Breathing pattern characteristics in refractory chronic cough patients

Breathing pattern characteristics in refractory chronic cough patients Chamberlain S, 1,2,3 Bellas H, 4 Clark L, 2 Douiri A, 5 Birring SS, 2,3 Garrod R 3 ¹ Keele University, School of Health and Rehabilitation, McKay Building, Keele University, UK 2 King s College Hospital, London, United Kingdom 3 King s College London, London, United Kingdom 4 Sutton and Merton Community Respiratory Service 5 NIHR Biomedical Research Centre, London, United Kingdom

Background Chronic cough is defined as a cough present for > 8weeks duration 1 High prevalence of chronic cough in Europe (11-13%) 2-7 Main causes in people with a normal chest x-ray are 1 : Asthma Gastroesophageal reflux Rhinitis

Background Cough suppression therapy (CST) has been found to be an effective treatment in reducing cough symptoms for refractory chronic cough 10-12

Background Cough suppression therapy (CST) has been found to be an effective treatment in reducing cough symptoms for refractory chronic cough 10-12 CST consists of a package of treatment: 10-13 Education Cough suppression techniques and breathing pattern retraining exercises Vocal Hygiene and hydration techniques Psycho-educational counselling Despite breathing pattern retraining exercises being included in CST little is known about the breathing pattern characteristics of people with refractory chronic cough

Methods This study was completed as part of a larger multi-centred RCT Efficacy of a Physiotherapy, Speech and Language Therapy Intervention (PSALTI) for patients with chronic cough: a randomised controlled trial Inclusion Criteria Cough >8 weeks, normal chest x-ray Minimal sputum production (<10ml a day) Negative investigations and/or failed treatment trials for asthma, rhinitis and reflux Exclusion Criteria Vocal cord malignancies, and active aspiration Upper respiratory tract in past 4 weeks Current smokers Known Respiratory disease: lung cancer, pneumonia, pulmonary fibrosis, sarcoidosis, pleural effusion, bronchiectasis

Methods Breathing pattern was assessed in sitting, over 1 minute by one trained respiratory physiotherapist. Normal RR was defined as 12-16 bpm 14. Route and region of most movement during breathing was also recorded.

Results - Demographics Demographics N 49 Male: Female 18 : 31 Age Mean(SD) years 56 (13) Median Cough Duration (months) 66 (107)

Breathing Pattern characteristics 51% (n=25) had a predominant upper chest movement (UCM) breathing pattern. 31% (n=15) had increased RR (>16); 16% (n=8) had decreased RR (<12) Significant correlation between RR and breathing pattern (r s =0.3, p=0.038) Significant difference in RR when participants with an increased UCM were compared to participants with abdominal movement (ABM) breathing pattern. Median(IQR) ABM 13(5), UCM 16(7) (p=0.04). 96% were nose breathers

Conclusions High proportion of people with chronic cough have increased upper chest movement A 1/3 of our participants had increased respiratory rate Our findings provide some evidence to support the role of breathing pattern retraining exercises for people with chronic cough

Conclusions Further research is needed : to investigate whether there is a relationship between breathing pattern characteristics and cough symptoms. to investigate whether breathing pattern exercises included in CST are effective in changing people s breathing patterns To investigate whether changes in breathing pattern effect cough symptoms in individuals

Acknowledgement We would like to thank the Physiotherapy Research Foundation.

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