“Sam, your cough is so bad still.”
“Troy, are you sick?”
“Stay away from my baby, you’re coughing.”
“May I place you on a brief hold? (cough cough cough)”
When it Won’t Go Away
Millions of us get sick each year with some type of upper respiratory infection. We get a sore throat, we get sinus congestion, and we get a cough. Many of us have asthma, chronic bronchitis, or reflux and we get a cough as well, as we are treated with medication for these conditions. But, what if the cough persists? What if it’s been months, even years since you spent an entire day without coughing?
What is Chronic Refractory Cough?
Chronic cough is a cough that has lasted more than 8 weeks. It can occur in around 10-20% of the general population, and can persist long after an illness or irritant has been eradicated. This type of cough is truly frustrating, because the cause is not well understood. We believe it’s related to dysfunctional nerves, making the cough neurogenic. Coughing can disrupt sleep, making a person feel tired with trouble focusing attention. Coughing can drain a person financially and emotionally because they seek improvement and usually get multiple tests, from multiple physicians, with no answers. Plus, it’s isolating to have a chronic cough because others tend to stay away from the person for fear they are ill, and the person with the cough often avoids social gatherings because they don’t want to bother others.
Why Speech Pathology?
It is so common that people with chronic cough come to my clinic unimpressed and annoyed because they don’t have a clue why their physician referred them to “speech therapy” for their cough. They are then happily surprised, on most occasions, when after 1-4 sessions of voice therapy, their cough is gone. Speech-language pathologists are specially trained to administer vocal hygiene, education, cough suppression techniques, breathing techniques and hydration education. Sessions teach the patients to take conscious control of their cough, which results in: 1) lessening cough reflex sensitivity, 2) lessening frequency of cough, 3) improving quality of life for the patient.
Differential diagnosis is key to preventing unnecessary medications and improving patient’s symptoms as quickly as possible. Primary care, otolaryngology, pulmonology, allergists, gastroenterologists and SLPs can work together to determine the best course of action, but only if we communicate.
How Does it Work?
Your speech language pathologist teaches you to identify different feelings and then helps you practice rescue breathing and cough suppression techniques. They tailor each treatment to the patient’s specific needs, helping the patient identify components of the cough cycle, and reverse and replace those components. They give the patient control for prevention, which helps reorganize the motor function from the brain.
What if Speech Therapy STILL Doesn’t Help?
When all tests have come back negative for what is causing the cough and speech language pathology has not improved symptoms, it might be time to discuss options with the laryngologist for more invasive treatment. New research has come out that tested capsaicin (the spicy stuff in chili) when taken orally (by mouth). The study showed that oral consumption of capsaicin, reduced the cough symptoms. More interesting still are the promising results with medication options like neuromodulators, Elavil and Gabapentin. Your laryngologist should perscribe these on a patient by patient basis, as different neuromodulators react differently to different people and different medications the patient is already taking. Interesting still, is the newer treatment of a superior-laryngeal nerve block for treatment of chronic cough.
Resources to Help SLPs Treat Patients
Two fabulous books have come out in the last 5 years, including Chronic Cough by Thomas Carroll and Speech Pathology Management of Chronic Refractory Cough by Anne Vergitan and Peter Gibson. I have linked articles found on Pubmed in the sources below. If you are a speech-language pathologist treating chronic cough, and want handouts that are easily accessible for your patients and for you, check out Chronic Cough Handouts in my Store.
Carroll, Thomas. Chronic Cough, Plural Publishing 2019
Dillon VK. (2019) Superior laryngeal nerve block for neurogenic cough: A case series. Laryngoscope Investigation OtoLaryngology Jul 5;4(4):410-413. doi: 10.1002/lio2.292
Ternesten-Hasseus E, Johannson EL, Millqvist E (2014) Cough reduction using capsaicin. Respiratory Medicine. Volume 109, Issue 1, p27-37. doi: https://doi.org/10.1016/j.rmed.2014.11.001
Vertigan, A & Gibson, P. Speech Pathology Management of Chronic Refractory Cough and Related Disorders, Compton Publishing 2016
Wei W, Liu R, ZhangTong Y, Qiu Z. (2016) The efficacy of specific neuromodulators on human refractory chronic cough: a systematic review and meta-analysis Journal of Throacic Disorders. Oct;8(10):2942-2951
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.