Persistent cough, cough, cough
This month´s blog is inspired by a patient of mine, let´s call her Susan. She suffers from chronic cough, that means a persistent cough of more than 4 weeks, in her case it was 8 years! Chronic cough is a real problem significantly affecting quality of life. Imagine trying to go to the cinema when you are coughing all the time. For Susan it seriously affected her sleep meaning she needed to sit in a chair at least two or three times a night. For many people it´s often worse during talking or laughing so it can really limit enjoyment. But what can be especially difficult to cope with is that in up to 42% of cases, despite extensive investigations and treatments trials, the cause of cough remains unexplained. However, there is emerging evidence that physio and speech and language therapy treatments can be helpful.
Last year, Sarah Chamberlain-Mitchell, a physiotherapist under the supervision of myself and Dr Surinder Birring, successfully completed her Ph.D. Well done Dr Chamberlain-Mitchell ! Here is a photo of her presenting the work at an international conference – she was great!
Our study looked at the effect of a combined physio and speech and language therapy intervention on chronic cough (PSALTI). We studied 76 patients with chronic cough of unknown cause and randomly assigned them to active treatment or placebo (general health and relaxation advice). The results were extremely positive with our treatment group showing reductions in the frequency of cough (measured by a special monitor), urge to cough and quality of life. Whilst our placebo group showed some improvement (possibly as a result of being seen by a therapist) the differences between the groups in favour of treatment were statistically important.
So how has Susan fared? Well after 4 weekly sessions with me I am happy to say she is now sleeping through the night, her quality of life has significantly improved and she reports that the “urge to cough” has also reduced.
There are many different theories as to why some people develop chronic cough but the truth is we don´t fully understand it yet. One idea however, is that the receptors in the brain that detect cough signals from the throat and pharynx become hypersensitive meaning even small triggers can cause a cough. One aspect of treatment then is to teach people techniques that will hopefully, in the long term, reduce this hypersensitivity. However, cough is an important protective mechanism and there are many reasons for cough, from flu, to asthma, or other diseases, so it is essential that medical tests are performed to rule out any other cause before physiotherapy begins.
If you think you might need help with chronic cough, please get in touch and I can advise you regarding the necessary steps. There is hope I promise!
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