A pilot study of nebulized 3D-cultured mesenchymal stem cell-derived extracellular vesicles for the treatment of post-COVID-19 chronic cough.

Chronic multimorbidity refers to the coexistence of two or more chronic diseases in the same individual. In China, the prevalence of chronic diseases among the older adults is as high as 64.9%, among which the proportion of chronic multimorbidity among rural older adults is 63.3% (). Studies have demonstrated that people with two existing chronic diseases have a higher risk of developing a third chronic disease (), and each additional chronic disease increases the risk of mortality by 36% (). In addition, chronic multimorbidity results in complicated treatment, increased health management costs, and reduced quality of life, posing a major challenge to public health in China. Patient activation refers to patients' recognition of their own role in self-management, willingness to cooperate with medical staff, possession of knowledge and skills for self-management and health care, and ability to proactively seek health-related information, assistance from medical professionals, and high-quality care (). Patients with high activation exhibit greater self-management efficacy and are more likely to adopt health-promoting behaviors, thereby achieving favorable health outcomes (). Multiple studies have indicated () that patients with a high level of patient activation are more likely to engage in self-management behaviors, including physical exercise, healthy diet, non-smoking, adherence to medication instructions, and monitoring of their own conditions. These behaviors not only help improve patients' health outcomes but also reduce medical costs. Medication burden refers to the related burdens experienced by patients during medication use, including medication attitudes, practical difficulties, doctor-patient relationships, therapeutic effects, interference with daily life, side effects, medication behaviors, and economic costs (). Research has demonstrated that patients' medication burden is a core factor influencing their medication beliefs, medication adherence, and medication safety, as well as an important determinant of their self-medication management and disease outcomes (). Focusing on patients' medication burden may provide new perspectives for reducing medication-related problems (, ). Medication burden affects patients' health behaviors: while individuals recognize the benefits of adopting healthy behaviors, they are also aware of the difficulties associated with changing maladaptive behaviors. The greater the perceived barriers, the lower the likelihood that individuals will adopt healthy behaviors. Conversely, when patients perceive a lower medication burden, they are more likely to value self-management and demonstrate higher levels of patient activation.