Cough is a common symptom of many respiratory conditions such as Chronic Obstructive Pulmonary Disease (COPD), upper airway cough syndrome (UACS), asthma, and reflux diseases. These conditions are optimally assessed and treated as per standard guidelines recommended by The American  College of Chest Physicians (CHEST) and European Respiratory Society (ERS). When the cough persists beyond 8 weeks, with an unidentified etiology, a normal chest X-ray, and is not responding to medical treatment for the common causes, it is labelled as ‘chronic refractory cough (CRC)’. These patients undergo multiple clinic visits, assessment procedures, and treatment trials before being labelled with CRC and continue to suffer from the consequences of chronic cough. They experience a deterioration in their physical well-being and quality of life in social contexts, work life, and leisure. The cough remains unresolved or partially treated with medical management and thus alternative approaches are explored. A multi-disciplinary approach to the management of cough is advocated in the literature. Novel treatment approaches have emerged which targets the behavioural aspects – in addition to the existing standard of care. The behavioural interventions involved sessions focusing on four key principles: cough education, cough suppression techniques, vocal hygiene and psycho-educational counselling. More efficacy studies on behavioural interventions are needed to bring awareness among physicians and clinicians. The present study intends to investigate the effectiveness of a behavioural intervention in the treatment of chronic refractory cough.

Hypothesis statement - The patients who receive both medical and behavioural intervention will show improvement in terms of cough related quality of life and cough severity scores compared to the group receiving only medical intervention.