The CoughRetrain Program: Restoring Control Through a Non-pharmacological Intervention

PURPOSE: Non-pharmacological cough interventions are recommended for refractory chronic cough (RCC), yet structured development processes and integration of behavioral theory are rarely described. We report on the development and feasibility of CoughRetrain, a theory-informed telehealth behavioral program that integrates behavior-change strategies to support voluntary control of coughing in RCC. METHODS: CoughRetrain was developed following Medical Research Council guidance through staged problem identification, evidence review, multidisciplinary refinement, remote adaptation, and formative testing in interstitial lung disease. The final five-session individual program integrates education, graded suppression practice, motivational interviewing, and goal setting. A single-group feasibility pilot in adults with RCC assessed adherence, fidelity, adverse events, general self-efficacy (New General Self-Efficacy Scale), cough-specific self-efficacy (Cough-Specific Self-Efficacy Scale), cough-related quality of life [Leicester Cough Questionnaire (LCQ)], cough severity visual analogue scale (CS-VAS), and 24-hour objective cough frequency. RESULTS: Twelve participants were enrolled, and eleven (median age 51 [38-63] years; 55% female; median cough duration 6 [3-20] years) completed the program. All core components were delivered. Two non-serious adverse events occurred (urticaria; headache). General self-efficacy remained stable (mean change 0.04 ± 0.19). Cough-specific self-efficacy increased by 0.3 ± 0.6. LCQ increased by 3.6 ± 3.0 points (95%CI 1.5 to 5.6). CS-VAS decreased by 18.8 ± 25.0 mm (95%CI -35.7 to -1.9), and 24-hour cough frequency decreased by 48% (95%CI -74% to +3%). CONCLUSIONS: CoughRetrain is a safe and feasible telehealth intervention for RCC developed through a transparent, patient-informed process. Preliminary findings align with behavioral cough literature. Larger controlled studies evaluating long-term efficacy are warranted.