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      Assessing referral and practice patterns of patients with chronic cough referred for behavioral cough suppression therapy

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          Abstract

          The purpose of this exploratory research was to describe current referral and practice patterns for behavioral cough suppression therapy (BCST) throughout the United States, and to assess the need for improving the efficiency of BCST referral patterns. In study I, 126 speech-language pathologists, who treat patients with refractory chronic cough (RCC) in the United States, completed a survey about referral patterns, cough duration, and patient frustration level. In study II, 36 adults with RCC referred for BCST completed a four-part survey about cough symptoms and treatment. The survey included the Leicester Cough Questionnaire (LCQ) before and after BCST. Study I revealed significant patient frustration about the treatment process and the wait-time for BCST. Participants in study II reported average cough duration of over 2 years before BCST. Twenty-seven of 31 participants in study II improved by at least 1.3 on the LCQ, indicating a clinically significant improvement in 87% of patients. This study suggests that the current management model for CC may be unduly time-consuming, and expensive for patients with CC who are successfully treated with BCST. Practitioners are encouraged to consider BCST earlier in the treatment process.

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          Prevalence, pathogenesis, and causes of chronic cough.

          Cough is a reflex action of the respiratory tract that is used to clear the upper airways. Chronic cough lasting for more than 8 weeks is common in the community. The causes include cigarette smoking, exposure to cigarette smoke, and exposure to environmental pollution, especially particulates. Diseases causing chronic cough include asthma, eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip syndrome or rhinosinusitis, chronic obstructive pulmonary disease, pulmonary fibrosis, and bronchiectasis. Doctors should always work towards a clear diagnosis, considering common and rare illnesses. In some patients, no cause is identified, leading to the diagnosis of idiopathic cough. Chronic cough is often associated with an increased response to tussive agents such as capsaicin. Plastic changes in intrinsic and synaptic excitability in the brainstem, spine, or airway nerves can enhance the cough reflex, and can persist in the absence of the initiating cough event. Structural and inflammatory airway mucosal changes in non-asthmatic chronic cough could represent the cause or the traumatic response to repetitive coughing. Effective control of cough requires not only controlling the disease causing the cough but also desensitisation of cough pathways.
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            Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines.

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              The diagnosis and management of chronic cough.

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                Author and article information

                Journal
                Chron Respir Dis
                Chron Respir Dis
                CRD
                spcrd
                Chronic Respiratory Disease
                SAGE Publications (Sage UK: London, England )
                1479-9723
                1479-9731
                11 February 2018
                August 2018
                : 15
                : 3
                : 296-305
                Affiliations
                [1 ]Department of Communicative Sciences and Disorders, University of Montana, Missoula, Montana, USA
                [2 ]Benefis Medical Center, Acute Care Therapies, Great Falls, Montana, USA
                Author notes
                [*]Laurie Slovarp, Department of Communicative Sciences and Disorders, University of Montana, 32 Campus Dr., Missoula, MT 59812, USA. Email: laurie.slovarp@ 123456umontana.edu
                Article
                10.1177_1479972318755722
                10.1177/1479972318755722
                6100168
                29430939
                652b29ef-5ed0-4a46-acbd-6730ee75b01b
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 25 February 2017
                : 17 November 2017
                : 15 December 2017
                Funding
                Funded by: Mountain West Clinical Translational Research – Infrastructure Network, https://doi.org/;
                Award ID: 17-746Q-UM-PG55-00
                Categories
                Original Papers

                Respiratory medicine
                chronic cough,refractory chronic cough,behavioral cough suppression therapy (bcst),leicester cough questionnaire,cough hypersensitivity syndrome (chs),speech-language pathology

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