Effectiveness of the Therapy Program for Management of Chronic Cough: Preliminary Data From a Randomized Clinical Trial

A Comparison of Therapy Adherence for Vocal Fold Atrophy and Chronic Cough

INTRODUCTION

Therapy is a common treatment for dysphonia attributable to vocal fold atrophy and chronic cough with the goal of decreasing procedural intervention. We compared the rates of therapy adherence and the factors associated with therapy adherence across groups.

METHODS

Retrospective chart review at a single institution since 2019. Groups were compared with chi-square and relative risk.

RESULTS

Across both diagnoses, 263 patients were identified; 131 (49.8%) with vocal fold atrophy and 132 (50.2%) with chronic cough. 173 patients (66%) were referred to speech therapy (81/131 atrophy, 61.8%; 91/132 cough, 69.7%; p = 0.207). Patients were evaluated in a multidisciplinary setting 30.1% of the time. Among those referred to therapy, patients who underwent their initial evaluation the same day within a multidisciplinary clinic were more likely to complete their course (30.7% vs 10.7%, p = 0.001). This association held on multivariable analysis (relative risk [RR] 2.39, 95% confidence interval 1.13-5.07, p = 0.02). Patients with atrophy and cough had similar therapy completion rates (22.2% vs 11.9%, p = 0.07). Male patients were more likely to complete therapy on multivariable analysis (RR 2.35, 1.16-4.47, p = 0.017). Patients who completed a procedure prior to therapy were not more likely to complete their course (p = 0.52).

CONCLUSIONS

Multidisciplinary clinic with a speech pathologist and laryngologist is associated with an increased rate of therapy adherence in both vocal fold atrophy and chronic cough, regardless of diagnosis. Pre-therapy procedural interventions were not associated with increased therapy adherence.

LEVEL OF EVIDENCE

3 Laryngoscope, 2025.

Development of a Comprehensive Cough Therapy Program (CCTP) for chronic cough in India: a qualitative study

PURPOSE

Chronic Cough (CC) is an emerging area of practice in speech language pathology. Behavioral treatment for managing CC has gained attention in the recent past. This study aimed to devise a comprehensive behavioural therapy program for CC by involving allied health professionals (AHPs), who are typically involved in management of CC.

METHODS

A qualitative methodology was used to devise a behavioral treatment module for CC. Practice patterns of medical professionals, AHPs and yoga practitioners for CC were gathered through semi-structured interviews. A constant comparative framework was used to recruit participants until data saturation was achieved. The interview transcripts were analyzed to identify relevant components for the module. A post-interview survey was conducted to finalize the module through a consensus-based approach.

RESULTS

Three themes and respective sub-themes were identified from analysis. The module was developed based on the treatment strategies followed by professionals and was labeled 'Comprehensive Cough Therapy Program (CCTP)'. This comprised four components - similar to what is available in literature - patient education, breathing exercises, laryngeal hydration, and cough control strategies. This was devised using inputs from the interviews and evidence in the literature.

CONCLUSION

In line with global guidelines, this behavioral treatment module can serve as a possible management option for CC.

Awareness and practices of Speech Language Pathologists (SLPs) working with chronic cough in India: a call for action

OBJECTIVE

A cough persisting beyond eight weeks is referred as chronic cough (CC) and is a common symptom of many respiratory conditions and non-respiratory conditions. The role of a speech language pathologist (SLP) in CC is emerging and this study aimed to profile the awareness and practice patterns of SLPs practicing in India.

STUDY DESIGN

Cross-sectional study.

METHOD

An online survey was used to profile the assessment, treatment and counselling practices in CC among SLPs working in India. It sought to identify the awareness levels among SLPs regarding their role and availability of behavioural interventions for CC. Only SLPs who dealt with CC could complete the entire survey while other SLPs, filled regarding awareness and availability of behavioural interventions.

RESULTS

127 eligible responses obtained from SLPs working across clinical settings in India were analysed. 75.59% (n=96) of them had not seen patients with CC in their career. 47.24% (n=60) of them were aware that behavioural interventions were available for CC. Thirty-one SLPs completed the entire survey and their practice patterns indicated that few clinicians used cough-specific protocols while largely relying on voice and swallowing related assessment and treatment for CC.

CONCLUSION

This survey the lack of awareness of SLPs' role in CC and that their practices are dominated by existing procedures for voice and swallowing disorders. Increasing the awareness of SLP's role in CC may increase the caseload of patients referred and expand the SLP's scope of practice. Development of guidelines in CC practice and inclusion in coursework/curriculum are future considerations.

Chronic Refractory Cough: Long-Term Outcomes Following Cough Suppression Therapy

OBJECTIVE

This study aimed to determine the long-term outcomes of patients with chronic refractory cough (CRC) following treatment for cough suppression therapy (CST). Currently, there is a lack of objective data regarding the long-term outcome of behavioral treatment for CRC.

METHODS

From the charts of 106 adult patients diagnosed with CRC, 24 patients were identified as having long-term data at least 3 months post-CST in the form of otolaryngologic examination, Voice Handicap Index-10 (VHI-10), and Cough Severity Index (CSI) scores. Patients underwent otolaryngologic evaluation and completed the VHI-10 and CSI assessments during pretreatment, posttreatment, and long-term follow-up visits. Patients were also divided into two groups based on their number of comorbidities.

RESULTS

Twenty of the 24 patients had significant reduction in cough severity after completing CST (P < 0.001). A significant difference was also found in CSI scores from pretherapy to the long-term follow-up visits (P = 0.001). No significant difference was found in CSI scores from posttherapy to long-term follow-up visits (P = 0.93). No significant difference was found in VHI-10 scores over time (P = 0.83). No correlation was found between changes in cough and voice severity and number of comorbidities at the tested level.

CONCLUSIONS

Findings of no significant change in CRC over the long term compared to posttherapy measures suggest that patients were able to maintain improvement in cough over the long term despite various comorbidities. The current results suggest that CST represents a satisfactory approach to treating CRC and provides patients with an ongoing tool to maintain reduced cough severity. No significant correlations between number of comorbidities and mean CSI or VHI-10 scores were found over the long term.

State of the Art for Refractory Cough: Multidisciplinary Approach

Chronic cough is a common problem that can be refractory to medical treatment. Nonpharmaceutical management of chronic cough has an important role in well selected patients. This review article outlines the history of chronic cough management, current approaches to speech pathology management of the condition and new modalities of nonpharmaceutical treatment. There is a need for further research into nonpharmaceutical options with well described randomised control trials.