, Volume 192, Issue 1, pp 75–85 | Cite as

Nonpharmacological Interventions for Refractory Chronic Cough Patients: Systematic Review

  • Sarah ChamberlainEmail author
  • Surinder S. Birring
  • Rachel Garrod



For people with refractory chronic cough, nonpharmacological interventions are emerging as alternatives to antitussive medications. These treatments generally are delivered by physiotherapists and speech and language therapists and consist of education, breathing exercises, cough suppression techniques, and counselling. Although the number of studies investigating these treatment options has increased in recent years there has not been a systematic review of the efficacy of these treatment options.


Studies were searched for in EMBASE, AMED, Medline, CINAHL, and PsycINFO databases. Bibliographies of studies and reviews were searched by hand. Critical appraisal was carried out by one reviewer using the SIGN appraisal tools and Cochrane handbook for systematic reviews.


From a total of 184 studies, 5 full-text English language articles were included in the review. Nonpharmacological interventions were found to significantly reduce cough reflex sensitivity, improve quality of life, and lead to reductions in cough severity and frequency. However, few studies used validated and reliable tools to measure cough severity and frequency thereby limiting the robustness of these findings.


Present data support the use of two to four sessions of education, cough suppression techniques, breathing exercises, and counselling in order to achieve improvements in cough sensitivity and cough-related quality of life for people with chronic refractory cough. Due to the lack of validated outcome measures, results for other aspects of cough should be interpreted with caution. There is a need for additional larger-powered comparative studies investigating nonpharmacological interventions for refractory chronic cough.


Refractory chronic cough Nonpharmacological intervention Physiotherapy Speech and language therapy Cough suppression 



We gratefully acknowledge funding from the Physiotherapy Research Foundation and the Chartered Society of Physiotherapy  (CSP) Charitable Trust for the salary of Sarah Chamberlain and Rachel Garrod.

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sarah Chamberlain
    • 1
    • 2
    • 3
    Email author
  • Surinder S. Birring
    • 2
  • Rachel Garrod
    • 1
  1. 1.Therapies DepartmentKing’s College HospitalLondonUK
  2. 2.Asthma Allergy and Lung Biology DivisionKing’s College LondonLondonUK
  3. 3.School of Health and Rehabilitation, McKay BuildingKeele UniversityStaffordshireUK

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