Non-pharmacological approaches to chronic cough.

While cough is a protective reflex it can occur in the absence of any physical need to clear the airway. In chronic cough, cough can be triggered by innocuous stimuli and persist despite medical treatment. Non-pharmacological interventions such as cough control therapy, provided by speech pathologists, have gained popularity in recent years. Intervention targets refractory or unexplained chronic cough and efficacy has been studied in randomised controlled trials. Key elements of cough control therapy include education, anticipation and control of the urge to cough, reducing laryngeal irritation and psychoeducational counselling. Our understanding of the mechanisms behind the success of non-pharmacological treatment is developing. It is likely the mechanisms of action are multi-factorial across peripheral, central and higher cortical regions. Non-pharmacological cough control therapy interventions are now included in international cough guidelines. However, approach to service delivery is not standardised and varies between regions and countries.