Study Examines Success Factors in Finishing Cough Suppression Therapy

A recently published retrospective chart review sought to identify why patients with chronic cough would decide to pursue and complete cough suppression therapy (CST).

CST is a type of behavioral intervention, but like other behavioral interventions, it requires significant work on the part of the patient, meaning motivation, therapy attendance, and compliance with therapy techniques.

The researchers, writing in the Journal of Voice, sought to pinpoint the “motivational factors that prompt patients’ progression from the contemplation to action stage of change and attend cough suppression therapy.”

“Previous studies have shown the internal factors of self-efficacy and goal commitment are integral to patient motivation to pursue CST,” the authors wrote.

Chronic cough is defined by persistent symptoms for more than 8 weeks; the estimated prevalence is estimated at 12%-13% of the general population. While it has been considered a component of other disease processes in the past, in recent years, it has become increasingly recognized as a disease that may be caused by several factors, including disordered neural sensitivity, disbalance of peripheral activation, or altered central cough control.

While drug therapy is typically the first line of treatment, the use of behavioral therapy in chronic cough is growing. Behavioral CST typically consists of education, cough suppression techniques, laryngeal hygiene, and psychoeducational counseling.

To grasp a patient’s willingness and readiness to change behavior, providers turn to a 6-step model known as the Transtheoretical Model of Change (TTM); the TTM is defined by progression through precontemplation, contemplation, preparation, action, maintenance, and termination.

The current study continued looking at a cohort of patients studied previously, who were surveyed between February 2021 to July 2021. The prior work sought to determine the link between symptomatology and motivating factors prompting patients to seek behavioral therapy.

That study included 35 patients interested in CST with the most common motivating factors including the desire to improve cough (65.7%), improve symptoms for self (71.4%) and others (57.1%), decreased quality of life (37.1%), improve voice (31.4%), and shortness of breath (40.0%).

In the current study, patient compliance with CST was identified (yes/no) as well as the number of visits and cough severity index (CSI) at therapy, if available. Ages ranged from 33-76 and most were female (n = 25) with a mean presenting CSI of 19.9. The mean duration of chronic cough was nearly 8 years.

After expressing intent, 71% of patients entered the action phase of change and attended CST with an average improvement in CSI of 4.4 (P = .14).

The most common motivational factors overall were “cough bothersome to self” (96% of patients compliant with therapy reported this, compared with 100% of those non-compliant with therapy) and “desire for cough to improve” (reported by 94% of those who were therapy compliant, compared with 85% of those who were non-compliant).

In addition, those who completed therapy were more likely to say that their cough bothers those around them (80%) compared with those who did not (50%).

The study had a few limitations. It was conducted at a tertiary academic laryngology center and often attracts patients seeking more advanced care; they may have also been more open to alternative therapies if first-line drug therapies did not work for them. There may have been selection bias and the study had a small sample size.

Reference

Fabian SB, Kwon J, Rao SJ, Ruckart KW, Madden LL. Chronic cough: evaluation of patients' success in completing cough suppression therapy. J Voice. Published online October 28, 2022. doi:10.1016/j.jvoice.2022.09.022