Introduction and objectives Idiopathic chronic cough patients have symptoms that persist despite trials of empirical treatment with no underlying cause found. Higher-order brain processes are involved in modulating the cough reflex, but very little is known about the psychological processes underlying idiopathic cough. As the first step in the development of a complex intervention, we sought to elicit an in-depth understanding of patient experience of this condition.

Methods Fourteen patients (12 females, mean age = 59 years) participated in qualitative interviews theoretically based upon the comprehensive cognitive-behavioural model. Interviews were thematically analysed and cross-validated using the guidelines outlined by Braun and Clark (2006).

Results Eight key themes emerged illustrating the complex, all-encompassing nature of idiopathic cough. ‘Individual vulnerability’ described precipitating factors possibly linked with cough onset. ‘More than just a cough’ highlighted the co-occurrence of severe physical and emotional experiences. ‘Cough in the social sphere’ highlighted the effort of dealing with others’ reactions and concerns about the contagious image. ‘Cough and Identity’ described how the cough often defines the person. The occurrence of ‘Vicious circles’ became apparent, contributing to cough maintenance. ‘The battle for control’ highlighted the unpredictable nature of the cough, its subsequent impact and the management strategies employed to counter this. Framing the ‘Cough in relation to other health conditions’ provided coughers with a point of reference and some coherence to an otherwise confusing condition. The theme ‘‘At the end of the line’: the cough healthcare journey’ described the care experienced and the continuing search for answers.

Conclusions The onset and persistence of idiopathic cough is complex, involving many interlinking factors. Experiential evidence confirmed previous findings of the involvement of biological (e.g. urge-to-cough sensations) and psychological (e.g. attention) mechanisms. Importantly, it also highlighted the role of the social dimension in how the cough is perceived and managed. These insights suggest a valuable target for future interventions, which accordingly need to take a multi-disciplinary and integrative approach.

Reference 1 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101