Why can’t I stop coughing? … I’m not sick!

A cough is considered "chronic" if it persists for 8-weeks or more, and is unrelated to any ongoing illness or respiratory disease. Coughing happens when the vocal cords are cued to open rapidly releasing a burst of air (and sound) from the throat.

There are 4 different kinds of coughing, these include: 

1. Voluntary - this is when you "decide" to cough, in order to clear the airway.

2. Reflexive - this is caused by direct activation of sensory receptors in the throat.

3. Expiratory - this occurs when a solid or liquid comes in contact with the airway (as in choking).

4. Neurogenic - this is a type of chronic cough, associated with sensory nerve changes in the throat, it can be triggered by things like strong smells and change in temperature.

Chronic coughing can be a distressing experience. For some, it may lead to social isolation, pain/soreness (especially in the upper shoulders and neck), and fatigue. Research indicates that chronic cough has a prevalence of approximately 10-12% in the general population (Ruddy & Sandage, 2017).  

How does a cough become chronic?

There are sensory receptors located in the upper airway (throat), these exist to trigger a reflexive and/or expiratory cough, in order to protect the airway. For example, breathing in dust or choking on a sip of water might (appropriately) trigger these sensory receptors to initiate a cough. 

Over time, if these sensory receptors become triggered frequently (e.g., after an extended period of illness, or chronic inflammation due to Laryngopharyngeal Reflux (LPR)) their activation threshold will be lowered and they can become "hypersensitive".

This becomes a positive feedback loop, in which the more coughing happens, the more coughing is reinforced.

Common Triggers Include: 

• Mouth breathing 

• Poor vocal hygiene 

• Dry environments 

• Sudden temperature change 

• Strong odours 

• Chronic irritation from Laryngopharyngeal Reflux (LPR)  

• Talking/yelling 

• Stress

• Excessive muscle tension 

• Excessive mucous production 

  
  

Cough triggers will be different for everyone. In order to recover from chronic coughing it is important to first identify all triggers and manage exposure to them. This is where a Speech-Language Pathologist (SLP) can help! Identifying and managing triggers is not always easy, your SLP will help you become aware of triggers and how they feel in your body before a cough is triggered. 

Many of the triggers on the list above will reinforce each other. For example, breathing through the mouth drys out the throat and introduces unfiltered irritants (breathing through the nose acts as a humidifier and filter). This increases inflammation of tissues and thick/hardened mucous production, this irritates sensory receptors and initiates a cough response. 

I know why I’m coughing… now what? 

Once triggers have been identified, your SLP will work with you to establish Cough Suppression Techniques. These are used to actively stop the cough hypersensitivity cycle and restore baseline threshold activation.

Coughing is under the control of the cerebral cortex and CAN be voluntarily inhibited or initiated - with the right tools and strategies!

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Chronic Cough Support at Beyond Speech Therapy

Please do not hesitate to reach out if you or someone you know is expereincing chronic cough or chronic throat clearing. We offer a a free 15-minute consultation to speak with an SLP about your needs to determine if Speech Therapy is right for you. A consultation can also help us match your needs with a knowledgeable and passionate SLP. 

Please don’t hesitate to reach out if you gave any questions info@beyondspeech.ca