Cough Suppression

Introduction

This Leaflet is available to all patients that require advice and support on the management of the cough that is irritable. It is designed, in conjunction with your physiotherapist’s guidance, to provide exercise advice and management for suppressing your cough symptoms. You should only undertake this form of management following direct guidance from a physiotherapist.

Cough reflex

Coughing is a normal bodily reflex. The role of a cough is to prevent harmful materials from entering the airway/lungs (i.e. food/drink, smoke). It also helps us to clear mucus that is produced in the lungs (i.e. if you have a cold or a chest infection).

What is chronic cough?

A chronic cough is a cough that has been present for more than 8 weeks. It may be described as a dry cough that is brought on by an irritation/tickling sensation. Chronic cough is a common problem that is often not resolvable purely with medical management.

Some causes of chronic cough include:

• Postnasal Drip: Excessive mucus production from the nose or sinuses that “drips down” the back of the throat and causes irritation which leads to coughing. Some over the counter or prescription nasal sprays/sinus rinses may help to reduce the impact of this.
• Gastro-Oesophageal Reflux: Acid contents from the stomach can rise up and sit around the vocal cords which can cause irritation and coughing. This is best managed with lifestyle/diet alterations, postural management and medications in attempt to reduce the reflux.
• Infections: A cough can persist following a period of illness (i.e. a cold or virus).
• Underlying lung condition: Some lung conditions can lead to a chronic cough due to the over-production of mucus. This cough is usually productive of phlegm and can put you at risk of infection. The treatment of this includes methods to help clear the phlegm, rather than trying to eliminate the cough completely.
• Medication: Coughing can be a side effect of some medications. If you have noticed a link between coughing and commencing a new medication, it may be helpful to discuss this with your GP to see if there is any alternative.

What is a hypersensitive cough?

A hypersensitive or over sensitive cough is when a cough reflex is triggered by a non-harmful stimulus (i.e. cold air). This is sometimes known as laryngeal hypersensitivity. This is thought to be caused by abnormal functioning of the nerves in the throat and the parts of the brain that stop a cough.

Common triggers for people with cough sensitivity include:

• Cold air
• Exercise
• Chemicals (i.e. cleaning products)
• Reflux
• Talking/laughing
• Dehydration
• Medication
• Stress/anxiety
• Pollen/Dust

Cough hypersensitivity can be distressing as it can lead to poor sleep quality, disordered breathing, loss of bladder control, anxiety, isolation and voice changes.

The “Stop Cough” technique

When a cough occurs, the response to this is usually taking a deep breath afterwards. This often then leads to further coughing as the “big breath” can irritate the throat/lungs further. This then causes a vicious cycle of coughing which is often difficult to control.

You should practice the cough control techniques regularly, even when you are not coughing. This will help to retrain and reset the normal mechanics of coughing in attempt to reduce your symptom burden.

1. When you feel a cough or throat irritation, put your hand over your mouth
2. Swallow once
3. Hold your breath for a few seconds. Start breathing again, taking very slow and smooth breaths for at least 30 seconds
4. Tell yourself you are not going to cough
5. Start to take normal smooth breaths through your nose and remove your hand from your mouth
6. If you continue to feel the cough, re-start the technique until the urge to cough subsides

Cough distraction techniques

• Remind yourself there is no benefit or need to cough.
• Take a sip of water to try and prevent the cough.
• If you do not have water, try to dry swallow several times.
• Pursed lip breathing: breathe in gently through your nose, and out through your mouth making a small “O” shape with your lips as you blow out (almost to mimic breathing out through a straw). Try to make the “out breath” longer. This helps to relax the throat muscles.
• “Sniff puff puff”: take a sharp sniff through your nose and blow out twice through pursed lips. This helps to open the vocal cords to reduce irritation.

Other advice

• Ensuring that you are well hydrated prevents irritation caused by dryness.
• Avoiding triggers where possible and making adaptations to reduce the impact of triggers. For example if triggered by cold air, it may be useful to wear a scarf to cover the nose/mouth on cold days.
• Discuss any potential triggers with your doctor for further advice (i.e. medication, reflux, sinus/nasal congestion).
• The stop cough technique should not be used in the presence of mucus on your lungs. If you experience a cold or chest infection, you should cough to clear the mucus.

Other formats

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Further information

For further information or clarification on any points in this information leaflet please contact your respiratory physiotherapist.