How To Help Chronic Cough

  • Reference Number: HEY-427/2016
  • Departments: Speech and Language

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should be answered by this leaflet. However, it is not meant to replace the discussion between you and your doctor or therapist, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a chronic cough?

A chronic cough is a constant, irritating cough that can be annoying and distressing to everyone, especially the person suffering from this condition.

It is important to understand the difference between a ‘productive cough’ and an ‘unproductive cough’. A productive cough is one that shifts phlegm or mis-swallowed food or liquid out of the airway in order to allow you to breathe normally. An unproductive cough can be caused by dryness or a sensation of ‘something in the throat’ that does not shift with coughing but, equally, does not affect a person’s ability to breathe normally. Sometimes, the larynx (voice box) continues to be ‘irritated’ after the major symptoms of a throat or chest virus or infection have resolved.

If a cough persists after phlegm, food or liquid have been shifted or infections have resolved, it is important to learn how to control the cough otherwise it can develop into a vicious cycle that may end in fits of choking, retching or vomiting. Once the larynx (voice box) becomes irritated, there usually follows an urge to keep coughing. At this point, or even before the cough starts, it is essential to start deterring it. If not, continual coughing can damage and harden the delicate lining of the vocal cords or rupture tiny blood vessels causing bleeding or vocal nodules. Both conditions can affect the quality of the voice, making it sound hoarse or gruff or lower in pitch. Constant coughing can also cause painful soreness or tenderness in the throat or the upper chest, stomach or abdominal muscles.

Common triggers of chronic cough

  • Cold air – cover mouth and nose, if necessary, with a scarf.
  • Physical exercise – start rhythmic breathing through the nose as you exercise.
  • Pollen, dust – cover mouth and nose with a scarf or dust mask.
  • Aerosol sprays, strong cleaning substances – avoid them or cover mouth/nose.
  • Dryness – central heating, hayfever, medication. To help this you could breathe in through your nose over a mug of boiling water for a minute for 2 to 3 times a day, sip water, suck boiled sweets, drink at least 8 glasses of water or cordial a day, avoid too much tea and coffee [limit intake to about 2 to 3 cups a day] or see your GP about medication for allergies.
  • Viral infections – colds/flu.
  • Bronchitis, Chronic Obstructive Airways Disease (COAD), asthma.
  • Medication, eg.some tablets for high blood pressure, heart disease, etc can cause dry cough and some asthma inhalers can cause husky voice.
  • Acid or non-acid reflux from the stomach, especially at night. Research shows that some chronic conditions such as asthma and otitis media can be caused by gastric reflux.

Cough suppression techniques

There is no ‘quick fix’ to stop a chronic or persistent cough, you are the best person to understand what triggers the cough and which cough suppression strategies work best for you. It is essential to practice the chosen technique(s) regularly and use them consistently in order to self-manage your cough.

The following techniques can be used in combination or rotation. The only way to break the cycle is to keep working at suppressing the cough for as long as each bout of coughing continues.

If you feel a cough coming on, you can use a combination of the following:

  • Swallow hard several times.
  • Cough as softly as possible in order to reduce high impact (loud) coughing as soon as it starts and prevent croaky voice, vocal cord nodules or throat tenderness or soreness.
  • Sniff in quickly through the nose 2 to 3 times in succession and then blow out gently through pursed lips. Breathing in through your nose warms and moisturises the air .
  • Blowing out through the lips channels the air and ‘cushions’ the vocal cords to help reduce irritation.
  • Inhale through a straw and exhale through pursed lips (eg gentle blowing out through mouth) or make the sound “sssss”.
  • As the throat feels calmer, take a sip of water or cordial but only if you are confident it will not trigger the cough again.
  • If you suffer with asthma or other breathing difficulties, does your inhaler reduce the desire to cough? If so, seek advice from your GP about using it as often as you need.
  • Slow panting with tongue out.
  • Sucking an ice cube or sipping very cold water before a cough starts can sometimes prevent it.

If you have a chronic cough it is important to:

  • Practice these techniques even when you are not coughing. This will remind you to use the techniques when you do start coughing again.
  • Keep working at suppressing the cough for as long as each bout of coughing continues. It is the only way to break the cycle.
  • Seek advice from your GP regarding any medications that may be causing the cough or could be prescribed to improve it. A cough may be caused by several different factors. If it is due to gastric acid or non-acid (‘silent’) reflux, then this condition will require treatment or further investigation.

If you have had a persistent cough for some time, your GP may wish to consider referring you to the Cough Clinic at Castle Hill Hospital where a Consultant Chest Physician specialising in chronic cough accepts referrals from all over the UK.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact The Speech and Language Therapy Department on telephone number (01482) 604331.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

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