Non-pharmacological Management of Non-productive Chronic Cough in Adults: A Systematic Review

Abstract

BackgroundChronic cough is a common reason for medical referral and its prevalence is on the rise. With only one pharmaceutical therapy currently under review for the treatment of refractory chronic cough, exploring non-pharmacological chronic cough management therapies is important. This systematic review summarizes the effectiveness of non-pharmacological chronic cough therapies in adults with non-productive refractory chronic cough or cough due to chronic respiratory diseases.MethodsWe searched Medline, Embase, Cochrane, CINAHL, and Scopus from inception to September 2021. Randomized controlled trials published in English, Portuguese, or French, and examining the effects of non-pharmacological therapies in adults with chronic non-productive cough (>8 weeks; <2 teaspoons sputum) were included. Mean differences, medians, and odds ratios were calculated as appropriate.Results16,546 articles were identified and six articles representing five unique studies were included. Studies evaluated 228 individuals with refractory chronic cough or chronic cough due to a chronic respiratory disease [162 women (71%); 52 ± 11 to 61 ± 8 years old]. Obstructive sleep apnea was the only chronic respiratory disease studied. Non-pharmacological therapies included education, cough suppression, breathing techniques, mindfulness, and continuous positive airway pressure. When standing alone, non-pharmacological cough therapies improved cough-specific health related quality of life when not associated with interventions (mean diff MD 1.53 to 4.54), cough frequency (MD 0.59 95%CI 0.36 to 0.95), and voice outcomes (MD 0.3 to 1) when compared to control interventions.ConclusionThe evidence of non-pharmacological therapies for non-productive chronic cough is limited. Existing studies reflect the heterogeneity in study design, sample size, and outcome measures. Thus, clinical recommendations for using the most effective interventions remain to be confirmed.

Gender Differences in Antitussive Prescriptions for Chronic Cough in Korea

“…Chronic cough management includes pharmacological and non-pharmacological therapy. The effectiveness of pharmacological therapies is limited in refractory cough and unexplained cough [40,41]. Non-pharmacological therapy is effective for chronic cough with fewer side effects, whether alone or combined with pharmacological therapies, but there is a paucity of clinical data [2,42].…”

Holistic management of patients with progressive pulmonary fibrosis

“…Available treatments are mainly pharmacological, have limited effectiveness [ 44 , 45 ] and significant adverse effects, such as drowsiness and risk of addiction [ 46 ]. There is a paucity of evidence on non-pharmacological interventions in patients with chronic respiratory diseases, specifically in PF [ 47 ]. Observational and case studies have shown that multicomponent programmes consisting of education, vocal/laryngeal hygiene, hydration, cough control techniques, and psychoeducational counselling can help.…”

State of the Art for Refractory Cough: Multidisciplinary Approach

“…Therapy resulted in decreased objective cough counts, improvements in symptom scores and cough quality of life. A systematic review by Ilicic et al [ 21 ] reported that in comparison with control interventions, nonpharmacological therapy improves cough specific health related quality of life, as measured by the Leicester Cough Questionnaire (LCQ), by 1.53 points. This improvement is more than the minimally clinically important difference of 1.3 [ 22 ].…”