Efficacy of a behavioural intervention for chronic refractory cough: a randomized control trial

Cough is a commonsymptom of many respiratory conditions such as Chronic Obstructive PulmonaryDisease(COPD), upper airway cough syndrome (UACS), asthma, and reflux diseases. These conditions are optimallyassessed and treated as per standard guidelines recommended by TheAmerican  College of Chest Physicians(CHEST) and European Respiratory Society (ERS). When the cough persists beyond 8weeks, with an unidentified etiology, a normal chest X-ray, and is notresponding to medical treatment for the common causes, it is labelled as ‘chronicrefractory cough (CRC)’. These patients undergo multipleclinic visits, assessment procedures, and treatment trials before beinglabelled with CRC and continue to suffer from the consequences of chroniccough. They experience a deterioration in their physical well-being and quality of life in socialcontexts, work life, and leisure. The cough remains unresolved orpartially treated with medical management and thus alternative approaches areexplored. A multi-disciplinary approach tothe management of cough is advocated in the literature. Novel treatment approaches have emerged which targets the behaviouralaspects – in addition to the existing standard of care. The behaviouralinterventions involved sessions focusing on four key principles: cougheducation, cough suppression techniques, vocal hygiene and psycho-educationalcounselling. More efficacy studies onbehavioural interventions are needed to bring awareness among physicians andclinicians. The present study intends to investigate the effectiveness of abehavioural intervention in the treatment of chronic refractory cough.

**Hypothesis statement -**The patients who receive both medical and behaviouralintervention will show improvement in terms of cough related quality of lifeand cough severity scores compared to the group receiving only medicalintervention.