The development of a joint medical and Speech and Language therapist (SLT) 'one stop' cough clinic.
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Authors
Hunter, C
Butler, J
Peace, L
Green, L
Sharp, J
Parker, S
Issue Date
2024
Type
Article
Language
en
Keywords
chronic cough
Alternative Title
Abstract
Background: This study reports preliminary outcomes from a joint Respiratory Consultant and Speech and Language Therapist (SLT) 'one stop' cough clinic. Local and tertiary referrals were accepted. Patients underwent full medical and SLT assessment, including laryngoscopy with provocation. Relevant "treatable traits" were addressed; SLT-led cough suppression therapy (CST) follow up was available for patients with cough hypersensitivity.
Methods: Retrospective data was collected for all patients attending the clinic between July 2023 and June 2024. Data included demographics, observed 'treatable traits', management decisions, SLT intervention, and patient reported CST outcomes.
Results: 30 patients were seen; 19/30(63%) were tertiary referrals. Most were female 22/30(73.3%); mean age 58yrs (range 61). The average cough duration was 11yrs (range 49.5). Mean baseline Leicester Cough Questionnaire (LCQ)9.7 (range 9.3).
The mean number of treatable traits was 4. Commonest traits; cough hypersensitivity 26/30(87%), reflux 19/30(63%), rhinosinusitis 17/30(57%), anxiety/low mood 15/30(50%). Cough hypersensitivity was the dominant trait in 25/30(83%).
Medication was changed/initiated for 8/30(27%); trial asthma treatment 4, PPI 3; Trial MST 1, withdrawal Gabapentin 1, withdrawal MST 1. Onward referral to other MDT members 5/30(17%) (physiotherapy/psychology/nurse). Further Investigations 5/30, i.e. HRCT (17%).
28/30 had laryngoscopy with provocation. The most common observation was laryngeal hypersensitivity 26/28(93%). Cough was provoked and suppressed in 18/28(64%), cough provoked and not suppressed 3/28(11%), cough not provoked 4/28(14%). Other observations included: Inducible laryngeal obstruction 5/28(18%), muscle tension dysphonia 10/28(36%), muscle tension dysphagia 11/28(39%), and breath holding 20/28(71%). Further ENT advice sought for laryngeal pathology 4/28(14%).
Most patients received SLT intervention 26/30(87%): "advice only" was provided to 4/26(15%) within the clinic; follow up SLT intervention was provided to 22/26(85%). The mean number of follow up SLT appointments was 2.2 (range 3).
Of the 18 patients that completed CST; 13(72%) reported improved symptom control, 3(17%) reported no change and 2(11%) were lost to follow up.
Conclusion: A joint cough clinic offers quick and effective treatment. Patients are complex with multiple traits, emphasising the need for MDT working. Laryngoscopy with provocation is clinically useful. In this study, non-pharmacological treatment was the most common management approach, and most patients improved with CST.
Description
Citation
Hunter, C., Butler, J., Peace, L., et al. (2024) P130 The development of a joint medical and Speech and Language therapist (SLT) 'one stop' cough clinic. Thorax; 79 (supp_2) : A186.
Publisher
License
Journal
Thorax
Volume
Issue
PubMed ID
ISSN
1468-3296