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Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough.

Ryan NM, Vertigan AE, Bone S, Gibson PG - Cough (2010)

Bottom Line: Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment.The number of treatments required to effect a response was also assessed.This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, 2308, NSW, Australia. Nicole.Ryan@newcastle.edu.au.

ABSTRACT

Rationale: Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed.

Objective: The aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement.

Methods: Adults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life.

Results: Following treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean +/- SD at baseline: 72.5 +/- 55.8 vs. post treatment: 25 +/- 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean +/- SD log C5 at baseline: 0.88 +/- 0.48 vs. post treatment: 1.65 +/- 0.88, p < 0.0001).

Conclusions: This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough.

Trial registration: Australian New Zealand Clinical Trials Register, ACTRN12608000284369.

No MeSH data available.


Related in: MedlinePlus

Objective measure-Cough Threshold (a) and Participants urge-to-cough at C5 (b) (Baseline vs Post Treatment). Effect of speech-language pathology treatment on refractory chronic cough outcomes of a) Log Cough Threshold at baseline (Base), and post treatment (Post Rx). b) Urge to Cough score at baseline (Base), and post treatment (Post Rx).
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Figure 3: Objective measure-Cough Threshold (a) and Participants urge-to-cough at C5 (b) (Baseline vs Post Treatment). Effect of speech-language pathology treatment on refractory chronic cough outcomes of a) Log Cough Threshold at baseline (Base), and post treatment (Post Rx). b) Urge to Cough score at baseline (Base), and post treatment (Post Rx).

Mentions: Cough threshold at baseline was Mean ± SD log CT 0.47 ± 0.38 and was significantly altered during treatment: treatment visit 1, cough threshold (T1) log CT 0.72 ± 0.60, p = 0.024, treatment visit 2 (T2) log CT 0.80 ± 0.60, p = 0.025, treatment visit 3 (T3) log CT 0.69 ± 0.23, p = 0.002, until maximum effect had been achieved with no significant change at treatment visit 4 (T4) log CT 0.66 ± 0.65, p = 0.122. After completion of therapy, cough threshold improved significantly: log CT 1.14 ± 0.76, p = 0.001 [Individual cough threshold data (baseline v post treatment) represented in Figure 3a].


Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough.

Ryan NM, Vertigan AE, Bone S, Gibson PG - Cough (2010)

Objective measure-Cough Threshold (a) and Participants urge-to-cough at C5 (b) (Baseline vs Post Treatment). Effect of speech-language pathology treatment on refractory chronic cough outcomes of a) Log Cough Threshold at baseline (Base), and post treatment (Post Rx). b) Urge to Cough score at baseline (Base), and post treatment (Post Rx).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2921346&req=5

Figure 3: Objective measure-Cough Threshold (a) and Participants urge-to-cough at C5 (b) (Baseline vs Post Treatment). Effect of speech-language pathology treatment on refractory chronic cough outcomes of a) Log Cough Threshold at baseline (Base), and post treatment (Post Rx). b) Urge to Cough score at baseline (Base), and post treatment (Post Rx).
Mentions: Cough threshold at baseline was Mean ± SD log CT 0.47 ± 0.38 and was significantly altered during treatment: treatment visit 1, cough threshold (T1) log CT 0.72 ± 0.60, p = 0.024, treatment visit 2 (T2) log CT 0.80 ± 0.60, p = 0.025, treatment visit 3 (T3) log CT 0.69 ± 0.23, p = 0.002, until maximum effect had been achieved with no significant change at treatment visit 4 (T4) log CT 0.66 ± 0.65, p = 0.122. After completion of therapy, cough threshold improved significantly: log CT 1.14 ± 0.76, p = 0.001 [Individual cough threshold data (baseline v post treatment) represented in Figure 3a].

Bottom Line: Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment.The number of treatments required to effect a response was also assessed.This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, The University of Newcastle, Newcastle, 2308, NSW, Australia. Nicole.Ryan@newcastle.edu.au.

ABSTRACT

Rationale: Speech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed.

Objective: The aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement.

Methods: Adults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life.

Results: Following treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean +/- SD at baseline: 72.5 +/- 55.8 vs. post treatment: 25 +/- 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean +/- SD log C5 at baseline: 0.88 +/- 0.48 vs. post treatment: 1.65 +/- 0.88, p < 0.0001).

Conclusions: This is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough.

Trial registration: Australian New Zealand Clinical Trials Register, ACTRN12608000284369.

No MeSH data available.


Related in: MedlinePlus