Respiratory · ENT · SLT · UK
Chronic cough clinic, by a combined MDT.
A cause-first work-up for a cough that has run over eight weeks. Respiratory physician, ENT surgeon and PSALTI-trained speech therapist under one roof, with access to gefapixant (Lyfnua) where NICE TA1051 criteria are met.
Why patients choose us
- 01
A combined respiratory, ENT and SLT clinic
Not a single-specialty consult. A named respiratory physician, ENT surgeon and cough speech and language therapist working from one plan.
- 02
A structured cause-first work-up
Spirometry, FeNO, laryngoscopy and 24-hour impedance-pH before any drug is added. We do not empirically stack tablets on an unclear diagnosis.
- 03
Access to gefapixant (Lyfnua)
NICE TA1051 approved the first cough-specific drug in decades. Our clinics prescribe it privately when the criteria are met.
Indicative pricing
What a private chronic cough clinic costs.
Indicative ranges across our London partner centres. Send us your history and we come back with two or three firm options.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial consultant cough clinic (60 min) | £350 to £550 | 60 min | Same visit |
| Spirometry, FeNO and reversibility bundle | £250 to £420 | 45 min | Same visit |
| Fibreoptic laryngoscopy | £280 to £480 | 15 min | Same visit |
| 24-hour ambulatory impedance-pH monitoring | £950 to £1,650 | 24 hours | 7 to 10 days |
| Objective cough monitor (LCM or VitaloJak, 24 hours) | £280 to £450 | 24 hours | 10 to 14 days |
| PSALTI SLT programme (4 sessions) | £1,200 to £1,800 | 4 x 45 min | 6 to 8 weeks |
| Gefapixant (Lyfnua) 45 mg bd, private self-pay | £6,500 to £8,500 / year | Ongoing | Repeat prescription |
| Full MDT work-up and 12-week programme | £4,500 to £8,500 | 12 weeks | Structured pathway |
The journey
From first enquiry to a working plan.
One team from history-taking through to prescription, with objective proof that treatment is working.
- 01 Before
You send us the story
A short confidential form: how long, what triggers it, what has already been tried, and any red flag features such as haemoptysis or weight loss.
- 02 Before
We match you to a cough clinic
Within one working day: which London centre fits your case, whether ENT or respiratory leads, and an indicative price.
- 03 Before
Pre-clinic tests
Chest X-ray, spirometry with reversibility, FeNO and a full blood count. Sputum induction where eosinophilic bronchitis is suspected.
- 04 On the day
Consultant assessment
A 60-minute consultation with structured history, examination, review of imaging and completion of the Leicester Cough Questionnaire baseline score.
- 05 On the day
Targeted investigations
Fibreoptic laryngoscopy for reflux and post-nasal drip signs. 24-hour ambulatory impedance-pH monitoring if silent reflux is suspected. HRCT if the chest film is abnormal.
- 06 On the day
MDT formulation
Respiratory, ENT and SLT agree the driving cause or diagnose cough hypersensitivity syndrome. You leave with a written plan, not a guess.
- 07 After
Treatment and follow-up
PSALTI cough suppression therapy, neuromodulator titration, or gefapixant if criteria are met. Follow-up LCQ at 4 and 12 weeks to prove it is working.
Causes we work through
The aetiology cascade for chronic cough.
Four causes account for the majority. We work through them in a structured order, and screen for the rarer structural, infective and neoplastic causes at the same visit.
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Asthma and eosinophilic bronchitis
Cough-variant asthma is the single commonest cause. FeNO, spirometry reversibility and induced-sputum eosinophils confirm it. Inhaled corticosteroid trial is usually diagnostic and therapeutic.
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GORD and silent laryngopharyngeal reflux
A PPI trial for eight weeks, laryngoscopy for posterior laryngitis, and 24-hour impedance-pH to catch non-acid reflux that a standard pH probe misses.
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Upper airway cough syndrome (UACS)
Post-nasal drip from chronic rhinosinusitis or allergic rhinitis. ENT review, nasal endoscopy and CT sinuses. Intranasal steroid plus antihistamine, or endoscopic sinus surgery.
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Chronic refractory cough and CHS
About 40 per cent of cases stay unexplained after full work-up. Cough hypersensitivity syndrome (Morice) reflects neural sensitisation of vagal afferents to cold air, perfume, speech, laughing and throat clearing.
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ACE inhibitor drug cough
Ramipril, lisinopril and other ACE inhibitors cause a dry cough in up to 15 per cent of patients. Switching to an ARB usually settles it within four weeks.
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Bronchiectasis and chronic infection
A wet productive cough with recurrent chest infections. HRCT confirms. Sputum culture screens for Pseudomonas and non-tuberculous mycobacteria such as Mycobacterium avium complex.
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Interstitial lung disease and structural
ILD, tracheobronchomalacia and inhaled foreign body all present with chronic cough. HRCT, dynamic CT and bronchoscopy sort them out.
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Red flags: haemoptysis, weight loss, night sweats
Any of these, or a smoking history with a new persistent cough, needs a two-week-wait lung cancer pathway, not an outpatient clinic.
Work-up and treatment ladder
Every step, in the order we use it.
Investigations first, then the six-step treatment ladder: treat the cause, PSALTI, low-dose amitriptyline or nortriptyline, morphine SR 5 mg bd, gabapentin or pregabalin, and gefapixant.
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Structured history and Morice classification
Timing, triggers, sputum, hoarseness, throat clearing, laryngeal paraesthesia. Adults with cough over 8 weeks (children over 4 weeks per ERS) are classified as chronic idiopathic cough or CHS if unexplained.
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Baseline physiology bundle
Chest X-ray, spirometry with bronchodilator reversibility, FeNO and full blood count with eosinophils. HRCT if the chest film or spirometry is abnormal.
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Fibreoptic laryngoscopy
The ENT arm of the clinic. Looks for posterior laryngitis, arytenoid oedema and pooling of secretions - the classic silent-reflux picture - and screens for vocal cord dysfunction.
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24-hour impedance-pH monitoring
Catches both acid and non-acid reflux events and correlates them with cough symptoms recorded by the patient. Superior to a bare pH probe for silent reflux.
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Sputum induction for eosinophilic bronchitis
Hypertonic saline induces a sputum sample. An eosinophil count above 3 per cent confirms eosinophilic bronchitis, which responds well to inhaled steroid.
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Objective cough monitoring
A wearable Leicester Cough Monitor (LCM) or VitaloJak records cough frequency over 24 hours. Useful before and after treatment to prove an objective response.
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PSALTI cough suppression therapy
Physiotherapy and speech and language therapy intervention. Chamberlain 2013 showed a 40 per cent reduction in cough at four sessions. First-line for chronic refractory cough.
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Neuromodulator and gefapixant ladder
Low-dose amitriptyline 10 to 25 mg nocte, gabapentin or pregabalin (Ryan 2012), morphine SR 5 mg bd (Morice BURDEN dose-response), and gefapixant 45 mg bd (NICE TA1051 2024) for refractory or unexplained cough.
Our London network
A small panel of specialist cough clinics.
Royal Brompton Private Cough Clinic (Professor Chung’s team), Guy’s and St Thomas’ Private Cough Clinic, Imperial Private Charing Cross, HCA Wellington Chest, Chelsea and Westminster Private Respiratory, and One Welbeck Chest Imaging and Endoscopy.
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Consultant respiratory physicians with a specialist cough interest and access to cough monitoring
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ENT surgeons who perform on-site fibreoptic laryngoscopy in the same clinic visit
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Speech and language therapists trained in the PSALTI cough suppression protocol
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Access to gefapixant (Lyfnua) prescribing where NICE TA1051 criteria are met
Safety and stopping rules
What to expect, honestly.
Cough treatments have real side effects. We titrate slowly, review at four and twelve weeks, and stop anything that has not moved the LCQ.
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Cause first, drug second
A confirmed cause (asthma, GORD, UACS, ACE inhibitor) is treated on its own for at least eight weeks before layering additional therapy.
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PSALTI is first-line for refractory cough
Four sessions of speech and language therapy reduce cough frequency by around 40 per cent (Chamberlain 2013). Try this before adding a systemic drug.
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Amitriptyline and gabapentin side effects
Drowsiness, dry mouth, weight change and dizziness are common. Titrate slowly and review at four weeks. Warn about driving until stable.
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Low-dose morphine is not addiction risk
Morphine SR 5 mg twice daily has a specific antitussive effect (Morice BURDEN). At this dose in a supervised cough clinic, dependence is not the practical concern; constipation and nausea are.
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Gefapixant taste disturbance
Around 60 per cent of patients on Lyfnua notice altered taste. It usually settles or is tolerable, but is the commonest reason for stopping.
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Objective monitoring beats symptom scores
LCQ and VAS are useful, but a wearable cough monitor at baseline and 12 weeks removes the argument about whether treatment is working.
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Watch for red flags at any visit
Haemoptysis, weight loss, night sweats or a change in cough character in a smoker triggers immediate CT and lung cancer pathway referral, even mid-treatment.
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Reasonable stopping rules
If a treatment shows no LCQ or objective improvement at 12 weeks, we stop it. We do not carry passengers on the prescription list.
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NHS availability is limited
Full MDT cough clinics exist only in a handful of NHS tertiary centres. Private access shortens waits from many months to a few weeks.
Reading your cough clinic letter
Your clinic letter in four parts.
Whichever centre you attend, the letter you receive keeps to the same shape.
- 01 History
Duration, triggers and Morice classification
How long the cough has run, what sets it off, associated features, and whether it fits chronic idiopathic cough or cough hypersensitivity syndrome.
- 02 Investigations
Physiology, imaging and reflux studies
Spirometry, FeNO, eosinophil count, chest imaging, laryngoscopy findings, and impedance-pH result if performed.
- 03 Diagnosis
Driving cause or refractory / unexplained
A named diagnosis (asthma, GORD, UACS, drug-induced, structural, refractory) with the reasoning made explicit.
- 04 Plan
Treatment ladder and review interval
Read this first: which treatment starts today, in which order the ladder is climbed, and when the LCQ is repeated.
Recognised by major UK insurers
Insurer cover for cough clinics varies. Consultation and standard investigations are usually funded; gefapixant is typically self-pay.
Frequently asked
Everything we get asked about chronic cough.
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What counts as a chronic cough?
A cough lasting more than 8 weeks in adults, or more than 4 weeks in children, is defined as chronic by the European Respiratory Society. Coughs under 3 weeks are acute (usually viral) and coughs of 3 to 8 weeks are subacute (often post-infectious).
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What are the commonest causes?
Four causes dominate: cough-variant asthma and eosinophilic bronchitis, gastro-oesophageal reflux (including silent laryngopharyngeal reflux), upper airway cough syndrome from post-nasal drip or chronic rhinosinusitis, and chronic refractory or unexplained cough (cough hypersensitivity syndrome). ACE inhibitor drugs, smoking, bronchiectasis, ILD, TB, whooping cough and lung cancer must all be excluded.
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What is cough hypersensitivity syndrome?
Around 40 per cent of chronic coughs stay unexplained after a full work-up. Professor Alyn Morice described these as cough hypersensitivity syndrome: neural sensitisation of vagal afferents that fires the cough reflex in response to cold air, perfume, speech, laughing or simple throat clearing. It is a real neurological condition, not a habit.
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What is gefapixant (Lyfnua)?
Gefapixant is a P2X3 receptor antagonist, the first cough-specific drug licensed in decades. NICE Technology Appraisal TA1051 (2024) recommends it for refractory or unexplained chronic cough at 45 mg twice daily. Private self-pay is around £6,500 to £8,500 per year. Around 60 per cent of patients notice altered taste.
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Do I need speech and language therapy?
Yes, in most refractory cases. The PSALTI protocol (physiotherapy and speech and language therapy intervention for cough) is first-line for chronic refractory cough. Chamberlain 2013 showed a 40 per cent reduction in cough at four sessions, and it has no drug side effects.
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What does a private cough clinic cost?
An initial 60-minute consultation is £350 to £550. A full MDT work-up with laryngoscopy, impedance-pH and objective cough monitoring runs £4,500 to £8,500 across 12 weeks. Gefapixant privately adds £6,500 to £8,500 per year. London centres include Royal Brompton, Guy’s and St Thomas’, Imperial Charing Cross, HCA Wellington Chest, Chelsea and Westminster and One Welbeck.
Book a private cough clinic
Eight weeks of coughing is enough. Let us find the cause.
Send us the history and we match you to a London MDT cough clinic within one working day, with a firm quote.
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