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Non-pharmacological therapy to treat chronic cough was first described in the 1980s, in patients thought to be suffering from ‘habit’ or ‘psychogenic’ cough.1 ,2 Improvements were reported with the application of speech and language therapy techniques originally developed for a variety of voice disorders, accompanied by individualised psychotherapeutic approaches. Twenty years later, Ann Vertigan published the first randomised controlled trial evidence that speech and language therapy techniques improved symptoms scores for cough, breathing, voice and upper airway symptoms in patients with refractory chronic cough attending a single hospital service.3 This study delivered an intervention based on the original reports, comprising four elements: education about the nature of chronic cough, strategies to control the cough, psychoeducational counselling and vocal hygiene education to reduce laryngeal irritation. Following this single study, many clinical cough services have implemented speech and language therapy,4 largely motivated by the limited treatment options for chronic cough, which can be severe and disabling. However, an important outstanding question has been whether such inventions can be successfully applied in other settings and by therapists from other disciplines.
In Thorax, Chamberlain et al5 replicate Vertigan's findings in the first multicentre randomised controlled trial of PSALTI (Physiotherapy, Speech and Language Therapy Intervention), demonstrating a significant improvement in cough-specific quality of life and an estimated 40% reduction in cough frequency in refractory chronic cough. An intervention similar to Vertigan's was delivered by either speech and language therapists or physiotherapists, and improvements in cough were captured using …