Using Behavioral Management to Control Chronic Refractory Cough


Noninvasive, efficacious treatment options are available to help patient outcomes and improve quality of life.

Patients with chronic refractory cough (CRC) may benefit from behavioral cough suppression therapy (BCST). In a session of the 2021 American Cough Conference, Laurie Slovarp, PhD, CCC-SLP, associate professor at the University of Montana in Missoula, said increased awareness of BCST is needed for clinicians and patients to know it as a noninvasive, efficacious, and inexpensive form of cough treatment, as well as to understand how this therapy works and how to identify eligible candidates.

According to Slovarp, BCST is known by various names, including speech pathology treatment for chronic cough, respiratory retraining, and cough-suppression physiotherapy.

“Just about every single paper refers to it by a different name,” she said. “If you see ‘speech pathology’ and ‘cough’ together, you can bet that we’re probably talking about the same therapy.”

Prior to using BCST, patients will often see multiple care providers, undergo multiple tests, and try multiple medications, she said.

However, up to 88% of patients with CRC using BCST have shown a reduction in cough severity through published studies. These reductions occurred in cough frequency and sensitivity, while also increasing quality of life for patients.

“These are all patients that have already failed just about every other medical treatment available to them,” Slovarp said.

A survey study published by Slovarp in 2021 investigated the post-BCST satisfaction of 164 patients in the United States and Australia. It found that 58% of patients reported being “quite satisfied” or “completely satisfied” following therapy. The mean change of 6.6 from the Leicester Cough Questionnaire was significant, according to Slovarp.

“There’s pretty reasonable efficacy data on BCST,” she said. “These patients are not just getting better a little bit, many of them have a pretty dramatic improvement.”

According to Slovarp, onset of CRC often occurs with a cough-inducing event, such as a respiratory virus. CRC may present itself in various ways, from a once-a-week coughing fit to a cough that induces gagging or vomiting.

“In my clinic, I see a wide variety of severity,” she said.

BCST is often determined with extensive case history, oral mechanism exam that may find muscle tension or tenderness in the neck, shoulders and suprahyoid, voice evaluation, urge-to-cough testing, and validated patient-report questionnaire.

“The biggest thing for me is the case history,” she said. “Most of the patients we see have been coughing for years.”

Treatment options may be educating patients about coughing including the safety of cough suppression, training patients to suppress coughing; increasing awareness of cough triggers and a pending cough; management of laryngopharyngeal reflux and postnasal drip, voice therapy, and, if needed, a challenge.

Cough-control breathing, relaxation, and swallowing techniques, as well as distractions, and resonant voicing are some of the methods employed in BCST.

“Over time, with suppression, you will feel a reduction in urge to cough,” she said.


Slovarp L. Issues in clinical cough management: Behavioral management of chronic refractory cough. Presented at: American Cough Conference; virtual. June 11, 2021.

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