Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough

Abstract

RationaleSpeech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed.ObjectiveThe aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement.MethodsAdults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life.ResultsFollowing treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001).ConclusionsThis is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough.Trial RegistrationAustralian New Zealand Clinical Trials Register, ACTRN12608000284369.

Chronic cough – assessment of treatment efficacy based on two questionnaires

“…There is an ongoing search for new medications and methods of CIC management. One of the treatment options is speech language training, as it reduces the number of cough episodes and decreases cough reflex hypersensitivity [39]. …”

Management Modalities of Chronic Cough in Adults

“…Başka bir çalışmada aynı yaklaşımın öksürük refleks duyarlılığı üzerine de etkisi gösterilmiştir. Bu etkinin öksürük sıklığı azalması, öksürük semptom skoru ve öksürük yaşam kalitesi artışı ile korele olması önemlidir [61]. Kontrollü olmayan bir çalışmada ise, tetikleyiciden kaçınıl-ması ve istemli öksürük baskılamasına odaklanan öksürük fizyoterapisi, öksürükte azalmaya yol açmıştır [62].…”

Neurophysiology and Clinical Implications of the Laryngeal Adductor Reflex

“…Also, gabapentin, a neuromodulator, has shown to be effective in some individuals with refractory chronic cough or throat clearing 40–42 . Behavioral cough therapy, generally performed by trained speech language pathologists, has demonstrated decreased cough sensitivity, decreased urge to cough and increased cough threshold 43,44 .…”