Year of Award

2026

Document Type

Thesis

Degree Type

Master of Science (MS)

Degree Name

Speech-Language Pathology

Department or School/College

College of Health Sciences

Committee Chair

Dr. Jane Salois

Committee Co-chair

Dr. Laurie Slovarp

Commitee Members

Dr. Jane Salois, Dr. Laurie Slovarp, Dr. John Quindry

Keywords

refractory chronic cough; cough hypersensitivity syndrome; behavioral cough suppression therapy

Abstract

Background: 
Refractory chronic cough (RCC) is a prevalent condition that substantially impairs quality of life and is associated with significant physical, psychological, and social burden. Behavioral cough suppression therapy (BCST), delivered by speech-language pathologists, is an evidence-based nonpharmacologic intervention shown to improve cough-related quality of life. However, variability exists in how BCST is implemented, and the relative contribution of specific treatment components remains unclear.

Objective: 
To evaluate the effectiveness of a BCST program implemented in a community otolaryngology clinic that emphasizes consistent suppression at the urge-to-cough and neuroplasticity-informed behavioral principles.

Methods: 
This observational retrospective case series examined clinical records of adults with RCC who completed BCST between 2022 and 2025 at a private otolaryngology clinic in Missoula, Montana. Participants were included if they were ≥18 years of age, had a diagnosis of chronic cough (ICD-10 R05.3), completed speech-language pathology evaluation, and had pre- and post-treatment Leicester Cough Questionnaire (LCQ) scores available. The primary outcome measure was change in LCQ total score. A paired-samples t-test assessed differences between baseline and post-treatment LCQ scores.

Results: 
Sixty-nine participants met inclusion criteria (mean age = 64 years; 83% female). Participants attended a mean of 2.93 BCST sessions, and 51% received voice therapy in addition to BCST. Adherence to cough-suppression attempts when experiencing an urge-to-cough (UTC) was documented for 51 participants (74%). Among those with available data, the majority reported high adherence, with 82% attempting suppression during ≥80% of UTC episodes. Mean LCQ scores improved significantly from baseline (11.22 ± 2.71) to post-treatment (17.21 ± 2.41), representing a mean increase of 6.00 points (95% CI, 5.19–6.80; t(68)=14.79, p< .001; Cohen’s d=1.78), substantially exceeding the minimal clinically important difference (MCID) of 1.3.

Conclusions: 
BCST delivered in a community clinical setting and emphasizing adherence to cough suppression at the urge-to-cough and neuroplasticity-informed principles was associated with large improvements in cough-related quality of life. These findings support the real-world effectiveness of BCST and suggest that protocols emphasizing consistent cough suppression may achieve outcomes comparable to previously reported BCST models. Prospective controlled trials are needed to confirm these findings and further refine BCST protocols.

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© Copyright 2026 Mary B. Walsh, Laurie Slovarp, Kassidi Heinle, John Quindry, and Jane Salois