Chronic Cough
Why do our bodies cough? The primary function of a cough (which occurs when your
vocal cords slam together to expel something) is to protect the airway and eject
anything that has entered the airway and is heading toward the lungs. When something
touches the vocal cords, a reflexive cough is triggered. When we are sick or have a
cold, we cough to expel mucous from the airway.
What causes chronic cough?
Ø Smoking is one common cause of chronic cough.
Ø Underlying pulmonary impairments (asthma, bronchitis, etc.) can cause a dry
chronic cough.
Ø Other times, something is actually repeatedly touching the vocal cords and
causing a reflexive cough to protect the airway. Causes of this could include:
• a post nasal drip from allergies,
• a swallowing impairment resulting in aspiration (which can happen even
on saliva, not just when eating or drinking),
• reflux coming all the way back up to the level of the vocal cords, or
• mucous being coughed up from the lungs.
Ø Certain blood pressure medications (ACE inhibitors) can also cause a chronic
cough.
How is chronic cough treated? The key to managing chronic cough is determining the
underlying cause. Typically, once the root of the cough is found, it can be managed
effectively. There are many healthcare professionals who could be involved in the
assessment and treatment of a chronic cough.
An ear, nose, and throat physician, allergist, and/or a gastroenterologist can confirm or
rule out allergies, reflux, or other potential causes for the cough and treat them
accordingly. A pulmonologist may also complete testing to rule out other causes such
as asthma. A speech pathologist can confirm or rule out a swallowing impairment as an
underlying cause and treat any swallowing impairment that is uncovered.
©
Swallowing
and
Neurological
Rehabilitation,
LLC
www.tulsasnr.com
Habitual Coughing
If all of that has been assessed and ruled out (or has been found and treated… e.g.,
you’re taking reflux or allergy meds but are still coughing), another possibility is that the
cough has become habitual. Often it starts as a productive/necessary cough (e.g.,
during a cold), but then after the sickness has gone away, the cough becomes a habit
due to sensory changes in the larynx.
There are sensory nerves in the vocal cords that have counterparts called motor nerves.
When the sensory nerves are triggered (e.g., by reflux or post nasal drip touching the
vocal cords), they cause a motor response- a cough. Over time, if the sensory nerves
are constantly set off by reflux, allergies, etc., the sensory threshold lowers and it starts
to take much less (even just a little saliva, for example, that wouldn’t have triggered a
cough previously) to induce a cough response. Things that wouldn’t have triggered a
cough before trigger one now. Then the more we cough, the more the sensory nerves
are damaged and the threshold is further lowered…It’s a vicious cycle.
Often a chronic cough begins with a legitimate sickness, but the sensory nerves
become hypersensitive, and the cough can then linger after the sickness.
The solution to ending this cycle is letting the vocal cords heal by protecting them from
slamming together (like they do during a cough), which only further damages them. This
is done by replacing the cough with a different motor response to give the vocal folds a
chance to rest and heal.
There are a few alternatives to a cough that can help to clear the sensation that is felt
without leading into a cough.
Some of these replacement techniques include the following:
• Sniff and swallow
• Hard, effortful swallow
• Brief breath hold
• Fake cough with a puff of air- “Huh” (NOT a throat clear)
• Drink of water
• Sucking on hard candy (fruity flavors are best, not menthol)
Try to implement these techniques at the first sign that a cough may occur (e.g., when
you feel a tickle in the throat, a tingling sensation, etc.) to suppress the cough and
hopefully eventually prevent the coughing episodes altogether. Once the sensory
nerves in the vocal cords have time to heal, the threshold raises back to normal, and the
constant sensation of needing to cough will most likely resolve.
Even a chronic cough that has persisted for several years CAN improve.
©
Swallowing
and
Neurological
Rehabilitation,
LLC
www.tulsasnr.com
