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Chronic Cough

Chronic Cough Education

This information is specifically designed for patients who experience chronic cough and excessive throat clearing.  It can be helpful to understand the nature of cough when you are attempting to control the cough.

The following diagram shows a picture of the larynx which is sometimes referred to as the ‘voice box’.  The vocal folds, which are part of the larynx, open when you breathe so that air can pass freely in and out of the lungs.  The vocal folds close when you speak.  Air passes through the vocal folds causing them to vibrate and produce voice.  When you cough, or clear your throat, the vocal folds slam together.  Frequent coughing and throat clearing can be very damaging to the vocal folds.  When you swallow, your vocal folds also close but they do so with a gentle movement.  They close to prevent food, liquid or saliva entering our airway.

Six facts about cough                                                                  

Fact one.  A cough can be triggered by irritation of larynx, throat, or breathing tubes leading to the lungs.  A large number of people also cough deliberately in response to irritation in the throat.  Coughing can become a viscous cycle where irritation leads to coughing, coughing causes more irritation, and irritation leads to more coughing.

Fact two.  A cough protects the body by clearing the lungs and tubes of things that irritate the body and secretions such as phlegm and mucous.  Therefore, in some cases a cough can be beneficial.  This is particularly true when you have swallowed food down the wrong way or when you have a chest infection.

Fact three.  Your cough is not always necessary.  In the case of chronic cough, the cough is often occurring in response to irritation rather than because anything needs to be cleared from your lungs or chest.  In other words, there is no benefit to coughing.  In fact, there are a lot of negative side-effects to coughing, such as increasing throat irritation and urinary incontinence.

Fact four.  Coughing is both automatic and under conscious control.  Coughing, like everything else we do, is controlled by the brain.  The brain is made up of many different sections.  The bottom section controls all the automatic functions of our body such as breathing and maintaining body temperature.  This part of the brain is called the medulla and has an important role in cough.  The top section of our brain is responsible for conscious actions, for example walking, talking, driving a car, playing golf, thinking etc.  This section s called the cerebral cortex.  Research has shown that the cerebral cortex is also activated during cough.  So although coughing often occurs automatically, there is still an element of conscious control.  That is why we can suppress a cough at times and why we can cough deliberately.  In speech therapy treatment we aim to strengthen your voluntary control of cough.

Fact five.  The most common causes of cough are asthma, gastroesophageal reflux, post nasal drip, eosinophilic bronchitis, smoking, lung pathology and vocal cord dysfunction.  In approximately 10% of patients, no cause can be found.  Speech pathology intervention is designed for patients who (1) have no known cause for their cough, (2) have vocal cord dysfunction, and (3) have cough persisting despite treatment for asthma, rhinitis and gastroesophageal reflux.

Fact six.  Medical treatment is effective for most people with chronic cough.  In fact, 80% of patients with chronic cough are helped by medical treatment.  However, 20% of people with chronic cough do not respond to medical treatment.  In other words, for every 100 people with chronic cough, 80 will improve and 20 will not improve after medical treatment.  Speech therapy treatment is designed for these individuals.

The feeling is real, but the need to cough is not. 

Dr Florence Blager, 2003

Two ways that speech therapy treatment can help your cough

1.       Increase conscious control over the cough.  Speech therapy treatment increases your ability to voluntarily control your cough.  Although irritation may build up in the throat, it will eventually be possible for you to learn to control your cough.  It is also possible to control or suppress the cough when you feel that something needs to be coughed up.

2.      Reduce the irritation that triggers coughing.  Speech therapy treatment also reduces the degree of irritation in your throat and airway.  A cough is triggered once irritation builds up to a certain level.  Increasing irritation can trigger a cough, whereas reducing irritation reduces coughing.  So if the rate of irritation can be slowed, then a cough is less likely to be triggered.

Speech therapy treatment has been proven to be beneficial for people with chronic cough.  A large study examined 87 patients with chronic cough that persisted despite extensive medical treatment.  These patients were randomly selected to receive either the speech therapy treatment or a placebo intervention.  Of those who received the speech therapy intervention, 88% improved, whereas 14% of those who received the placebo intervention improved

Vertigan, A. & Gibson, P.  (2016) Speech Pathology Management of Chronic Refractory Cough and Related Disorders. 1st ed. Oxford, UK: Compton Publishing Ltd.

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