Behavioral Cough Suppression Therapy

Dr. Michelle Frank

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October 27, 2022
CoughPro is not a medical product. It is a wellness app intended only for users to obtain a better understanding of their cough. It is not intended to diagnose, monitor, or treat any illness.

We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.

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Coughing, especially a chronic cough for which no form of treatment works, can significantly affect your quality of life. Globally, an estimated 10% of people observe an impairment in their general well-being due to a chronic cough.1 

While comprehensive tests are often conducted for those with a long-term cough, a viable cause is not always found. It is possible to then attempt to suppress the cough through a series of over-the-counter medications and standard treatment protocols followed for a cough

However, among a fraction of chronic coughers, none of these treatment methods provide relief.

In such cases, exploring behavioral cough suppression might assist with improving a chronic cougher’s quality of life.

What Is Behavioral Cough Suppression Therapy?

Behavioral cough suppression therapy (BCST), as the name indicates, is a method for suppressing your cough reflex consciously. 

We often understand coughing as an unconscious reflex that helps to expel irritants within our respiratory tracts. While this is true, we can actually control our coughing reflex to an extent by understanding how cough centers work. 

When Is Behavioral Cough Suppression Therapy Used?

Physicians generally recommend BCST when standard medical care is not making significant progress in reducing the patient’s symptoms. The patient is then referred to a speech-language pathologist who educates them on the basics of BCST and its long-term benefits.2 This is done after comprehensive tests are conducted that show medication will not be effective in managing chronic cough. 

How Does Behavioral Cough Suppression Therapy Work?

Cough receptors are sensitive to external stimuli. For some, especially among chronic coughers, this sensitivity can be higher, meaning that the slightest provocation to the cough receptors can result in a cough. Additionally, coughing for a prolonged duration can further increase cough receptor sensitivity.

Chronic coughers are often familiar with the sensation or urge that signals a cough is looming. This could be a slight tingle or itching sensation within the throat. With BCST, identifying this signal and consciously suppressing the urge to cough with distractors is the main step in this method of behavioral cough suppression. 

Distractors can include swallowing liquids, sucking on a lozenge, or cough-control breathing. The main aim of these is to alleviate the urge to cough with a different sensation within the larynx than that of a cough.

The first few sessions are conducted in a supervised setting without exposure to potential cough stimulants. Along with teaching you to suppress coughs, speech therapists also look into your breathing techniques. Deep breaths, with a focus placed on exhalation, are a part of the behavioral cough suppression techniques.

Psychological elements of long-term cough are also analyzed as a part of BCST. Your physician will educate you on how your cough does not originate from conditions such as asthma, GERD, or other possible cough triggers. Understanding potential emotional cough stressors is also a crucial role in behavioral cough suppression therapy.

Why Does Cough Suppression Therapy Work?

Multiple research studies have showcased the efficacy of behavioral cough suppression therapy.3 These studies have highlighted that two to four sessions of education, mastering cough suppression techniques and breathing, and counseling result in the greatest benefits from BCST.

Continual benefits of BCST are being studied and fine-tuned for patients with refractory cough. A recent 2021 survey with 164 chronic coughers showcased that almost 58% of those who tried BCST were quite satisfied with their results.4 

The key to its benefit is the training of the cough reflex to be less sensitive to both external stimuli and continuous coughing. Our cough receptors follow the principle of neuroplasticity.5 The hypothesis is that by neurologically training their function, over time, it is possible to intentionally navigate away from possible triggers to the cough reflex.

For conclusive results, significant studies on why this works are still necessary. However, there are already many studies into its efficiency that showcase it as a promising course of management for those suffering from a long-term nagging cough.

Uses For Behavioral Cough Suppression Therapy

A cough that lasts longer than eight weeks is classified as a chronic cough. For about 5-10% of chronic coughers the underlying cause for the cough is unknown6.The greatest benefit of behavioral cough suppression therapy is observed in these cases.

BCST for Chronic Cough

For those who check in with their physicians for a chronic cough, they attempt all other methods to manage the cough first. They will conduct comprehensive examinations, including physical exams and diagnostic tests, to narrow down a root cause. 

Gastroesophageal reflux (GERD), postnasal drip, and asthma are observed to be the most common causes of chronic cough.7 Physicians must also rule out serious lung conditions, such as lung cancer, chronic bronchitis, occupational lung disease, or other pulmonary disorders, before categorizing a chronic cough as idiopathic – of no physical cause. 

In many cases, these chronic coughs receive standard cough treatments and remedies such as OTC cough suppressants, steroids, antacids, and nasal sprays. But these are usually in vain, with no change in the frequency of the cough or the quality of life toll it takes.

Another crucial aspect of cough monitoring is examining a patient’s lifestyle. Smoking, occupational exposure, pollution (both indoor and outdoor), and allergens have to be assessed. 

Patients get information on habits that could potentially be cough-triggering. Additionally, staying hydrated and preventing overuse of vocal cords are methods to reduce cough frequency.

After all this and with no improvement, a doctor may refer a chronic cougher to a speech-language pathologist who will train them to control their cough. Following a few weeks of supervision, generally, the cougher develops an ability to control their cough reflex on their own. Fatigue and mood changes due to a chronic cough also often subside a few weeks into therapy.8 

Cough suppression therapy improves the quality of life and encourages individuals to participate more in daily activities.

Conclusion

There are limited studies demonstrating how behavioral cough suppression therapy works, and the results also vary from patient to patient. Some might note changes within a few sessions, whereas others might have to receive supervised sessions for a month or more to report changes.

Chronic coughers usually investigate treatment methods on their own to manage their coughs, and you may have learned of BCST before your physician brings it up. Once you start discussing BCST with your physician, you may see the potential benefits of this form of therapy.

Managing the urge to cough, rather than the cough itself, is the cornerstone of BCST. Tracking triggers, cough reflex, and environments can help make the whole experience with cough suppression therapy more effective.

Finally, always consider discussing alternatives to standard treatment with your physician. Understanding the benefits of various treatment strategies can significantly improve your quality of life while living with a persistent cough.

References
  1. Arinze, J. T., de Roos, E. W., Karimi, L., Verhamme, K., Stricker, B. H., & Brusselle, G. G. (2020). Prevalence and incidence of, and risk factors for chronic cough in the adult population: the Rotterdam Study. ERJ open research, 6(2), 00300-2019.[]
  2. Slovarp, L., Loomis, B. K., & Glaspey, A. (2018). Assessing referral and practice patterns of patients with chronic cough referred for behavioral cough suppression therapy. Chronic respiratory disease, 15(3), 296–305.[]
  3. Chamberlain, S., Birring, S. S., & Garrod, R. (2014). Nonpharmacological interventions for refractory chronic cough patients: systematic review. Lung, 192(1), 75–85.[]
  4. Slovarp, L. J., Jetté, M. E., Gillespie, A. I., Reynolds, J. E., & Barkmeier-Kraemer, J. M. (2021). Evaluation and Management Outcomes and Burdens in Patients with Refractory Chronic Cough Referred for Behavioral Cough Suppression Therapy. Lung, 199(3), 263–271.[]
  5. Brooks S. M. (2011). Perspective on the human cough reflex. Cough (London, England), 7, 10.[]
  6. Gibson, P., Wang, G., McGarvey, L., Vertigan, A. E., Altman, K. W., Birring, S. S., ... & Wiener, R. S. (2016). Treatment of unexplained chronic cough: CHEST guideline and expert panel report. Chest149(1), 27-44.[]
  7. D'Urzo, A., & Jugovic, P. (2002). Chronic cough. Three most common causes. Canadian family physician Medecin de famille canadien, 48, 1311–1316.[]
  8. Hulme, K., Deary, V., Dogan, S., & Parker, S. M. (2017). Psychological profile of individuals presenting with chronic cough. ERJ open research, 3(1), 00099-2016.[]

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