Article Text

other Versions

PDF
Original article
Physiotherapy, and speech and language therapy intervention for patients with refractory chronic cough: a multicentre randomised control trial
  1. Sarah A F Chamberlain Mitchell1,2,
  2. Rachel Garrod3,
  3. Lynne Clark4,
  4. Abdel Douiri5,6,
  5. Sean M Parker7,
  6. Jenny Ellis7,
  7. Stephen J Fowler8,
  8. Siobhan Ludlow9,
  9. James H Hull10,
  10. Kian Fan Chung10,
  11. Kai K Lee1,
  12. H Bellas11,
  13. Anand Pandyan2,
  14. Surinder S Birring1
  1. 1Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
  2. 2School of Health and Rehabilitation, Keele University, Keele, UK
  3. 3King's College London, Denmark Hill Campus, London, UK
  4. 4Speech and Language Therapy Department, King's College Hospital, London, UK
  5. 5Department of Primary Care and Public Health Sciences, King's College London, London, UK
  6. 6NIHR Biomedical Centre, King's College London, London, UK
  7. 7Respiratory Medicine, Northumbria Healthcare NHSFT, North Tyneside General Hospital, North Shields, UK
  8. 8Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, The University of Manchester and Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  9. 9Speech and Language Therapy Department, Leighton Hospital, Mid Cheshire Hospitals Trust, Leighton, UK
  10. 10NIHR Respiratory Biomedical Research Unit at the Royal Brompton NHS Foundation Trust and Imperial College London, London, UK
  11. 11Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sarah Ann Frances Chamberlain Mitchell, Division of Asthma, Allergy and Lung Biology, King's College London, Denmark Hill, London SE9 5RS, UK; s.chamberlain.mitchell{at}keele.ac.uk

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.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Jaclyn A Smith Jemma Haines Janelle Yorke
  • Airwaves
    The Triumvirate