A Non-pharmacological Cough Control Therapy
A Non-pharmacological Cough Control Therapy
Coughing affects almost all individuals with ILD leading to physical, psychological and
 social distress and prevents individuals from performing their activities of daily living,
 working or socialising in public places. Unfortunately, there are no licensed medications
 available to treat chronic cough and the few drugs that have been tried resulted in little
 efficacy and significant side effects. Drug-free cough control interventions have shown
 promise in reducing the severity and impact of coughing on patients' lives but have not been
 tested in individuals with ILD. This study aims to explore the feasibility and effectiveness
 of a non-pharmacological cough control therapy, as an adjuvant of pulmonary rehabilitation,
 in patients with ILD and chronic cough (>8 weeks in duration).
Research questions and hypotheses

 i) Is a non-pharmacological cough control therapy feasible to treat chronic cough in patients
 with ILD? Hypothesis: Given the results of previous non-pharmacological interventions in
 patients with refractory cough, we predict that this intervention will be feasible and well
 accepted in patients with ILD.

 ii) Is a non-pharmacological cough control therapy more effective than pulmonary
 rehabilitation (PR) alone to treat chronic cough in patients with ILD? Hypotheses: Given the
 results of previous non-pharmacological interventions in patients with refractory cough, we
 predict that improvements observed in participants receiving the non-pharmacological
 intervention will exceed those receiving PR alone. Improvements are expected in HRQOL
 (exceeding the minimal clinically important difference), intensity of cough-related
 sensations and symptoms of fatigue.

 Research Design The proposed research is a feasibility pre-post intervention study.

 Study details:

 Adults with ILD and chronic cough will be enrolled in this study. Potential eligible patients
 will be recruited from the outpatient PR program at West Park Healthcare Centre and St.
 Joseph's Healthcare. As the outpatient pulmonary rehabilitation program at West Park
 Healthcare Center and St. Joseph's Healthcare will transition partially to virtual meetings,
 the interactions between the research team and patients will be completed via phone calls or
 online.

 This research study will be delivered online using the Zoom Healthcare Plan, an online
 platform that is available at West Park Healthcare Centre, and is used for telerehabilitation
 programs. Participants will be enrolled into a PR program composed of aerobic and
 strengthening exercises, disease-specific education and self-management, as part of their
 usual care. Two weeks before termination of PR, participants will start the
 non-pharmacological cough control therapy, following the intervention proposed by Chamberlain
 colleagues (2017). Participants will attend four virtual sessions of 45 to 60 minutes of
 educational and self-management

 This study will measure several clinical outcomes.

 1. Feasibility will be reflected by the number of eligible patients enrolling (enrolment
 rate of at least 75%) and completing the intervention (attendance rate of at least 80%),
 compliance with the sessions and adverse events.

 2. Leicester cough questionnaire

 3. The King's Brief Interstitial Lung Disease (KBILD)

 4. Modified Borg scale (mBorg

 5. Cough Hypersensitivity Questionnaire (CHQ)

 6. Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F)

 7. Global rating of change questionnaire (GRCQ)

 8. Satisfaction Semi-structured interviews using open-ended questions will be conducted
 before and after the cough control intervention to capture participants' expectations
 and perspectives about the cough control therapy.
Inclusion Criteria:

 -  Individuals will be included if having confirmed diagnosis of any ILD by a physician
 (as per Canadian Thoracic Society's guideline for evaluating patients with fibrotic
 interstitial lung disease) and a chronic cough lasting more than 8 weeks in duration

 Exclusion Criteria:

 -  self-reports of moderate or large sputum production

 -  effective or suspected exacerbation of the respiratory condition in the past month

 -  upper respiratory tract infection in the past month

 -  use of angiotensin-converting enzyme inhibitor medication

 -  changes in the prescribed medication in the previous month

 -  evidence of traction bronchiectasis in the HRCT

 -  evidence of other medical conditions that prevent performance of an exercise training
 program

 -  unable to read or speak in English / unable to provide informed consent.