Physiotherapy, and speech and language therapy intervention for patients with refractory chronic cough: a multicentre randomised control trial.
Physiotherapy, and speech and language therapy are emerging non-pharmacological treatments for refractory chronic cough. We aimed to investigate the efficacy of a physiotherapy, and speech and language therapy intervention (PSALTI) to improve health-related quality of life (HRQoL) and to reduce cough frequency in patients with refractory chronic cough.



In this multicentre randomised controlled trial, patients with refractory chronic cough were randomised to four weekly 1:1 sessions of either PSALTI consisting of education, laryngeal hygiene and hydration, cough suppression techniques, breathing exercises and psychoeducational counselling or control intervention consisting of healthy lifestyle advice. We assessed the change in HRQoL at week 4 with the Leicester Cough Questionnaire (LCQ). Secondary efficacy outcomes included 24-hour objective cough frequency (Leicester Cough Monitor) and cough reflex sensitivity. The primary analysis used an analysis of covariance adjusted for baseline measurements with the intention-to-treat population. This study was registered at UK Clinical Research Network (UKCRN ID 10678).



Between December 2011 and April 2014, we randomly assigned 75 participants who underwent baseline assessment (34 PSALTI and 41 controls). In the observed case analysis, HRQoL (LCQ) improved on average by 1.53 (95% CI 0.21 to 2.85) points more in PSALTI group than with control (p=0.024). Cough frequency decreased by 41% (95% CI 36% to 95%) in PSALTI group relative to control (p=0.030). The improvements within the PSALTI group were sustained up to 3 months. There was no significant difference between groups in the concentration of capsaicin causing five or more coughs.



Greater improvements in HRQoL and cough frequency were observed with PSALTI intervention. Our findings support the use of PSALTI for patients with refractory chronic cough.



UKCRN ID 10678 and ISRCTN 73039760; Results.
Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.|School of Health and Rehabilitation, Keele University, Keele, UK.
Sarah A F
SA
Chamberlain Mitchell
King's College London, Denmark Hill Campus, London, UK.
Rachel
R
Garrod
Speech and Language Therapy Department, King's College Hospital, London, UK.
Lynne
L
Clark
Department of Primary Care and Public Health Sciences, King's College London, London, UK.|NIHR Biomedical Centre, King's College London, London, UK.
Abdel
A
Douiri
Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK.
Sean M
SM
Parker
Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK.
Jenny
J
Ellis
Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, The University of Manchester and Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
Stephen J
SJ
Fowler
Speech and Language Therapy Department, Leighton Hospital, Mid Cheshire Hospitals Trust, Leighton, UK.
Siobhan
S
Ludlow
NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK.
James H
JH
Hull
NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK.
Kian Fan
KF
Chung
Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
Kai K
KK
Lee
Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.
H
H
Bellas
School of Health and Rehabilitation, Keele University, Keele, UK.
Anand
A
Pandyan
Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
Surinder S
SS
Birring
D000368:Aged; D002908:Chronic Disease; D003371:Cough / Q000628:therapy*; D003376:Counseling; D005260:Female; D006801:Humans; D007808:Language Therapy; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016037:Single-Blind Method; D013070:Speech Therapy; D016896:Treatment Outcome
Cough/Mechanisms/Pharmacology