Heather Gross, M.S., CCC-SLP
In this day and age, a cough can be especially alarming.
“It’s not COVID, it’s just my chronic cough.”
“I just can’t get this cough to go away!”
People cough for various reasons. A cough may be caused by an acute respiratory illness, like a cold or the flu. Or it could be caused by exposure to an irritant or toxin in the environment.
But what if your cough persists? What if it’s been weeks, or even months, and the cough just doesn’t go away?
Why do we cough?
Coughing is an important protective mechanism that comes from your larynx, or “voice box.” When you cough, your vocal cords come together to protect your airway and lungs from laryngeal irritants or toxins in your environment. An occasional cough is a normal, healthy bodily function. Your throat and airway are equipped with nerves that are there to detect irritants and get rid of them.
What causes chronic cough?
What is a chronic cough? A cough is considered chronic if it lasts eight weeks or longer. This length of time makes it less likely that your cough is caused by a respiratory infection or common cold.
A chronic cough can be annoying, uncomfortable, and socially isolating. It can significantly impact your quality of life and cause damage to your voice if not treated.
What causes a chronic cough? Here are some possible underlying causes:
Lung diseases: These include COPD, asthma, or pulmonary fibrosis. These lung issues can be controlled with the help of your primary care doctor and pulmonologist.
Allergies: When you have an allergy, your immune system produces antibodies that identify a particular substance in your environment as harmful. Coughing is one symptom of an allergy. It could mean that you are allergic to something in your environment, especially if the cough coincides with other symptoms such as a runny nose, itching, sneezing, or watery, red, or swollen eyes.
GERD and other digestive problems: Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back up through the tube connecting your mouth and stomach (the esophagus). It sometimes even flows up into the throat, which leads to chronic cough and may cause voice problems. This condition may be managed with simple lifestyle and dietary changes, depending on the root cause.
Medications: Certain medications, such as ACE inhibitors, are known to cause chronic cough in a small percentage of people. If you suspect a medication may be causing side effects, work with your doctor to see if there might be a better medication for you. Always speak with your doctor before stopping any prescribed medications.
Smoking: Chemicals and toxins entering the airway and lungs from tobacco use can cause chronic coughing.
Long COVID: A cough can persist for weeks or months after COVID-19 infection, often accompanied by shortness of breath, chronic fatigue, and/or pain. Talk with your doctor about ways to overcome this chronic condition.
Irritable larynx syndrome (ILS): This syndrome includes a wide range of symptoms and conditions, such as chronic throat clearing, chronic cough, paradoxical vocal cord dysfunction, and laryngospasm. In ILS, the larynx, or voice box, becomes hyper sensitive and hyper responsive to external stimuli. The vocal cords close in response to triggers such as strong odors, cold air, talking, anxiety, and certain foods. Even if you’re no longer exposed to the irritant, you may still have the sensation of needing to clear your throat and cough, as the brain remembers and processes that experience.
This is not an exhaustive list, but the conditions above are commonly associated with chronic cough. In order to get an accurate diagnosis and treatment plan, work with your primary care doctor. They may refer you to one of the following specialists:
Allergist
Ear, nose, and throat (ENT) specialist
Pulmonologist
Gastroenterologist
What helps a chronic cough?
Depending on the underlying cause, there are different options for chronic cough treatment. Here are some ways you can treat a chronic cough and find relief.
Stay hydrated. Drinking plenty of fluids helps to lubricate and protect your vocal fold tissues. It also decreases the irritation that contributes to the “tickle” in your throat. Be sure to drink plenty of healthy fluids like water throughout the day.
Treat dry mouth or dry throat. If you have a dry mouth or dry throat, try using a humidifier, steamer, or simply breathing in the steam from a warm shower. Breathing in moist air can help to break up the mucus in your throat. Another tip is to practice breathing through your nose, rather than through your mouth. Using a lozenge to encourage salivation will also help you cough less. Drink more water, and decrease your use of antihistamines and mint. Check any medications you take for possible drying effects. Try lozenges with ingredients such as slippery elm, manuka honey, or fennel.
Reduce throat clearing. Clearing your throat can contribute to overall laryngeal irritation. To reduce the need to clear your throat, you can try a gentle hum to move the vocal cords, followed by a swallow.
Suppress the need to cough. When you feel the need to cough, try focusing on your breath. Inhale through your nose, and exhale through pursed lips (like you’re blowing out a candle). You can also try inhaling through the nose, and exhaling on a “ssss” sound. Breathe in and out slowly and feel the breath moving from deep in your belly.
Treat allergies or reflux disease. A chronic cough or constant throat-clearing could be signs of allergies or reflux disease. See your doctor to get to the root cause. If you have acid reflux, try these dietary and lifestyle changes to see if your voice quality improves.
Pay attention to possible irritants in your environment. These irritants can be found both inside and outside! They may include possible allergens such as mold or pollen, perfumes, air fresheners, smoke, and/or fragrance from beauty products.
Always check with a medical professional before taking cough suppressants or expectorants.
How a certified speech therapist can help chronic cough
Research shows that speech pathology is an effective way to manage chronic cough. Look for a speech pathologist who specializes in this area. They will work with you to help reduce the sensitivity of your airway, increase your cough threshold (which means increasing your airway’s resilience to pollutants and irritants), and reduce overall laryngeal irritation. Your speech therapist will teach you ways to suppress the urge to cough. They will also teach you how to take care of your voice, known as vocal hygiene, since coughing can be harmful to your vocal cords. Your speech therapist can work with you to improve your vocal health to reduce the damage to your vocal cords.
Having a chronic cough can greatly affect your ability to communicate and connect with others. Finding the root cause, making lifestyle changes, and working with a professional to learn treatment strategies can help you find relief.
