Introduction Non pharmacological cough suppression therapy (CST) delivered by speech and language therapists is one of the few effective treatments available for patients suffering from a chronic refractory cough (CRC) although its use is not currently widespread. CST is a relatively new and developing area, our understanding of its mechanisms and the optimal treatment strategies are limited. We currently have no way of predicting response to therapy.

Method Retrospective review of records from patients undergoing CST in the period 2014–2017. Objective measures included quality of life (QOL) measured using the Leicester cough questionnaire (LCQ) and Laryngeal symptoms (Newcastle Laryngeal Hypersensitivity Questionnaire, LHQ).

Results 198 predominantly female (73.2%) patients with chronic refractory cough underwent CST. Baseline/follow up LCQ and LHQ scores were available on 183/122 patients and 144/90 patients respectively. Most had a cough of >1 year duration (85.9%), impaired QOL (Baseline LCQ mean=11.6 (SD 3.52) and significant laryngeal symptoms (Baseline LHQ: mean 14.7 SD 3.08). The median number of CST sessions was 3. CST improved both QOL (Mean change in LCQ=4.97 SD 3.81) and laryngeal symptoms (Mean change in LHQ=3.13 SD 2.81). Most patients had a response greater than the minimally clinically important difference (MCID) for both LCQ (84.4%) and LHQ (64.4%) but a significant subgroup showed no improvement in objective markers or were worse after CST (15.6% LCQ, 34.4% LHQ). Sex, age, previous smoking status, duration of cough and baseline LHQ and LCQ did not predict non response to treatment.

Conclusions This is the largest series of patients undergoing CST published so far. Most patients show meaningful improvements in both symptoms and quality of life. Use of CST is not currently widespread and it is important that we improve access to this therapy. There is a significant subgroup of treatment non responders. Identifying those most likely to benefit will help us to personalise therapy for this challenging group of patients.