Telehealth group behavioural cough-suppression therapy for refractory chronic cough using a rolling enrolment model.

Background: Refractory chronic cough (RCC) is a burdensome condition with few effective treatments. While behavioural cough-suppression therapy (BCST) has demonstrated high efficacy, access is limited by geographical and provider constraints. This pilot study evaluated the efficacy of BCST delivered in a group telehealth format. Methods: BCST was delivered to small groups (2-5 participants) via telehealth using a rolling enrolment model. Participants attended 4-6 sessions (60-90 min each), led by a trained speech-language pathologist and a graduate student. Each session followed a structured format with emphasis on understanding cough hypersensitivity, training in cough-suppression techniques, adherence monitoring and discussion of participant challenges related to cough suppression. Outcome measures included the Leicester Cough Questionnaire (LCQ) and Patient Global Impression of Severity (PGI-S), with optional cough frequency monitoring using the CoughPro smartphone app. Results: 47 participants (mean age 56.8 years; 42 women) from four countries completed the study. Six participants provided sufficient cough monitoring data. After treatment, 98% (46 of 47) exceeded the LCQ's minimal clinically important difference of 1.3 points. Mean LCQ improvement was 7.04 at both 1 week and 1 month after treatment assessments (both p<0.001; d=2.54 and 2.35, respectively). PGI-S scores showed a median reduction of 2 points. Among those with cough monitoring, the mean hourly cough rate dropped by 68% and cough bouts decreased by 78%. Discussion: Group telehealth BCST focused primarily on consistent cough suppression is an extremely efficacious intervention and can increase availability and access to treatment for patients with RCC.