Chronic Cough
What is a cough, and why do we do it?
The primary function of a cough (which occurs when our 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?
Chronic cough is defined as a cough lasting more than eight weeks in adults. Below are a few of the common causes.
1. Smoking.
2. Underlying pulmonary impairments (asthma, bronchitis, etc.) can cause a dry chronic cough.
3. 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.
4. Certain blood pressure medications (ACE inhibitors) can also cause a chronic cough. A thorough medication review is an important consideration when determining the cause of an ongoing cough with no other apparent cause.
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 process.
An ear, nose, and throat physician
and/or a gastroenterologist can confirm or rule out allergies, reflux, or other potential causes for the cough and treat them accordingly.
A speech pathologist can confirm or rule out a swallowing impairment as an underlying cause and treat any swallowing impairment that is uncovered.
A pulmonologist can rule out an underlying respiratory causes (asthma, COPD, bronchitis, etc.) and treat them accordingly.
Habitual Coughing
If all of the above potential causes have been explored and ruled out, another possibility is that sometimes a cough can simply become a habit. Often it starts as a productive/necessary cough (e.g., during a cold), but then after the sickness has gone away the cough or throat clear remains as a habit.
Again, the biological purpose of a cough is to protect our airway. So if our bodies are coughing during a meal because something has gone down the wrong way, if we are coughing up mucous, etc., this is great because we want to clear the foreign material out of our airway. However, a dry cough that is not coughing anything up is not benefiting us in any way. In fact, all this is doing is hurting the vocal cords over time by frequently slamming them together unnecessarily. One alternative to clearing the throat throughout the day is the “sniff and swallow” technique to try to reduce that tingling sensation and suppress the cough if it’s not actually a productive cough to clear something. If the cough is productive, the underlying issue needs to be addressed (e.g., strengthen the swallowing muscles to reduce the aspiration risk, treat the underlying reflux, allergies, or lung issues, etc.).
Chronic cough when left untreated can lead to voice impairments from the damage being caused to the vocal cords over time. The most difficult aspect of the treatment of chronic cough for most patients I’ve encountered is pinpointing the cause. It’s important to thoroughly explore every possibility.
If you are looking for someone to assess your swallowing and voice and help you work toward solving the puzzle, we collaborate with several local ENTs and see patients with chronic cough frequently and are happy to help!