P6 Non-pharmacological cough suppression therapy for cough associated with underlying lung disease

Abstract

Introduction Chronic cough is a common and debilitating condition. Patients may have chronic refractory cough (CRC) with no clear cause, or cough associated with lung disease (explained cough). Cough reflex hypersensitivity may underlie all causes of cough and has been proposed as a specific ‘treatable trait’ in airways disease. In clinical practice, treatment of explained cough is often challenging and cough may persist even after conventional treatment of the underlying condition. Non-pharmacological cough suppression therapy (CST) has been shown to be an effective treatment for CRC, but there are no reports of using CST in explained cough. Method Review of records from patients undergoing CST in the period 2014–2018. A subjective assessment of outcome was made by the treating therapist. Quality of life (QOL) (Leicester cough questionnaire,LCQ) and laryngeal symptoms (Newcastle Laryngeal Hypersensitivity Questionnaire,LHQ) were recorded before and after therapy. The minimally important clinical difference (MCID) for LCQ is 1.3 and for LHQ is 1.7. Results 98 (74.5% female) patients with explained cough, mainly associated with airways disease (asthma(n=58), COPD(n=12), bronchiectasis(n=16), xerotrachea due to CTD(n=5) and ILD(n=7), underwent CST. Most (89.8%) had a cough for at least one year. Median number of CST sessions=3(range 1–6). Subjectively, 51.0% of patients improved, treatment was unsuccessful in 24.5%, 20.4% were lost to follow up and 4.1% had deteriorating health. Pre and post treatment objective data were available for 57 patients for QOL (LCQ) and 51 patients for laryngeal symptoms (LHQ). At the start of treatment, patients reported impaired QOL (Baseline mean LCQ: 11.36(SD 4.12)) and significant laryngeal symptoms (Baseline LHQ mean: 14.69(SD 3.16)). CST improved both QOL (mean change in LCQ=3.76 (SD 5.07)) and laryngeal symptoms (mean change in LHQ=2.34 (SD 3.03)). Most patients had a response greater than the MCID for both LCQ (68.4%) and LHQ (54.9%). Conclusions To our knowledge, this is the first report of a series of patients undergoing CST to treat cough associated with underlying lung disease that persists despite optimised treatment. Most patients show meaningful improvements in both symptoms and quality of life. The use of CST in this difficult group, particularly patients with asthma, appears promising.