Introduction Chronic cough affects up to 12% of the adult UK population but currently there are no licensed therapies for patients who are refractory to treatment of underlying causes. Non-pharmacological treatment approaches, specifically speech and language therapy (SLT), have been reported to be effective, as have some pharmacological interventions e.g. low dose morphine and gabapentin/pregabalin, however less is known about combining these treatments.

Aims To determine the effect of SLT on cough specific quality of life when delivered in conjunction with anti-tussive pharmacological management.

Method We retrospectively reviewed all patients attending our tertiary cough service, between January 2017 and May 2018, who had completed a course of SLT cough control therapy with documented LCQ scores pre and post treatment.

Results Thirty seven data sets were available for analysis [76% female; median (range) age 60 (25–82) years]. The median (range) number of SLT sessions was 3 (2–5). There was overall improvement in LCQ score from mean (±standard deviation) 10.8 (±3.5) pre SLT to 15.9 (±3.5) post SLT [mean difference 5.1 (95% CI 6.1 to 4.1), p≤0.001]; minimal important difference (MID) 1.3. The improvement in quality of life with SLT was greatest in those with worst quality of life at baseline i.e. lowest LCQ score (r=−0.47 p=0.004), but was unrelated to the number of therapy sessions (r=−0.13 p=0.45). Interestingly, patients who received an antitussive prior to SLT (morphine, pregabalin or gabapentin, n=16) had similar cough specific quality of life at baseline and experienced similar improvements with SLT to those who received SLT alone [mean baseline LCQ 10.1 (±2.5) vs 11.3 (±4.0), p=0.30; mean improvement 5.8 (±3.9) vs 4.6 (±2.1), p=0.26]. However those previously treated with antitussives required fewer therapy sessions [3.2 (±0.4) vs 3.7 (±0.72). p=0.018].

Conclusion Non-pharmacological treatment of refractory chronic cough afforded equal benefit whether delivered alone or as an adjunct to pharmacological anti-tussive treatments, but those treated with antitussive therapy may respond more rapidly to SLT. Further prospective controlled trials are warranted to evaluate the combination of pharmacological and non-pharmacological approaches to the treatment of refractory chronic cough.