1
|
Khan S, Brister D, Abraham T, Laventure S, Sahakian S, Juliá B, Satia I. Patient satisfaction with the management of refractory and unexplained chronic cough in Canada: Results from a national survey. PLoS One 2024; 19:e0308275. [PMID: 39088459 PMCID: PMC11293633 DOI: 10.1371/journal.pone.0308275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/05/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Chronic cough (persisting for ≥8 weeks) is a common disorder affecting approximately 5 to 10% of adults worldwide that is sometimes refractory to treatment (refractory chronic cough [RCC]) or has no identifiable cause (unexplained chronic cough [UCC]). There is minimal information on the patient's experience of RCC/UCC in Canada. The aim of this study was to evaluate the patient journey and perceptions related to RCC/UCC management in Canada. METHODS Our exploratory study included Canadians in the Leger Opinion Panel and focused on individuals with RCC or UCC. Key entry criteria were: age ≥18 years, cough on most days for ≥8 weeks, no smoking within 1 year, no serious respiratory disease or lung cancer, and not taking angiotensin-converting enzyme inhibitors. Individuals who met entry criteria were invited to complete an approximately 30-minute online survey with questions on demographic characteristics, healthcare professional (HCP) interactions, diagnosis of underlying conditions, current treatments, and satisfaction with HCPs and chronic cough therapies. RESULTS A total of 49,076 individuals completed the chronic cough screening questionnaire (July 30, 2021 to September 1, 2021): 1,620 (3.3%) met entry criteria for RCC or UCC, and 1,046 (2.1%) completed the online survey (mean age of 45 years, 61% female). Most respondents (58%) reported their chronic cough was managed by a general practitioner (GP). Forty-four percent of respondents did not have a diagnosis of an underlying condition for their cough. Breathing tests (39%) and chest imaging (34%) were the most common diagnostic tests. Cough suppressants (18%) were the most frequent current treatment. Respondents were moderately satisfied with their HCPs, but more than half considered their treatment ineffective and 34% had considered no longer seeking medical attention because of a lack of treatment success. CONCLUSIONS Individuals with RCC/UCC in Canada are largely unsatisfied with the effectiveness of treatment. Additional HCP education and new treatment options are needed to improve patient satisfaction.
Collapse
Affiliation(s)
- Sana Khan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Danica Brister
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ted Abraham
- Medical Affairs, Merck Canada Inc., Kirkland, Quebec, Canada
| | | | - Sevag Sahakian
- Medical Affairs, Merck Canada Inc., Kirkland, Quebec, Canada
| | | | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Ribeiro VV, Casmerides MCB, da Silva Reis ZMC, de Santana ÍV, do Carmo RD, Behlau M. Efficacy of Speech-language Pathology Therapy in Chronic Cough: Systematic Review With Meta-analysis. J Voice 2024; 38:674-682. [PMID: 34969556 DOI: 10.1016/j.jvoice.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To analyze the efficacy of speech-language pathology therapy in the self-assessment, in the cough frequency, and the vocal quality of adults with chronic cough. METHODS This is a systematic review with meta-analysis that answered the clinical question: "In adults with chronic cough, what is the effect of the speech-language pathology therapy in the self-assessment, in the cough frequency, and the vocal quality, compared to another intervention?" (PROSPERO 2021/CRD42021226729). An electronic search (MEDLINE, Web of Science, EMBASE, SCOPUS, Cochrane Library, and Lilacs), and a manual search (Journal of Voice, Brazilian Library of Theses and Dissertations, Open Grey and Clinical Trials) with specific search strategies was performed. The risk of bias was assessed using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. Meta-analysis (standardized difference of means, Inverse Variance, and random effects model) and heterogeneity analysis (Chi², Tau², and I²) were performed. RESULTS We found 610 studies and selected three. There was an uncertain risk of detection bias. The data were heterogeneous, and there was no difference between interventions in self-perception of cough severity (z = 0.09, P = 0.930; tau² = 0.65, I² = 90%) and in the self-perception of the effects of chronic cough on health status (z = 0.30, P = 0.77; tau² = 0.99, I² = 97%). The estimated mean difference was 0.97 to cough frequency, and it was differ significantly from zero (z = 4.47, P < 0.001) but the results are heterogeneous (Chi² (1) = 22.22, P < 0.001, I² = 95%). CONCLUSION The speech-language pathology therapy had a greater effect size than the control interventions on cough frequency. However, in the subjects' perception, there were no differences between the interventions.
Collapse
Affiliation(s)
- Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, João Pessoa, PB, Brazil.
| | | | | | - Ícaro Vinícius de Santana
- Student Speech-Language Pathology Department, Universidade Federal de Sergipe - UFS, Lagarto, Sergipe, Brazil
| | - Rodrigo Dornelas do Carmo
- Speech-Language Pathology Department, Universidade Federal do Rio de Janeiro - UFRJ, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Mara Behlau
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Wright ML, Slovarp L, Reynolds J, Roy N, Okifuji A, Sundar KM, Barkmeier-Kraemer JM. Prevalence of Anxiety as a Variable in Treatment Outcomes for Individuals With Chronic Refractory Cough. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:476-484. [PMID: 38052060 DOI: 10.1044/2023_ajslp-23-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE Anxiety is a mental state characterized by an intense sense of tension, worry, or apprehension relative to something adverse that might happen in the future. Anxiety is a known comorbidity in cough patients, yet its prevalence among those with chronic refractory cough (CRC) is unknown. Anxiety is not typically assessed during evaluation for CRC, but treatments for CRC such as neuromodulators and behavioral cough suppression therapy (BCST) may potentially attenuate anxiety. This preliminary study investigates the potential prevalence of anxiety in CRC and its possible role in treatment outcomes. METHOD CRC patients seen in a specialty clinic at the University of Utah or the University of Montana completed the Leicester Cough Questionnaire (LCQ) pre- and post-BCST treatment. Participants were dichotomized into positive anxiety screen (PAS) and negative anxiety screen (NAS) groups based on presence or absence of documented anxiety within electronic medical records at the University of Utah and based on a Generalized Anxiety Disorder-7 score > 5 at the University of Montana. RESULTS Of the 86 total participants, 37 (43%) were in the PAS group (29 females, Mage = 56 ± 13) and 49 (57%) were in the NAS group (36 females, Mage = 64 ± 14). Eighty-nine percent of CRC participants with a PAS reported a clinically meaningful improvement in LCQ total score following treatment compared to 65% of NAS participants. Furthermore, mean pre- to posttreatment change scores on the LCQ were significantly greater within the PAS group (p = .002, Cohen's d = 0.7, indicating a moderate to large effect size). CONCLUSION This preliminary study suggests that (a) anxiety may be prevalent among those with CRC and (b) those patients who screen positive for anxiety report greater benefit from BCST.
Collapse
Affiliation(s)
- Miranda L Wright
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Laurie Slovarp
- School of Speech, Language, Hearing and Occupation Sciences, University of Montana, Missoula
| | - Jane Reynolds
- School of Speech, Language, Hearing and Occupation Sciences, University of Montana, Missoula
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Akiko Okifuji
- Division of Pain Medicine, University of Utah, Salt Lake City
| | - Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City
| | - Julie M Barkmeier-Kraemer
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| |
Collapse
|
4
|
Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
| |
Collapse
|
5
|
Simmons E, Kim JF, DeChance D, Becerra BJ, Crawley B, Krishna P, Murry T. Chronic Refractory Cough: Long-Term Outcomes Following Cough Suppression Therapy. J Voice 2023:S0892-1997(23)00371-5. [PMID: 38057227 DOI: 10.1016/j.jvoice.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ethan Simmons
- School of Medicine, Loma Linda University, Loma Linda, California.
| | - Jessica F Kim
- School of Medicine, Loma Linda University, Loma Linda, California
| | - Daniel DeChance
- School of Medicine, Loma Linda University, Loma Linda, California
| | - Benjamin J Becerra
- Information & Decision Sciences, California State University, San Bernardino, San Bernardino, California
| | - Brianna Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California; Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California; Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
Fujiki RB, Wright ML, Fujiki AE, Thibeault SL. Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough. Pediatr Pulmonol 2023; 58:3466-3477. [PMID: 37737562 PMCID: PMC10872587 DOI: 10.1002/ppul.26677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Behavioral cough suppression therapy (BCST) with a speech-language pathologist is a common treatment for chronic nonspecific cough (a.k.a., tic cough) in children. Yet, the outcomes and duration of pediatric BCST have eluded formal investigation. This study examined whether BCST improves cough in children with nonspecific cough and factors that predict the course of treatment. Additionally, the cough characteristics and comorbidities associated with the condition were examined. METHODS A retrospective, observational cohort design was utilized. Cough characteristics, medical history, and BCST treatment details and outcomes for 151 children were extracted from the electronic medical record of a large outpatient pediatric otolaryngology clinic. RESULTS Cough was dry and onset unaccompanied by illness in most cases. Roughly half of patients reported gradual onset and cough proceeded by tickle. On average, patients experienced symptoms for 19 months (SD = 20.09) before diagnosis. Rates of comorbid General Anxiety Disorder were elevated compared to pediatric norms. Additionally, high rates of asthma (22.1%), reflux (62.3%), and disordered sleep breathing (19.2%) were observed. Common findings on laryngoscopy included interarytenoid edema and erythema. Vocal fold changes were observed in 22.9% of children. BCST reduced cough in 92.5% of patients following an average of 1.7 sessions. Comorbid behavioral health diagnoses (p = 0.013) or induced laryngeal obstruction symptoms (p = 0.025) were significant predictors of increased therapy sessions. Cough proceeded by tickle significantly predicted fewer sessions in therapy (p = 0.011). INTERPRETATION Although randomized clinical trials are needed, these data suggest that BCST is a low-risk, effective treatment for children with nonspecific cough.
Collapse
Affiliation(s)
| | - Miranda L Wright
- Department of Otolaryngology-Head & Neck Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Communication Sciences & Disorders, University of Utah, Salt Lake City, Utah, USA
| | - Amanda E Fujiki
- Department of Psychiatry - Child and Adolescent Division, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan L Thibeault
- Department of Surgery, University of Wisconsin - Madison, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Talbot N, Heller M, Nyirjesy S, Kim B, DeSilva B, Matrka L. Superior Laryngeal Nerve Block Response Rates in 54 Neurogenic Cough Patients. Laryngoscope 2023; 133:2647-2653. [PMID: 36688251 DOI: 10.1002/lary.30570] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Neurogenic cough related to hypersensitivity of the internal branch of the superior laryngeal nerve (SLN) is often treated with neuromodulating medications, which can cause considerable side effects. An alternative therapy is steroid and local anesthetic injection of the SLN ("SLN block"), initially proposed to benefit those with lateralizing symptoms (tenderness over the thyrohyoid membrane or unilateral cough source). Our objectives are to determine if SLN block produces subjective symptomatic improvements and if repeat injections further improve symptoms, and evaluate clinical factors potentially predictive of response. METHODS Retrospective chart review of 54 patients receiving SLN blocks at a tertiary medical academic center from January 2010 to June 2020. Medical history and anticipated predictors of positive response, including stigmata of laryngeal hypersensitivity, were recorded. Outcomes included symptomatic response, number of injections required, and side effects. Response was defined subjectively by asking patients whether the injection was beneficial and objectively by using CSI scores. RESULTS Fifty-four patients met the inclusion criteria. Thirty-eight patients (70.4%) endorsed improvement. No variables were identified as positive predictors of response. Thirty-two of the 38 (84.2%) endorsed improvement after one injection. Six of 15 (40%) patients who failed the first injection had positive response to the second. No significant side effects were reported. CONCLUSION No localizing symptoms, specific cough features, or aspects of the medical history helped predict response, suggesting that a broader range of patients may be offered the intervention. The majority of patients reported symptomatic improvement and repeat injections may benefit patients with initial nonresponse. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2647-2653, 2023.
Collapse
Affiliation(s)
- Nicholas Talbot
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Margaret Heller
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sarah Nyirjesy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brad DeSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
8
|
Peng Y, Zhang T, Yuan L, Xu X, Yu L. Management of non-pharmacologic therapy for chronic refractory cough: Mechanism, composition, applicable population, and assessment. Heliyon 2023; 9:e20351. [PMID: 37810829 PMCID: PMC10556583 DOI: 10.1016/j.heliyon.2023.e20351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Chronic cough is common in the clinic and can seriously affect the quality of life of patients. Following the existing guidelines for treatment, refractory chronic cough is defined as a clinical condition in which the cause of the cough remains unclear after comprehensive examination and treatment, or the cause is clear but symptomatic treatment is ineffective. It has been found that non-pharmacologic therapy can effectively improve the quality of life and reduce the frequency of coughing for some patients with refractory chronic cough. Compared with pharmacological therapy, non-pharmacologic therapy has no obvious adverse effects; therefore, non-pharmacologic therapy has good application prospects in the diagnosis and treatment of refractory chronic cough. This paper summarizes the composition, indication, action and mechanism of non-pharmacologic therapy in the diagnosis and treatment of refractory chronic cough and prospects for research on non-pharmacologic therapy.
Collapse
Affiliation(s)
| | | | | | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai 200065, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai 200065, China
| |
Collapse
|
9
|
Vertigan AE. State of the Art for Refractory Cough: Multidisciplinary Approach. Tuberc Respir Dis (Seoul) 2023; 86:264-271. [PMID: 37582675 PMCID: PMC10555522 DOI: 10.4046/trd.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Anne E. Vertigan
- Department of Speech Pathology, John Hunter Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Department of Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia
| |
Collapse
|
10
|
Guilleminault L, Demoulin-Alexikova S, de Gabory L, Varannes SBD, Brouquières D, Balaguer M, Chapron A, Grassin-Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. Guidelines for the management of chronic cough in adults. Endorsed by the French speaking society of respiratory diseases (Société de Pneumologie de Langue Française, SPLF), the Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), the Société Française de Phoniatrie et de Laryngologie (SFPL), the Société Nationale Française de Gastro-entérologie (SNFGE). Respir Med Res 2023; 83:101011. [PMID: 37087905 DOI: 10.1016/j.resmer.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
Patients with chronic cough experience a high alteration of quality of life. Moreover, chronic cough is a complex entity with numerous etiologies and treatments. In order to help clinicians involved in the management of patients with chronic cough, guidelines on chronic cough have been established by a group of French experts. These guidelines address the definitions of chronic cough and the initial management of patients with chronic cough. We present herein second-line tests that might be considered in patients with cough persistence despite initial management. Experts also propose a definition of unexplained or refractory chronic cough (URCC) in order to better identify patients whose cough persists despite optimal management. Finally, these guidelines address the pharmacological and non-pharmacological interventions useful in URCC. Thus, amitryptilline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are a mainstay of treatment strategies in URCC. Other treatment options, such as P2 × 3 antagonists, are being developed.
Collapse
Affiliation(s)
- Laurent Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, 31000, Toulouse, France.
| | - Silvia Demoulin-Alexikova
- CHU de Lille, Lille, France Univ. Lille, CNRS, Inserm, CHU Lille - Service des Explorations Fonctionnelles Respiratoires, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, 59000, Lille, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, Univ. Bordeaux, 33000, France
| | - Stanislas Bruley Des Varannes
- Gastroenterology Department, CHU de Nantes, Institut des Maladies de l'Appareil Digestif, IMAD CIC 1413, Université de Nantes, 44000, Nantes, France
| | - Danielle Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | - Mathieu Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Anthony Chapron
- Université de Rennes 1, CHU Rennes, Département de Médecine Générale, 35000, Rennes, France
| | - Stanislas Grassin-Delyle
- Respiratory Diseases Department, Foch Hospital, 92150, Suresnes, France; Infection and Inflammation, Health Biotechnology Department, Paris-Saclay University, UVSQ, INSERM, 78180, Montigny le Bretonneux, France
| | - Mathias Poussel
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire-Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000, Nancy, France; DevAH, Université de Lorraine, F54000, Nancy, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, 49000, Angers, France
| | - Virginie Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Sabine Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| |
Collapse
|
11
|
Guilleminault L, Demoulin-Alexikova S, de Gabory L, Bruley des Varannes S, Brouquières D, Balaguer M, Chapron A, Grassin Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. [Guidelines for the management of chronic cough in adults]. Rev Mal Respir 2023; 40:432-452. [PMID: 37080877 DOI: 10.1016/j.rmr.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/22/2023]
Abstract
Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.
Collapse
Affiliation(s)
- L Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, université de Toulouse III, Toulouse, France.
| | - S Demoulin-Alexikova
- CHU de Lille, Lille, France; Inserm, CNRS, U1019-UMR9017, service des explorations fonctionnelles respiratoires, centre d'infection et d'immunité de Lille (CIIL), Institut Pasteur de Lille, university Lille, CHU Lille, Lille, France
| | - L de Gabory
- Department of otorhinolaryngology - head and neck surgery, university hospital of Bordeaux, Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - S Bruley des Varannes
- IMAD CIC 1413, gastroenterology department, Institut des maladies de l'appareil digestif, université de Nantes, CHU de Nantes, Nantes, France
| | - D Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - M Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - A Chapron
- Département de médecine générale, université de Rennes 1, CHU Rennes, Rennes, France
| | - S Grassin Delyle
- Respiratory diseases department, Foch hospital, Suresnes, France; Inserm, UVSQ, infection and inflammation, health biotechnology department, Paris-Saclay university, Montigny-le-Bretonneux, France
| | - M Poussel
- Exploration fonctionnelle respiratoire, centre universitaire de médecine du sport et activités physiques adaptées, CHRU de Nancy, 54000 Nancy, France; DevAH, université de Lorraine, 54000 Nancy, France
| | - N Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - G Reychler
- Université catholique de Louvain, Louvain, Belgique
| | - W Trzepizur
- Department of respiratory and sleep medicine, Angers university hospital, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, équipe CarME, SFR ICAT, university of Angers, 49000 Angers, France
| | - V Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - S Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| |
Collapse
|
12
|
Slovarp LJ, Reynolds JE, Tolbert S, Campbell S, Welby S, Morkrid P. Cough desensitization treatment for patients with refractory chronic cough: results of a second pilot randomized control trial. BMC Pulm Med 2023; 23:148. [PMID: 37118696 PMCID: PMC10141869 DOI: 10.1186/s12890-023-02423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE The purpose of this study was to collect pilot efficacy data on a novel treatment for refractory chronic cough (RCC), which we call cough desensitization treatment (CDT). DESIGN AND METHODS In this parallel cohort, sham-controlled, randomized controlled trial, 21 adults with RCC were randomly assigned to 12 sessions of either CDT (progressive doses of aerosolized capsaicin while behaviorally suppressing cough; n = 11) or a sham treatment (repeated exposure to aerosolized saline; n = 9). The Leicester Cough Questionnaire (LCQ) was the primary outcome measure. Perceived cough severity with a visual analogue scale and cough challenge testing (for measuring cough-reflex sensitivity) were secondary outcome measures. Data were analyzed with mixed effects linear regression and follow-up contrasts. RESULTS Results on all measures favored CDT. Excluding one sham participant, whose baseline LCQ scores were deemed unreliable, mean change in LCQ at 3-weeks post treatment was 6.35 and 2.17 in the CDT and sham groups, respectively. There was moderate to strong evidence of a greater improvement in the CDT group in total LCQ score (p = .058) and LCQ Psychological domain (p = .026) and Physical domain (p = .045) scores. Strong evidence was found for a greater reduction in urge-to-cough during CCT in the CDT group (p = .037) and marginal for a reduction in the capsaicin cough-reflex sensitivity (p = .094). There was weak evidence of a greater reduction in cough severity in the CDT group (p = .103). DISCUSSION Although the study is limited due to the small sample size, the data provide additional evidence supporting further research on CDT. CDT resulted in a greater change in the primary efficacy measure (LCQ) than both pharmaceutical and behavioral treatments currently found in the literature. TRIAL REGISTRATION This trial (NCT05226299) was registered on Clinicaltrials.gov on 07/02/2022.
Collapse
Affiliation(s)
- Laurie J Slovarp
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA.
| | - Jane E Reynolds
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Sophia Tolbert
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Sarah Campbell
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Shannon Welby
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Paige Morkrid
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| |
Collapse
|
13
|
Sundholm N, Shelly S, Wright ML, Reynolds J, Slovarp L, Gillespie AI. Effect of Behavioral Cough Suppression Therapy Delivered via Telehealth. J Voice 2022:S0892-1997(22)00367-8. [PMID: 36550001 DOI: 10.1016/j.jvoice.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Behavioral cough suppression therapy (BCST) has demonstrated up to 88% effectiveness at treating refractory chronic cough (RCC). With onset of the COVID-19 pandemic, along with many other medical services, BCST shifted to telehealth delivery. Our group hypothesized that BCST delivered via telemedicine by a specialized Speech-Language Pathologist would be comparable to previously reported response to treatment for in-person settings. STUDY DESIGN Retrospective review. METHODS An Emory IRB approved, retrospective review of electronic medical records was completed for RCC patients who received BCST via telehealth from March 2020 through January 2022 at Emory Voice Center. Patients were included in the study if they had a diagnosis of RCC, were referred for BCST, were seen for at least one therapy session in the telehealth setting, and provided Cough Severity Index (CSI) data pre and post-treatment. Patients were excluded if they had incomplete datasets, a known pulmonary condition, structural laryngeal disorders, smoking history, dysphagia, and ACE-inhibitor use. Change in CSI score pre- and post-treatment was calculated to determine treatment effect. Paired-samples t-tests were conducted to compare pre-and post-treatment CSI score change. RESULTS Fifty-one RCC patients were included in this study; 88% were female with an average age of 60 years (SD = 12.68). Post-treatment CSI scores were significantly lower than pretreatment CSI scores (P < 0.0001). These findings are comparable to historical documented CSI change achieved with in-person BCST. CONCLUSIONS This study provides preliminary evidence of the efficacy of BCST via telehealth for treating RCC. The findings of this study support the continued flexibility in speech-language pathology service delivery to include in-person and telehealth platforms for RCC beyond the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Sandeep Shelly
- Emory Voice Center, Emory Healthcare, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Miranda L Wright
- Department of Communication Science and Disorders, University of Utah, Salt Lake City, Utah
| | - Jane Reynolds
- University of Montana School of Speech-Language-Hearing & Occupational Sciences, Missoula, Montana
| | - Laurie Slovarp
- University of Montana School of Speech-Language-Hearing & Occupational Sciences, Missoula, Montana
| | - Amanda I Gillespie
- Emory Voice Center, Emory Healthcare, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
14
|
Reynolds JE, Jetté ME, Wright ML, Sundar KM, Gillespie AI, Slovarp LJ. Normative Values for the Leicester Cough Questionnaire in Healthy Individuals. Ann Otol Rhinol Laryngol 2022; 132:705-708. [PMID: 35833581 DOI: 10.1177/00034894221112517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The primary self-assessment questionnaire used for patients with chronic cough is the Leicester Cough Questionnaire (LCQ). The LCQ is a validated questionnaire that ranges in total score from 3 to 21. While it is known that a higher score on the LCQ reflects a better quality of life, normative data have not been reported for this questionnaire. OBJECTIVE The purpose of this study was to determine normative LCQ scores on a healthy population without cough. METHODS The LCQ was distributed via electronic survey to the authors' universities, professional affiliation email lists, and personal contacts. Participants were included if they were at least 18, nonsmokers, and without abnormal cough, without pulmonary disease, and without neurological disease. Participants answered questions regarding age, gender, and race/ethnicity, and completed the 19 LCQ questions. RESULTS One hundred forty-three (118 women) LCQ responses were analyzed. Average participant age was 47 years (SD = 13) and 133 (93%) were Caucasian. The mean LCQ Total score was 20.23 (SD = 0.85) with scores ranging from 17.05 to 21. CONCLUSIONS This study determined the following LCQ scores should be considered normal threshold scores: Total score - 17.68, Physical domain - 5.36, Psychological domain - 5.81, and Social domain - 6.06. The findings of this study will assist clinicians in determining severity of cough impact on quality of life using the LCQ. Further research is needed to ensure more complete participant demographic representation.
Collapse
Affiliation(s)
- Jane E Reynolds
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, Missoula, MT, USA
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Miranda L Wright
- Department of Communication Sciences & Disorders, Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Pulmonary & Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Amanda I Gillespie
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA
| | - Laurie J Slovarp
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, Missoula, MT, USA
| |
Collapse
|
15
|
Ribeiro VV, Lopes LW, de Medeiros CMA, da Silva ACF, de Medeiros Neto AH, Behlau M. Effectiveness of the Therapy Program for Management of Chronic Cough: Preliminary Data From a Randomized Clinical Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1611-1620. [PMID: 35699263 DOI: 10.1044/2022_ajslp-21-00381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study is to analyze the effectiveness of the Therapy Program for Management of Chronic Cough (TMCC) in laryngeal sensations and symptoms related to the cough in individuals with chronic refractory cough (CRC). METHOD This research is a randomized double-blind clinical trial (Register Number: RBR-4m6x29). Eleven participants were allocated to two groups by parallel randomization: The Experimental Group-consisting of six individuals who underwent the TMCC; and the Control Group-consisting of five individuals who underwent the Comprehensive Vocal Rehabilitation Program (CVRP). Two primary outcomes were analyzed: self-perception of laryngeal sensations (Newcastle Laryngeal Hypersensitivity Questionnaire [LHQ-Br]) and self-perception of symptoms of upper airway-related cough (Cough Severity Index [CSI-Br]). The two-way repeated-measures analysis of variance was used to compare the evaluation moments and intervention groups. For multiple comparisons, the Tukey test with Bonferroni correction was used. To evaluate the effect size, eta partial square was used. RESULTS There was no difference between groups for any outcomes analyzed. There was a statistically significant difference with a large effect size for the moment factor in all outcomes. A statistically significant difference was observed with a large effect size for the interaction effect between group and moment for LHQ-Br total and CSI-Br psychological and functional. CONCLUSIONS The TMCC and CVRP were effective for the rehabilitation of CRC, considering the viewpoint of the subject. The TMCC improved laryngeal sensations and psychological and functional symptoms, while CVRP was relevant to improve psychological and functional symptoms in individuals with CRC.
Collapse
Affiliation(s)
- Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, Brazil
- Speech-Language Pathology Course, Universidade de Brasília - UnB, Distrito Federal, Brazil
| | - Leonardo Wanderley Lopes
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, Conjunto Presidente Castelo Branco III, Brazil
| | - Camila Macêdo Araújo de Medeiros
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, Conjunto Presidente Castelo Branco III, Brazil
| | - Allan Carlos França da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, Conjunto Presidente Castelo Branco III, Brazil
| | - Agostinho Hermes de Medeiros Neto
- Internal Medicine Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, Conjunto Presidente Castelo Branco III, Brazil
| | - Mara Behlau
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, Brazil
| |
Collapse
|
16
|
Wright ML, Fujiki RB, Lunga T, Thibeault SL. Patient-Reported Qualitative Analysis of Chronic Refractory Cough. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1719-1725. [PMID: 35512298 DOI: 10.1044/2022_ajslp-21-00364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Chronic cough has been shown to be associated with adverse effects on quality of life. There is a paucity of research characterizing quality-of-life factors associated with chronic refractory cough (CRC), a cough persisting > 8 weeks despite evaluation and treatment of possible etiologies. The purpose of this study was to elucidate the features of CRC from the patient's perspective, including presenting symptoms, past treatment methods, and quality-of-life factors. METHOD Prospective semistructured interviews were conducted, recorded, and transcribed for 20 patients diagnosed with CRC. Exclusion criteria included lung disease, smoking history, laryngeal cancer, and neurological disease. Grounded theory analysis was completed on transcribed interviews. RESULTS Eighteen participants were women. Mean participant age was 53.5 years (SD = 1.41), and average cough duration was 52 months (SD = 71.6 months). Responses to 30 open-ended questions revealed four dominant themes with 24 subthemes. CONCLUSIONS CRC affects patient quality of life. Understanding patient perspective on CRC diagnosis and treatment helps providers better understand the physical and emotional toll CRC takes on patients. Findings suggest that providers should spend more time counseling patients regarding their treatment and diagnosis, as patients with CRC do not always fully understand their diagnosis and resort to self-blame.
Collapse
Affiliation(s)
- Miranda L Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Robert Brinton Fujiki
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
| | - Tadeas Lunga
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| |
Collapse
|
17
|
Myers B, Hary E, Ellerston J, Barkmeier-Kraemer JM. Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:678-688. [PMID: 35077650 DOI: 10.1044/2021_ajslp-21-00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. METHOD In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory-perceptual, and quality-of-life treatment outcomes. RESULTS Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. CONCLUSIONS A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.
Collapse
Affiliation(s)
- Brett Myers
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Elizabeth Hary
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julia Ellerston
- Voice Disorders Center, University of Utah Health, Salt Lake City
| | - Julie M Barkmeier-Kraemer
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Voice Disorders Center, University of Utah Health, Salt Lake City
- Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City
| |
Collapse
|
18
|
Wamkpah NS, Peterson AM, Lee JJ, Jia L, Hardi A, Stoll C, Huston M. Curbing the Cough: Multimodal Treatments for Neurogenic Cough: A Systematic Review and Meta-Analysis. Laryngoscope 2022; 132:107-123. [PMID: 33085095 PMCID: PMC8058694 DOI: 10.1002/lary.29146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Neurogenic cough affects 11% of Americans and causes significant detriment to quality of life. With the advent of novel therapies, the objective of this review is to determine how procedural therapies (e.g., superior laryngeal nerve block) compare to other established pharmacologic and non-pharmacologic treatments for neurogenic cough. METHODS With the assistance of a medical librarian, a systematic review was performed using PICOS (patients, interventions, comparator, outcome, study design) format: adults with neurogenic cough receiving any pharmacologic or non-pharmacologic treatment for neurogenic cough compared to adults with neurogenic cough receiving any other relevant interventions, or treated as single cohorts, assessed with cough-specific quality of life outcomes, in all study designs and case series with ≥ 10 cases. Case reports, review articles, non-human studies, non-English language articles, and unavailable full-text articles were excluded. RESULTS There were 2408 patients with neurogenic cough in this review, treated with medical therapy (77%), speech therapy (19%), both medical and speech therapy (1%), and procedural therapy (3%). The included studies ranged from low to intermediate quality. Overall, most interventions demonstrated successful improvement in cough. However, the heterogeneity of included study designs precluded direct comparisons between intervention types. CONCLUSION This meta-analysis compared various treatments for neurogenic cough. Procedural therapy should be considered in the armamentarium of neurogenic cough treatments, particularly in patients refractory to, or intolerant of, the side effects of medical therapy. Lastly, this review illuminates key areas for improving neurogenic cough diagnosis, such as strict adherence to diagnostic and treatment guidelines, sophisticated reflux testing, and standardized, consistent outcome reporting. Laryngoscope, 132:107-123, 2022.
Collapse
Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Andrew M Peterson
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, U.S.A
| | - Jake J Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Lena Jia
- Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Angela Hardi
- Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Carolyn Stoll
- Washington University Division of Public Health Sciences, St. Louis, Missouri, U.S.A
| | - Molly Huston
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St. Louis, Missouri, U.S.A
| |
Collapse
|
19
|
Sato R, Handa T, Matsumoto H, Hirai K, Ohkura N, Kubo T, Hirai T. Antitussive Effect of a Chest Band in Patients with Interstitial Lung Disease: The Preliminary Results from a Pre-post Intervention Study. Intern Med 2021; 60:3701-3707. [PMID: 34853257 PMCID: PMC8710375 DOI: 10.2169/internalmedicine.6716-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/09/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Evidence supporting the efficiency of clinically administered therapies against interstitial lung disease (ILD)-related cough is limited. Thus, we conducted a study to evaluate the efficacy of short-term use of chest bands on cough in patients with ILD. Methods This pre-post intervention study was performed at two university hospitals between April 2017 and August 2020. Scores of the visual analog scale (VAS) for cough severity (in terms of frequency and intensity), Leicester Cough Questionnaire (LCQ)-acute, and frequency scale for symptoms of gastroesophageal reflux disease (FSSG) were assessed before and after the use of the chest band (24/48 hours). Patients The study included patients with idiopathic interstitial pneumonias (IIPs) or connective tissue disease-associated interstitial lung disease (CTD-ILD). Results Four patients with IIPs and seven with CTD-ILD were included in the analysis. The cough intensity and LCQ-acute total score improved significantly after the use of the chest band (p=0.007 and p=0.005, respectively), although the cough frequency showed no significant reduction (p=0.074). Furthermore, the FSSG total and acid-reflux symptom scores improved (p=0.018 and p=0.027, respectively), and a negative correlation between the change in LCQ-acute total score and that in FSSG score for acid-reflux symptoms was observed (Spearman rho =-0.841, p=0.001). Conclusion The results of the current study suggest that chest bands might be useful for treating chronic refractory cough in patients with ILD and gastroesophageal reflux disease. However, these results should be interpreted with caution due to methodological limitations associated with this study.
Collapse
Affiliation(s)
- Ryuhei Sato
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, Japan
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital, Japan
| | | | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| |
Collapse
|
20
|
Long-Term Treatment Outcomes after Behavioral Speech Therapy for Chronic Refractory Cough. Lung 2021; 199:517-525. [PMID: 34595607 DOI: 10.1007/s00408-021-00481-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Current literature reveals that up to 88% of individuals undergoing behavioral speech therapy (BST) for chronic refractory cough (CRC) demonstrate benefit at 4-8 weeks post-treatment. However, investigations of BST are confounded by overlapping use of neuromodulators, missing follow-up data, and an absence of long-term outcomes. This study investigated treatment outcomes beyond 6 months in individuals diagnosed with CRC, and whose treatment outcomes were clinically undocumented. METHODS Participants with CRC 6 months or greater beyond treatment completion were recruited. Participants completed a post-treatment Leicester Cough Questionnaire (LCQ) and a telephone interview. Demographic data, cough characteristics, treatment adherence, BST outcomes, and pre- and post-treatment LCQ scores were evaluated. RESULTS 80 individuals met inclusion criteria and 29 consented to participate. Of these, 27 were recommended BST. The majority were female (19/27) with average age of 58 years (SD = 12). Mean cough duration was 60 months (SD = 98) and mean post-BST duration was 20 months (SD = 9). A significant increase in pre- to post-treatment LCQ scores occurred [4.4 (SD = 4.2)] (p < 0.0001). CONCLUSION This study addressed long-term BST benefit for CRC and demonstrated a significant improvement in long-term post-treatment LCQ total scores more than a year after BST for CRC. More than half of participants indicated improvement or elimination of their cough. These findings further support the benefit of BST for CRC. Future research should consider patient perspectives about treatment outcomes given that 44% of participants reported no benefit from BST.
Collapse
|
21
|
LaTour D, Crawley B, Krishna P, Hahn R, Murry T. Effects of Cough Suppression Therapy on Voice Disorder Severity. Laryngoscope 2021; 131:2747-2751. [PMID: 34165792 DOI: 10.1002/lary.29705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES//HYPOTHESIS To determine changes in voice severity when treating chronic cough refractory to medical treatment with cough suppression therapy (CST) in patients with chronic cough and voice complaints. Chronic cough has been reported to be refractory to medical treatment and frequently co-occurs with voice disorders. The possible effects of CST on self-assessed changes in chronic cough and voice disorders have not been demonstrated. STUDY DESIGN Retrospective analysis of the effects of cough suppression therapy (CST) on self-assessed changes in chronic cough and voice disorder severity in patients with both chronic cough and voice disorders. METHODS Forty-three adult patients with the primary complaint of chronic refractory cough underwent pre- and post-treatment diagnostic examinations, completed pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Cough Severity Index assessments, and were treated by a licensed speech-language pathologist using CST. Twenty-seven subjects were assigned to the cough (C) group and 16 to the cough-voice (CV) group based on the severity of their VHI-10 scores. RESULTS Post-test analysis showed significant improvement in cough severity for both groups and significant improvement in voice severity for the CV group. The VHI-10 scores for the C group did not change significantly. The median number of treatment sessions was 3, with a range of 1-13 sessions. Correlation between changes in severity and number of treatment sessions was not found to be significant at the tested level. CONCLUSIONS CST represents a unifying approach for treatment of patients with CRC and comorbid voice disorders. CST offered cross-over effects to the voice when subjects were treated for their primary complaint of chronic cough. This treatment of the primary complaint improves function in systems that share a common pathway. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
Collapse
Affiliation(s)
- Donn LaTour
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Brianna Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A
| | - Rachel Hahn
- School of Medicine, Loma Linda University, Loma Linda, California, U.S.A
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|
22
|
Ribeiro VV, Lopes LW, Behlau M. Presentation of the Therapy Program for Management of Chronic Cough. Codas 2021; 33:e20200057. [PMID: 34076101 DOI: 10.1590/2317-1782/20202020057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/22/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To present a proposal for speech-language pathology rehabilitation called the Therapy Program for Management of Chronic Cough (TMCC) for the treatment of refractory chronic cough. METHODS TMCC was developed based on two stages: literature and clinical analysis. The literature analysis stage was carried out through the following procedures: electronic and manual search for articles and books published until June 2019 that included adult participants with chronic cough and intervention with speech-language pathology therapy; selection of sources; analysis of articles and books included; and, preparation of the initial version of the therapy program. The initial version of the therapy program resulting from literature analysis stage was submitted to clinical analysis stage through the following procedures: analysis by three judges; revision of the proposal by the authors; judges' re-analysis; elaboration of the final version called the Therapy Program for Management of Chronic Cough (TMCC). RESULTS TMCC synthesizes scientific knowledge and current clinical experience on the behavioral management of refractory chronic cough into a program with three main components, each one with specific objectives and strategies. TMCC consists of four sessions, with weekly frequency and duration between 30-45 minutes per session, executed in hierarchical phases, with specific objectives and strategies per session. CONCLUSION TMCC is a program structured to offer global cough rehabilitation. To obtain scientific evidence about its effectiveness is necessary, so that it can be used in clinical practice.
Collapse
Affiliation(s)
- Vanessa Veis Ribeiro
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
| | - Leonardo Wanderley Lopes
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | - Mara Behlau
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil
| |
Collapse
|
23
|
Slovarp LJ, Jetté ME, Gillespie AI, Reynolds JE, Barkmeier-Kraemer JM. Evaluation and Management Outcomes and Burdens in Patients with Refractory Chronic Cough Referred for Behavioral Cough Suppression Therapy. Lung 2021; 199:263-271. [PMID: 33821355 PMCID: PMC8203529 DOI: 10.1007/s00408-021-00442-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The 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. METHODS One 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. RESULTS Mean 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. CONCLUSION The results of this study suggest early intervention with BCST may be a cost-effective and efficient option for patients with RCC.
Collapse
Affiliation(s)
- Laurie J Slovarp
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, 32 Campus Dr., Missoula, MT, USA.
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Amanda I Gillespie
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jane E Reynolds
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, 32 Campus Dr., Missoula, MT, USA
| | | |
Collapse
|
24
|
Visca D, Beghè B, Fabbri LM, Papi A, Spanevello A. Management of chronic refractory cough in adults. Eur J Intern Med 2020; 81:15-21. [PMID: 32958373 PMCID: PMC7501523 DOI: 10.1016/j.ejim.2020.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
Cough is a common respiratory symptom that is considered to be chronic when it lasts more than eight weeks. When severe, chronic cough may significantly impact an individual's quality of life, and such patients are frequently referred for specialist evaluation. Current international guidelines provide algorithms for the management of chronic cough: in most cases, treatment of the underlying disease is sufficient to improve or resolve cough symptoms. Severe chronic cough may significantly affect patients' quality of life and necessitate frequent referral for specialist evaluations. In this narrative review, we summarize non-pharmacologic and pharmacologic management of adult patients with chronic cough of known cause that persists after proper treatment (chronic refractory cough, CRC) or chronic cough of unknown cause in adult patients. If chronic cough persists even after treatment of the underlying disease, or if the chronic cough is not attributable to any cause, then a symptomatic approach with neuromodulators may be considered, with gabapentin as the first choice, and opioids or macrolides as alternatives. Speech pathology treatment and/or neuromodulators should be discussed with patients and alternative options carefully considered, taking into account risk/benefit. Novel promising drugs are under investigation (e.g. P2×3 inhibitors), but additional studies are needed in this field. Speech pathology can be combined with a neuromodulator to give an enhanced treatment response of longer duration suggesting that non-pharmacologic treatment may play a key role in the management of CRC.
Collapse
Affiliation(s)
- Dina Visca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Bianca Beghè
- Section of Respiratory Diseases, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Michele Fabbri
- Section of Cardiorespiratory and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Alberto Papi
- Section of Cardiorespiratory and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| |
Collapse
|
25
|
Speech Pathology Intervention for Chronic Refractory Cough: A Pilot Study Examining the Benefit of Using Prerecorded Videos as an Adjunct to Therapy. J Voice 2020; 34:647.e7-647.e14. [DOI: 10.1016/j.jvoice.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
|
26
|
Ribeiro VV, Lopes LW, da Silva ACF, de Medeiros Neto AH, Gartner-Schmidt J, Behlau M. Cough Severity Index in Brazilian Portuguese: Translation and Cross-Cultural Adaptation. J Voice 2020; 36:289.e11-289.e16. [PMID: 32576524 DOI: 10.1016/j.jvoice.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To translate and cross-culturally adapt the Cough Severity Index to Brazilian Portuguese. MATERIAL AND METHODS This is a study with observational, cross-sectional, and analytical design. The procedure for translation and cross-cultural adaptation followed the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust and was performed in five stages: translation, synthesis, back translation, committee review, and pretesting. The sample for the pretest consisted of 34 participants with refractory chronic cough, 11 males and 23 females, with an average age of 48 years and 1 month. RESULTS The title of the questionnaire, the answer options, and seven of the ten questions were agreed upon by three judges, the remaining three questions were retranslated by a fourth judge. After back-translation and committee review, editing of question five was necessary. The option "never" was more frequently selected for four questions and the option "always" for six questions. There was a significantly higher proportion of other response categories of the instrument compared to the response category "not applicable." CONCLUSION This study resulted in the elaboration of a translated and cross-culturally adapted version of the Cough Severity Index in Brazilian Portuguese.
Collapse
Affiliation(s)
- Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil.
| | - Leonardo Wanderley Lopes
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Allan Carlos França da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | | | - Jackie Gartner-Schmidt
- University of Pittsburgh School of Medicine, Department of Otolaryngology, UPMC Voice Center, Pittsburgh, Pennsylvania
| | - Mara Behlau
- Speech-Language Pathology Department, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| |
Collapse
|
27
|
Adessa M, Xiao R, Hull D, Bowen AJ, Milstein CF, Benninger MS, Bryson PC. Benign Vocal Fold Lesions in Patients with Chronic Cough. Otolaryngol Head Neck Surg 2020; 162:322-325. [PMID: 31959050 DOI: 10.1177/0194599819900505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of benign vocal fold lesions (BVFLs) in patients with chronic cough over a 1-year period. STUDY DESIGN Case series with chart review. SETTING Tertiary academic medical center. SUBJECTS AND METHODS A retrospective cohort study of patients with chronic cough seen in our tertiary multidisciplinary cough clinic from 2016 to 2017 was conducted. Patient characteristics, presence of BVFLs by laryngoscopy, and Leicester Cough Questionnaire (LCQ) were recorded. RESULTS A total of 419 patients were included (average age: 61 years), and 67% of patients were female. Ten percent of patients had BVFLs: granuloma (5%), leukoplakia (3%), nodules (2%), and polyps (1%). Median cough duration was 2.9 years (interquartile range [IQR], 0.7-8.5); no significant difference in median cough duration was observed between patients with BVFLs and those with no lesions (2.6 vs 3.0 years, P = .86). In total, 178 patients (42%) had available LCQ data: median score of 10.2 (IQR, 7.9-13.9); no significant difference in median LCQ was observed between patients with BVFLs and those with no lesions (10.5 vs 10.1, P = .54). CONCLUSION Prevalence of BVFLs in our cohort of patients with chronic cough was 10%, with posterior glottic lesions-granuloma-being the most common (5%). Prevalence of midmembranous lesions was as follows: vocal fold nodules (2%) and vocal fold polyps (1%). BVFLs were not associated with longer cough duration or more severe cough. We cannot determine a causative or noncausative relationship between BVFLs and chronic cough at this time due to lack of a control group.
Collapse
Affiliation(s)
- Michelle Adessa
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roy Xiao
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Darcey Hull
- Ohio University Heritage College of Osteopathic Medicine, Cleveland Clinic South Pointe Hospital, Cleveland, Ohio, USA
| | - Andrew J Bowen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
28
|
Slinger C, Mehdi SB, Milan SJ, Dodd S, Matthews J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Cochrane Database Syst Rev 2019; 7:CD013067. [PMID: 31335963 PMCID: PMC6649889 DOI: 10.1002/14651858.cd013067.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cough both protects and clears the airway. Cough has three phases: breathing in (inspiration), closure of the glottis, and a forced expiratory effort. Chronic cough has a negative, far-reaching impact on quality of life. Few effective medical treatments for individuals with unexplained (idiopathic/refractory) chronic cough (UCC) are known. For this group, current guidelines advocate the use of gabapentin. Speech and language therapy (SLT) has been considered as a non-pharmacological option for managing UCC without the risks and side effects associated with pharmacological agents, and this review considers the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of SLT in this context. OBJECTIVES To evaluate the effectiveness of speech and language therapy for treatment of people with unexplained (idiopathic/refractory) chronic cough. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, trials registries, and reference lists of included studies. Our most recent search was 8 February 2019. SELECTION CRITERIA We included RCTs in which participants had a diagnosis of UCC having undergone a full diagnostic workup to exclude an underlying cause, as per published guidelines or local protocols, and where the intervention included speech and language therapy techniques for UCC. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of 94 records. Two clinical trials, represented in 10 study reports, met our predefined inclusion criteria. Two review authors independently assessed risk of bias for each study and extracted outcome data. We analysed dichotomous data as odds ratios (ORs), and continuous data as mean differences (MDs) or geometric mean differences. We used standard methods recommended by Cochrane. Our primary outcomes were health-related quality of life (HRQoL) and serious adverse events (SAEs). MAIN RESULTS We found two studies involving 162 adults that met our inclusion criteria. Neither of the two studies included children. The duration of treatment and length of sessions varied between studies from four sessions delivered weekly, to four sessions over two months. Similarly, length of sessions varied slightly from one 60-minute session and three 45-minute sessions to four 30-minute sessions. The control interventions were healthy lifestyle advice in both studies.One study contributed HRQoL data, using the Leicester Cough Questionnaire (LCQ), and we judged the quality of the evidence to be low using the GRADE approach. Data were reported as between-group difference from baseline to four weeks (MD 1.53, 95% confidence interval (CI) 0.21 to 2.85; participants = 71), revealing a statistically significant benefit for people receiving a physiotherapy and speech and language therapy intervention (PSALTI) versus control. However, the difference between PSALTI and control was not observed between week four and three months. The same study provided information on SAEs, and there were no SAEs in either the PSALTI or control arms. Using the GRADE approach we judged the quality of evidence for this outcome to be low.Data were also available for our prespecified secondary outcomes. In each case data were provided by only one study, therefore there were no opportunities for aggregation; we judged the quality of this evidence to be low for each outcome. A significant difference favouring therapy was demonstrated for: objective cough counts (ratio for mean coughs per hour on treatment was 59% (95% CI 37% to 95%) relative to control; participants = 71); symptom score (MD 9.80, 95% CI 4.50 to 15.10; participants = 87); and clinical improvement as defined by trialists (OR 48.13, 95% CI 13.53 to 171.25; participants = 87). There was no significant difference between therapy and control regarding subjective measures of cough (MD on visual analogue scale of cough severity: -9.72, 95% CI -20.80 to 1.36; participants = 71) and cough reflex sensitivity (capsaicin concentration to induce five coughs: 1.11 (95% CI 0.80 to 1.54; participants = 49) times higher on treatment than on control). One study reported data on adverse events, and there were no adverse events reported in either the therapy or control arms of the study. AUTHORS' CONCLUSIONS The paucity of data in this review highlights the need for more controlled trial data examining the efficacy of SLT interventions in the management of UCC. Although a large number of studies were found in the initial search as per protocol, we could include only two studies in the review. In addition, this review highlights that endpoints vary between published studies.The improvements in HRQoL (LCQ) and reduction in 24-hour cough frequency seen with the PSALTI intervention were statistically significant but short-lived, with the between-group difference lasting up to four weeks only. Further studies are required to replicate these findings and to investigate the effects of SLT interventions over time. It is clear that SLT interventions vary between studies. Further research is needed to understand which aspects of SLT interventions are most effective in reducing cough (both objective cough frequency and subjective measures of cough) and improving HRQoL. We consider these endpoints to be clinically important. It is also important for future studies to report information on adverse events.Because of the paucity of data, we can draw no robust conclusions regarding the efficacy of SLT interventions for improving outcomes in unexplained chronic cough. Our review identifies the need for further high-quality research, with comparable endpoints to inform robust conclusions.
Collapse
Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | | | - Steven Dodd
- Lancaster UniversityFaculty of Health and MedicineLancasterUK
| | - Jessica Matthews
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Aashish Vyas
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Paul A Marsden
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
- Wythenshawe Hospital, Manchester University NHS Foundation TrustNorth West Lung CentreManchesterUK
- School of Biological Sciences, University of ManchesterDivision of Infection, Immunity and Respiratory MedicineManchesterUK
| | | |
Collapse
|
29
|
Dhillon VK. Superior laryngeal nerve block for neurogenic cough: A case series. Laryngoscope Investig Otolaryngol 2019; 4:410-413. [PMID: 31453350 PMCID: PMC6703134 DOI: 10.1002/lio2.292] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/28/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives To demonstrate that an in‐office superior laryngeal nerve (SLN) block with lidocaine and steroids is an effective alternative to neuromodulators for patients with neurogenic cough. Study Design Retrospective study. Methods A retrospective review of 10 patients who underwent in office nerve block to the laryngeal nerve (SLN) for neurogenic cough. Demographic data and pre‐ and postcough survey index are the measure outcomes. Follow‐up was 3–6 months. Results We find that all patients in this study that underwent an SLN block showed significant improvement in cough severity index (CSI). The average number of blocks was 2.3. The mean follow‐up time from the first SLN block is 3.4 months. The mean CSI improvement 16.30. 95% confidence interval, 11.44–21.16; P < .0001. All patients in this study completed at least one session of cough suppression therapy with speech language pathology (SLP). No patients were on neuromodulators at the time of the SLN block. Conclusions There is a role for in‐office SLN block with lidocaine and steroids for patients with neurogenic cough, and can be an effective alternative to neuromodulators. Level of Evidence NA
Collapse
Affiliation(s)
- Vaninder K Dhillon
- Division of Laryngology, Department of Head and Neck Surgery Johns Hopkins University Bethesda Maryland U.S.A
| |
Collapse
|
30
|
Management of Cough. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1724-1729. [DOI: 10.1016/j.jaip.2019.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
|
31
|
Chamberlain Mitchell S, Ellis J, Ludlow S, Pandyan A, Birring S. Non-pharmacological interventions for chronic cough: The past, present and future. Pulm Pharmacol Ther 2019; 56:29-38. [DOI: 10.1016/j.pupt.2019.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 12/22/2022]
|
32
|
|
33
|
Mazzone SB. Chronic cough: a disorder of response inhibition? Eur Respir J 2019; 53:53/5/1900254. [DOI: 10.1183/13993003.00254-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022]
|
34
|
Vertigan AE, Haines J, Slovarp L. An Update on Speech Pathology Management of Chronic Refractory Cough. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1756-1761. [PMID: 30940533 DOI: 10.1016/j.jaip.2019.03.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/28/2022]
Abstract
Chronic cough is a common, debilitating condition that can persist for years with little relief from medical treatment. Speech pathology treatment is an effective treatment option for patients with chronic cough. This review outlines current speech pathology assessment and treatment for chronic cough and describes the evidence supporting the intervention. The rationale for speech pathology intervention is described with reference to speech pathology training and expertise that are relevant for this condition. Despite the efficacy and advantages of speech pathology intervention, there is limited guidance in the literature on when patients should be referred for treatment. Patients suitable for speech pathology intervention are those whose cough has persisted despite medical management. Speech pathology intervention may be particularly beneficial for patients with coexisting laryngeal disorders such as muscle tension dysphonia or inducible laryngeal obstruction. Limited information is available regarding current speech pathology training, practice, and service delivery for chronic cough internationally. Timely referral for speech pathology intervention could reduce the disease burden for individuals with chronic cough and decrease the economic burden of this complex condition.
Collapse
Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, New Lambton Heights, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Jemma Haines
- North West Lung Centre, Manchester University NHS Foundation Trust Wythenshawe Hospital, Manchester, United Kingdom
| | - Laurie Slovarp
- Speech, Language, Hearing Sciences Department, University of Montana, Missoula, Mont
| |
Collapse
|
35
|
Yang MS, Jee YK. How to Apply the Concept of Cough Hypersensitivity in Clinical Practice? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:589-592. [PMID: 31332971 PMCID: PMC6658411 DOI: 10.4168/aair.2019.11.5.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Min Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
| |
Collapse
|
36
|
Slovarp LJ, Bozarth E. Altering cough reflex sensitivity with aerosolized capsaicin paired with behavioral cough suppression: a proof-of-concept study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:7. [PMID: 30788354 DOI: 10.21037/atm.2018.12.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The purpose of this prospective, quasi-experimental, single cohort proof-of-concept study was to determine feasibility and proof-of-concept of programmatically decreasing cough sensitivity through use of cough suppression strategies following inhalation of aerosolized capsaicin, in gradually increasing doses, across repeated treatment sessions. Methods Five healthy adults, ages 20-32 years of age, enrolled and completed the study. The study commenced in three phases. Phase I consisted of baseline cough sensitivity testing using pharmaceutical-grade aerosolized capsaicin, delivered via a Koko DigiDoser with nebulizer. The single-inhale, dose-response method was used. Doses that elicited two coughs (C2) and five coughs (C5) were recorded. Testing ceased when participants met the C5 threshold or when they had been given the maximum dose of 1,000 µmol/L. Phase II consisted of 5-6 treatment sessions, during which participants were exposed to increasing doses of aerosolized capsaicin while implementing behavioral cough suppression strategies. In phase III, cough sensitivity was re-tested at 1 and 3 weeks post-treatment. Participants were given explicit instructions to not try to suppress their cough. Participants who did not reach the C2 or C5 threshold at 1,000 µmol/L were assigned a score of 1,250 µmol/L. Results Each participant demonstrated a gradual increase in maximum capsaicin dose suppressed during each treatment session, with each successfully suppressing at 1,000 µmol/L by the final treatment session. C2 was greater than baseline in 4 of the 5 participants at 1 week post-treatment, and in 3 of the 5, at 3 weeks post-treatment. C5 was greater in all 5 participants at both post-treatment time points. In fact, 4 of the 5 participants did not reach the C5 threshold during either post-treatment testing sessions. Wilcoxon's Signed Rank Test, using the logC2 and logC5 values, revealed a significant difference relative to baseline in logC5 at 1 week (z=-2.02, P=0.04) and 3 weeks (z=-2.03, P=0.04) post-treatment. The difference in logC2 neared significance at 1 week post-treatment (z=-1.77, P=0.077), but was insignificant at 3 weeks post-treatment (z=-1.46, P=0.144). Conclusions This study demonstrates the potential of treating patients with refractory chronic cough (RCC), due to cough hypersensitivity, with a progressive desensitization approach paired with behavioral cough suppression. Additional research is needed using a randomized, placebo-controlled trial with patients with RCC.
Collapse
Affiliation(s)
- Laurie J Slovarp
- Department of Communicative Sciences and Disorders, The University of Montana, Missoula, MT, USA
| | - Emma Bozarth
- Department of Communicative Sciences and Disorders, The University of Montana, Missoula, MT, USA
| |
Collapse
|
37
|
Vertigan AE, Kapela SM, Kearney EK, Gibson PG. Laryngeal Dysfunction in Cough Hypersensitivity Syndrome: A Cross-Sectional Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2087-2095. [DOI: 10.1016/j.jaip.2018.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/06/2018] [Indexed: 11/27/2022]
|
38
|
Slovarp L, Loomis BK, Glaspey A. Assessing referral and practice patterns of patients with chronic cough referred for behavioral cough suppression therapy. Chron Respir Dis 2018; 15:296-305. [PMID: 29430939 PMCID: PMC6100168 DOI: 10.1177/1479972318755722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 11/17/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
The purpose of this exploratory research was to describe current referral and practice patterns for behavioral cough suppression therapy (BCST) throughout the United States, and to assess the need for improving the efficiency of BCST referral patterns. In study I, 126 speech-language pathologists, who treat patients with refractory chronic cough (RCC) in the United States, completed a survey about referral patterns, cough duration, and patient frustration level. In study II, 36 adults with RCC referred for BCST completed a four-part survey about cough symptoms and treatment. The survey included the Leicester Cough Questionnaire (LCQ) before and after BCST. Study I revealed significant patient frustration about the treatment process and the wait-time for BCST. Participants in study II reported average cough duration of over 2 years before BCST. Twenty-seven of 31 participants in study II improved by at least 1.3 on the LCQ, indicating a clinically significant improvement in 87% of patients. This study suggests that the current management model for CC may be unduly time-consuming, and expensive for patients with CC who are successfully treated with BCST. Practitioners are encouraged to consider BCST earlier in the treatment process.
Collapse
Affiliation(s)
- Laurie Slovarp
- Department of Communicative Sciences and Disorders, University of Montana, Missoula, Montana, USA
| | | | - Amy Glaspey
- Department of Communicative Sciences and Disorders, University of Montana, Missoula, Montana, USA
| |
Collapse
|
39
|
Birring SS, Kavanagh JE, Irwin RS, Keogh KA, Lim KG, Ryu JH. Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report. Chest 2018; 154:904-917. [PMID: 30036496 DOI: 10.1016/j.chest.2018.06.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Chronic cough in interstitial lung disease (ILD) causes significant impairment in quality of life. Effective treatment approaches are needed for cough associated with ILD. METHODS This systematic review asked: Is there evidence of clinically relevant treatment effects for therapies for cough in ILD? Studies of adults aged > 18 years with a chronic cough ≥ 8 weeks' duration were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using CHEST guideline methodology. RESULTS Eight randomized controlled trials and two case series (≥ 10 patients) were included that reported data on patients with idiopathic pulmonary fibrosis, sarcoidosis, and scleroderma-related ILD who received a variety of interventions. Study quality was high in all eight randomized controlled trials. Inhaled corticosteroids were not supported for cough associated with sarcoidosis. Cyclophosphamide and mycophenolate were not supported for solely treating cough associated with scleroderma-associated ILD. A recommendation for thalidomide to treat cough associated with idiopathic pulmonary fibrosis did not pass the panel vote. In view of the paucity of antitussive treatment options for refractory cough in ILD, the guideline panel suggested that the CHEST unexplained chronic cough guideline be followed by considering options such as the neuromodulator gabapentin and speech pathology management. Opiates were also suggested for patients with cough refractory to alternative therapies. CONCLUSIONS The evidence supporting the management of chronic cough in ILD is limited. This guideline presents suggestions for managing and treating cough on the best available evidence, but future research is clearly needed.
Collapse
Affiliation(s)
- Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, King's Health Partners, London, UK.
| | | | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Karina A Keogh
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
40
|
Slinger C, Mehdi SB, Milan SJ, Dodd S, Blakemore J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Hippokratia 2018. [DOI: 10.1002/14651858.cd013067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | | | - Steven Dodd
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
| | - Jessica Blakemore
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Aashish Vyas
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Paul A Marsden
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
| |
Collapse
|
41
|
Perotin JM, Launois C, Dewolf M, Dumazet A, Dury S, Lebargy F, Dormoy V, Deslee G. Managing patients with chronic cough: challenges and solutions. Ther Clin Risk Manag 2018; 14:1041-1051. [PMID: 29922064 PMCID: PMC5995432 DOI: 10.2147/tcrm.s136036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy.
Collapse
Affiliation(s)
- Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France.,INSERM UMRS 1250, University Hospital of Reims, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Maxime Dewolf
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Antoine Dumazet
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Valérian Dormoy
- INSERM UMRS 1250, University Hospital of Reims, Reims, France
| | - Gaëtan Deslee
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France.,INSERM UMRS 1250, University Hospital of Reims, Reims, France
| |
Collapse
|
42
|
Cough management in primary, secondary and tertiary settings. Pulm Pharmacol Ther 2017; 47:93-98. [DOI: 10.1016/j.pupt.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/10/2017] [Accepted: 05/01/2017] [Indexed: 11/21/2022]
|
43
|
Hull JH, Backer V, Gibson PG, Fowler SJ. Laryngeal Dysfunction: Assessment and Management for the Clinician. Am J Respir Crit Care Med 2017; 194:1062-1072. [PMID: 27575803 DOI: 10.1164/rccm.201606-1249ci] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The larynx is one of the most highly innervated organs in humans and serves a number of vitally important, complex, and highly evolved biological functions. On a day-to-day basis, the larynx functions autonomously, addressing several roles including airway protection, swallowing, and phonation. In some situations the larynx appears to adopt a functional state that could be considered maladaptive or "dysfunctional." This laryngeal dysfunction can underpin and account for a number of respiratory symptoms that otherwise appear incongruous with a clinical disease state and/or contribute to the development of symptoms that appear "refractory" to treatment. These include conditions associated with a heightened tendency for inappropriate laryngeal closure (e.g., inducible laryngeal obstruction), voice disturbance, and chronic cough. Recognition of laryngeal dysfunction is important to deliver targeted treatment and failure to recognize the condition can lead to repeated use of inappropriate treatment. Diagnosis is not straightforward, however, and many patients appear to present with symptoms attributable to laryngeal dysfunction, but in whom the diagnosis has been overlooked in clinical work-up for some time. This review provides an overview of the current state of knowledge in the field of laryngeal dysfunction, with a focus on pragmatic clinical assessment and management.
Collapse
Affiliation(s)
- James H Hull
- 1 Department of Respiratory Medicine, Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Vibeke Backer
- 2 Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter G Gibson
- 3 Centre for Healthy Lungs, University of Newcastle, Newcastle, United Kingdom.,4 Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, United Kingdom.,5 Hunter Medical Research Institute, Newcastle, Australia
| | - Stephen J Fowler
- 6 Centre for Respiratory Medicine and Allergy, University of Manchester, Manchester, United Kingdom; and.,7 Manchester Academic Health Science Centre, Manchester, United Kingdom
| |
Collapse
|
44
|
Physiotherapy and Speech and Language therapy intervention for chronic cough. Pulm Pharmacol Ther 2017; 47:84-87. [PMID: 28389257 DOI: 10.1016/j.pupt.2017.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/10/2017] [Accepted: 04/01/2017] [Indexed: 11/20/2022]
Abstract
There are few effective pharmacological therapies available to treat refractory chronic cough. Functional MRI studies of the brain have recently shown that patients with chronic cough have dysfunctional inhibitory control of cough. Self-management therapies delivered by physiotherapists or speech therapists are effective at suppressing cough. They enable patients to consciously suppress the urge to cough. The intervention consists of education, laryngeal hygiene, cough suppression and distraction measures and behaviour modification. The efficacy of Physiotherapy and Speech And Language Intervention (PSALTI) has been confirmed in two randomised control trials. In one trial, there was a 41% reduction in cough frequency with PSALTI, assessed objectively with the Leicester Cough Monitor, and a clinically significant improvement in quality of life. Importantly, the improvement in cough was sustained when therapy was discontinued. The addition of the Speech Pathology Treatment to neuromodulator drug therapy, Pregabalin has also been evaluated in a clinical trial. There was a clinically significant improvement in quality of life, and this was sustained when therapy was discontinued. The mechanism of action of PSALTI is not known and this should be investigated in future. Further studies are needed to identify the components of PSALTI that deliver the most benefit, and determine whether PSALTI is effective in cough associated with other chronic lung disorders.
Collapse
|
45
|
Smith B, Milstein C, Rolfes B, Anne S. Paradoxical vocal fold motion (PVFM) in pediatric otolaryngology. Am J Otolaryngol 2017; 38:230-232. [PMID: 28139319 DOI: 10.1016/j.amjoto.2017.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Paradoxical vocal fold motion (PVFM) is a condition in which the vocal cords exhibit inappropriate inspiratory adduction, and it has been poorly studied in the pediatric population. METHODS Pediatric patients diagnosed with PVCM by a pediatric otolaryngologist and doctor of speech pathology from 2008 to 2012 were reviewed. Patients in whom another cause for their respiratory disturbance was eventually identified were excluded. Patient demographics, characteristics, treatment, and outcomes were reviewed. The study was approved by the Institutional Review Board at our institution. RESULTS Thirty patients met criteria for inclusion; one with chiari malformation was excluded. 17/29 (59%) were female. Body mass index (BMI) numbers ranged from 16 to 25 with a mean of 21. 9/29 (31%) competed at the highest level of a sport; only 3/29 (10%) did not participate in athletics. Average age of onset was 12.0years; average diagnosis delay was 1.3years. Mean follow up was 2.3years. 24/29 (83%) were previously treated for asthma. 23/29(79%) were previously treated for reflux. 25/29(86%) completed at least one session of respiratory and laryngeal control therapy with overall average of 2.2 sessions completed. All patients who attended a second therapy session were recorded as having improvement in symptoms. CONCLUSIONS Pediatric patients with PVFM often participate in high levels of organized sports and the frequency of concurrent asthma and reflux symptoms in this population supports the theory that laryngeal hypersensitivity contributes to the pathophysiology of PVFM. These patients were not found to have any associated psychiatric diagnoses. Pediatric patients with PVFM have an excellent prognosis when treated with speech therapy and for comorbid conditions as indicated.
Collapse
Affiliation(s)
- Blake Smith
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States.
| | - Claudio Milstein
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
| | - Bryan Rolfes
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
| | - Samantha Anne
- Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, United States
| |
Collapse
|
46
|
Chamberlain Mitchell SAF, Garrod R, Clark L, Douiri A, Parker SM, Ellis J, Fowler SJ, Ludlow S, Hull JH, Chung KF, Lee KK, Bellas H, Pandyan A, Birring SS. Physiotherapy, and speech and language therapy intervention for patients with refractory chronic cough: a multicentre randomised control trial. Thorax 2017; 72:129-136. [PMID: 27682331 DOI: 10.1136/thoraxjnl-2016-208843] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND 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. METHODS 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). FINDINGS 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. INTERPRETATION 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. TRIAL REGISTRATION NUMBER UKCRN ID 10678 and ISRCTN 73039760; Results.
Collapse
Affiliation(s)
- Sarah A F Chamberlain Mitchell
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
- School of Health and Rehabilitation, Keele University, Keele, UK
| | - Rachel Garrod
- King's College London, Denmark Hill Campus, London, UK
| | - Lynne Clark
- Speech and Language Therapy Department, King's College Hospital, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
- NIHR Biomedical Centre, King's College London, London, UK
| | - Sean M Parker
- Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK
| | - Jenny Ellis
- Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK
| | - Stephen J Fowler
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, The University of Manchester and Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Siobhan Ludlow
- Speech and Language Therapy Department, Leighton Hospital, Mid Cheshire Hospitals Trust, Leighton, UK
| | - James H Hull
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK
| | - Kian Fan Chung
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK
| | - Kai K Lee
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - H Bellas
- Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Pandyan
- School of Health and Rehabilitation, Keele University, Keele, UK
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| |
Collapse
|
47
|
Hulme K, Dogan S, Parker SM, Deary V. 'Chronic cough, cause unknown': A qualitative study of patient perspectives of chronic refractory cough. J Health Psychol 2017; 24:707-716. [PMID: 28810370 DOI: 10.1177/1359105316684204] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic refractory cough patients have persistent, unexplained, treatment-resistant symptoms. Very little is known about non-physiological processes underlying chronic refractory cough or patients' experience of the condition. In all, 14 patients participated in semi-structured interviews. Interviews were based on the comprehensive cognitive behavioural model and analysed thematically. Eight key themes emerged illustrating that the experience of the onset and persistence of chronic refractory cough is complex, often involving multiple interlinking factors. Themes highlighted the involvement of biological and psychological factors, and the prominent role of the social dimension in how the cough is experienced, perceived and managed. Implications for intervention development are discussed.
Collapse
Affiliation(s)
- Katrin Hulme
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK.,2 Staffordshire University, UK
| | - Sian Dogan
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK
| | - Sean M Parker
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK
| | | |
Collapse
|
48
|
Vigeland CL, Hughes AH, Horton MR. Etiology and treatment of cough in idiopathic pulmonary fibrosis. Respir Med 2016; 123:98-104. [PMID: 28137504 DOI: 10.1016/j.rmed.2016.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/07/2016] [Accepted: 12/22/2016] [Indexed: 01/02/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease of dysregulated wound healing leading to unremitting scarring and loss of lung function. The predominant symptoms are dyspnea on exertion and a persistent dry cough. For patients with IPF, cough is more than just bothersome; it has a significant negative impact on quality of life and is a marker of disease severity and progression. The etiology of cough in IPF is unclear but may be due to architectural distortion of the lungs, increased sensitivity of the cough reflex, airway inflammation, or changes in mucus production and clearance. There also may be an overlap between IPF cough and cough due to other common etiologies such as asthma, gastroesophageal reflux disease, upper airway cough syndrome, and medications. There are no approved therapies to specifically treat IPF cough, and recently approved medications for IPF have not been evaluated in cough. Few clinical trials have focused on treatments for IPF cough. To date, there is only one randomized, placebo control therapeutic study for IPF cough with thalidomide, which significantly reduced IPF cough and improved quality of life. Two additional cohort studies report that interferon-α and prednisolone also decrease IPF cough. However, no medication is approved to treat IPF cough. Currently, the mainstay of therapy for IPF cough is standard cough suppressants, which have limited efficacy and often intolerable side effects. Future studies are needed to determine an effective therapy to alleviate this particularly debilitating symptom and improve overall quality of life for patients suffering with IPF.
Collapse
Affiliation(s)
- Christine L Vigeland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, United States
| | - Andrew H Hughes
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, United States
| | - Maureen R Horton
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, United States.
| |
Collapse
|
49
|
Johansson EL, Ternestén-Hasseus E, Olsén MF, Millqvist E. Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 26847527 DOI: 10.1002/pri.1658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. METHODS Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. RESULTS Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p < 0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p < 0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p < 0.001). CONCLUSION Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients with SHR and signs of dysfunctional breathing. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Ewa-Lena Johansson
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Ewa Ternestén-Hasseus
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
50
|
Vertigan AE, Kapela SL, Ryan NM, Birring SS, McElduff P, Gibson PG. Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial. Chest 2016; 149:639-48. [PMID: 26447687 DOI: 10.1378/chest.15-1271] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/08/2015] [Accepted: 09/11/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic refractory cough (CRC) is a difficult problem to treat. Speech pathology treatment (SPT) improves symptoms but resolution is incomplete. Centrally acting neuromodulators also improve cough symptoms, but not cough reflex sensitivity, and the effect is short-lived. We hypothesized that combined SPT and centrally acting neuromodulators would have a superior outcome than SPT alone. Our goal was to determine whether combined pregabalin and SPT is more effective than SPT alone. METHODS Randomized placebo controlled trial. Forty patients with CRC were randomly assigned to receive either combined SPT and pregabalin 300 mg daily or combined SPT and placebo. Outcome measures were collected at baseline, end of treatment, and 4 weeks after the end of treatment. Primary outcome measures were cough frequency using the Leicester Cough Monitor, cough severity using a visual analog scale (coughVAS), and cough-related quality of life (QOL) using the Leicester Cough Questionnaire (LCQ). RESULTS Cough severity, cough frequency, and cough QOL improved in both groups. The degree of improvement in LCQ and coughVAS was greater with combined SPT and pregabalin than SPT alone; the mean difference in LCQ was 3.5, 95%CI of difference 1.1 to 5.8; the mean difference in coughVAS was 25.1, 95% CI of difference 10.6 to 39.6. There was no significant difference in improvement in cough frequency between groups. There was no deterioration in symptoms once pregabalin was withdrawn. Median capsaicin cough sensitivity improved from 15.7 to 47.5 μM with combined SPT and pregabalin and from 3.92 to 15.7 μM with SPT alone. CONCLUSIONS Combined SPT and pregabalin reduces symptoms and improves QOL compared with SPT alone in patients with CRC.
Collapse
Affiliation(s)
- Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, Australia.
| | - Sarah L Kapela
- Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia
| | - Nicole M Ryan
- Department of Toxicology & Pharmacology, The University of Newcastle, Calvary Mater Newcastle, Newcastle, Australia
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College Hospital, London, England
| | | | - Peter G Gibson
- Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, Australia; Department of Respiratory & Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| |
Collapse
|