Evaluation and Management Outcomes and Burdens in Patients with Refractory Chronic Cough Referred for Behavioral Cough Suppression Therapy

Laurie J Slovarp,Julie M Barkmeier-Kraemer,Amanda I Gillespie,Marie E Jetté,Jane E Reynolds

doi:10.1007/s00408-021-00442-w

Abstract

PurposeThe purpose of this study was to investigate the typical symptoms and medical management characteristics of adult patients with refractory chronic cough (RCC) who are referred to speech-language pathology (SLP) for behavioral cough suppression therapy (BCST) in order to estimate cost-effectiveness and efficiency of current practice patterns for this population.MethodsOne hundred sixty-four (164) patients with RCC referred for BCST were surveyed. Patients completed an initial survey at BCST onset related to symptom pattern and prior treatment, including the Leicester Cough Questionnaire (LCQ). Every four to six weeks patients completed follow-up surveys to assess their response to BCST.ResultsMean age was 58 years (83.5% women). The majority of patients reported their cough began two or more years prior to BCST. Approximately half (49%) reported seeing four or more physicians (including primary care physicians) and being prescribed four or more medications (57%) prior to BCST. Medications targeting post-nasal drip (72%), reflux (70%), asthma (56%), and allergies (56%) were most commonly prescribed. BCST resulted in a clinically significant improvement in 70.1% of participants. The mean change in LCQ for those who improved with BCST was 6.61. Over half (58%) reported they were quite satisfied to completely satisfied with their treatment response. The average time from enrollment to study completion was 64 days.ConclusionThe results of this study suggest early intervention with BCST may be a cost-effective and efficient option for patients with RCC.

Highlights

Chronic cough, defined as cough lasting more than 8 weeks, is highly prevalent [1] disabling [2], and carries substantial economic burden
All participants were referred for behavioral cough suppression therapy (BCST), were at least 18 years old, had a complaint of cough for at least the past 8 weeks, were not current smokers, did not have a formal pulmonary diagnosis, and had not taken an ACE-inhibitor medication within two months of enrollment
Given the primary purpose of this paper is to describe treatment patterns in patients with refractory chronic cough (RCC) who are referred for BCST, we report only the results related to relevant medical history, prior treatment, and response to BCST

Summary

Introduction

Chronic cough, defined as cough lasting more than 8 weeks, is highly prevalent [1] disabling [2], and carries substantial economic burden. The goal of evaluation across various disciplines is to determine an individual’s specific chronic cough phenotype, the most common of which are upper airway cough syndrome,. Lung (2021) 199:263–271 cough-variant asthma, gastroesophageal reflux (GERD), and eosinophilic bronchitis [4, 5]. When each of these has been evaluated and found to be absent or adequately treated yet symptoms persist, a patient is considered to have refractory chronic cough (RCC). Evaluation for utility of behavioral cough suppression therapy (BCST)— referred to in the literature as cough control therapy, cough suppression therapy, Physiotherapy and Speech-Language Therapy Intervention, among other similar variations [6,7,8]—typically occurs after completion of empiric treatment and testing for these common cough phenotypes [9,10,11,12]

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Methods

Conclusion