What is Chronic Refractory Cough?
Chronic refractory cough is a cough that has persisted for longer than eight weeks despite appropriate medical management. People report symptoms such as irritation or pain in the throat or chest, and cough triggered by talking, temperature changes, smells, eating/drinking, exercise and stress/anxiety. The cause of this condition is unknown; however, current theories suggest that perpetuation of cough beyond an initial cough trigger (e.g. cold, reflux or allergies) is related to something called cough hypersensitivity. This is when the body becomes sensitive and reacts more strongly to things that wouldn't normally cause a cough. This increased sensitivity is hypothesised to come from changes in two areas of the nervous system:
1) The peripheral nervous system ( the airway nerves)
Sensory fibres of the vagus nerve in your airway become easily triggered, thought to be due to ongoing irritation / inflammation. Certain sensors on the nerve fibres become more "switched on" leading to cough even when there is no real danger (i.e. threat to the airway).
2) The central nervous system (the brain's control of coughing)
The brain usually helps regulate 'put the brakes' on the urge to cough. In chronic cough certain areas of the brain involved in controlling/supressing coughing become less active while areas involved in sensing the cough become more active. This makes the brain more likely to send motor messages to the larynx to cough even in the presence of no or minor triggers.
Overtime, repeated coughing can make the sensitivity in both the peripheral and central nervous systems worse. It's a cycle: the more you cough, the more the nerves and brain stay on high alert and the easier it becomes to trigger more coughing.
1) The peripheral nervous system ( the airway nerves)
Sensory fibres of the vagus nerve in your airway become easily triggered, thought to be due to ongoing irritation / inflammation. Certain sensors on the nerve fibres become more "switched on" leading to cough even when there is no real danger (i.e. threat to the airway).
2) The central nervous system (the brain's control of coughing)
The brain usually helps regulate 'put the brakes' on the urge to cough. In chronic cough certain areas of the brain involved in controlling/supressing coughing become less active while areas involved in sensing the cough become more active. This makes the brain more likely to send motor messages to the larynx to cough even in the presence of no or minor triggers.
Overtime, repeated coughing can make the sensitivity in both the peripheral and central nervous systems worse. It's a cycle: the more you cough, the more the nerves and brain stay on high alert and the easier it becomes to trigger more coughing.
Treatment
Voice Therapy delivered by a Speech Pathologist is recognised as a successful treatment approach for chronic refractory cough. Voice therapy for management of chronic refractory cough aims to increase voluntary control over cough and reduce cough reflex sensitivity through learning of specific vocal exercises, training in vocal hygiene and psycho-educational support.
For more information on voice therapy please visit our voice therapy page. If you are looking for treatment of chronic refractory cough please contact us to book an appointment with our Speech Pathologist.
For more information on voice therapy please visit our voice therapy page. If you are looking for treatment of chronic refractory cough please contact us to book an appointment with our Speech Pathologist.
