Speech and language therapy for management of chronic cough

Slinger, Claire; Mehdi, Syed; Milan, Stephen J; Dodd, S.J.; Blakemore, Jessica; Vyas, Aashish; Marsden, Paul

doi:10.1002/14651858.cd013067

Cited by 6 publications

(5 citation statements)

References 53 publications

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“…2018) Laryngeal trauma might also arise from acute cough (Slinger et al . 2019), with post‐viral symptoms impacting voice and swallowing even in patients who have not been admitted to hospital. This leads to the potential for a surge of new referrals for ENT SLTs as the initial peak of the pandemic passes and needs to be accounted for in service delivery.…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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Background The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working.

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Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

View full text Add to dashboard Cite

show abstract

“…Despite the larynx's active role in cough production, the literature evaluating its contribution to physiology and pathophysiology is limited. Much of the published work on the laryngeal involvement in cough focuses on its sensory input in the cough reflex and dystussia, either as a therapeutic target in a chronic cough or, when deficient, as a risk factor in silent aspiration and dysfunctional deglutition 39 . Yet, much remains to be uncovered on the impact of laryngeal mechanics on cough generation.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cough Airflow and Acoustics After Injection Laryngoplasty

et al. 2022

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Objective/Hypothesis We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. Study Type/Design Prospective interventional study. Methods Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed‐rank test was used to compare the differences between pre‐ and post‐injection laryngoplasty in airflow and acoustic measures. A Spearman rank‐order correlation was used to evaluate the association between airflow and acoustic cough measures. Results Twenty‐five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: −0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2, SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: −0.31, p = 0.04) and peak power density (coefficient: −0.35, p = 0.02). Conclusions Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. Level of Evidence 3 Laryngoscope, 133:S1–S14, 2023

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“…Currently, the LCM system can record consecutive data for more than 24 hours (up to 4 days) (2) and has been applied to measure coughs in a wide range of clinical studies, including the investigation of healthcare use and costs in CC (120), post-exercise cough in asthma and cough patterns in asthma and non-asthma (121,122), CC in vocal cord dysfunction (VCD) (123), inhaled sodium cromoglicate in IPF (124), cough frequency in acute cough (125), COPD exacerbation (126), bronchiectasis (127) and TB (128,129), Physiotherapy and Speech And Language Intervention (PSALTI) for CC (130)(131)(132), as well as the evaluation of the antitussive efficacy of various neuromodulators, including gabapentin, pregabalin (133,134). A recent real-world retrospective study provided the prospects of the feasibility and clinical utility of LCM in the outpatient clinical setting, in which cough monitor was responsive to intervention and claimed to identify different diseases by the cough frequency and pattern (86).…”

Section: Lcmmentioning

confidence: 99%

Chronic cough—the limitation and advances in assessment techniques

Zhang¹,

Sykes²,

Brindle³

et al. 2022

J Thorac Dis

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Accurate and consistent assessments of cough are essential to advance the understanding of the mechanisms of cough and individualised the management of patients. Considerable progress has been made in this work. Here we reviewed the currently available tools for subjectively and objectively measuring both cough sensitivity and severity. We also provided some opinions on the new techniques and future directions.The simple and practical Visual Analogue Scale (VAS), the Leicester Cough Questionnaire (LCQ), and the Cough Specific Quality of Life Questionnaire (CQLQ) are the most widely used self-reported questionnaires for evaluating and quantifying cough severity. The Hull Airway Reflux Questionnaire (HARQ) is a tool to elucidate the constellation of symptoms underlying the diagnosis of chronic cough. Chemical excitation tests are widely used to explore the pathophysiological mechanisms of the cough reflex, such as capsaicin, citric acid and adenosine triphosphate (ATP) challenge test. Cough frequency is an ideal primary endpoint for clinical research, but the application of cough counters has been limited in clinical practice by the high cost and reliance on aural validation. The ongoing development of cough detection technology for smartphone apps and wearable devices will hopefully simplify cough counting, thus transitioning it from niche research to a widely available clinical application.

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Speech and language therapy for management of chronic cough

Abstract: Speech and language therapy for management of chronic cough.

Cited by 6 publications

References 53 publications

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Changes in Cough Airflow and Acoustics After Injection Laryngoplasty

Chronic cough—the limitation and advances in assessment techniques

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