especially bronchial provocation testing, was lower in secondary and primary hospitals. The proportion of physicians who intended to use bronchial provocation testing exceeded the proportion who actually performed it (41.57% vs 23.75%). For initial treatment, 91.05% of tertiary hospital physicians selected inhaled corticosteroids (ICS) combined with long-acting beta2 agonists (LABA). This was significantly higher than the proportions in secondary and primary hospitals (69.12% and 37.24%, respectively). Physicians in tertiary hospitals also showed greater awareness of CVA prognosis.Conclusion: Clear differences exist in CVA care across hospital tiers in Zhejiang, China. Lower-tier hospitals showed gaps in diagnosis, access to bronchial provocation testing, and ICS/LABA selection. In addition, the gap between intended and performed use of bronchial provocation testing may reflect a potential barrier to objective CVA diagnosis.Keywords: cough variant asthma, chronic cough, pulmonary function test, hospital tiers, guideline adherence, clinical practice