Chronic Cough and Laryngospasm Behavior Modification Therapy
Once all medical causes for a persistent chronic cough or laryngospasm attacks have been eliminated, a patient may finally be diagnosed with laryngeal sensory neuropathy, irritable larynx syndrome, neurogenic cough, vocal cord dysfunction, etc. Read more about chronic cough from a medical perspective here which further describes workup and treatment. Laryngospasm information can be found here.
Although medical treatment can stil be pursued, in such patients it is becoming recognized that voice therapy (under guidance from a qualified speech language pathologist or SLP) is beneficial to reduce signficantly a persistent cough or laryngospams attacks. Keep in mind that not all SLP are qualified, but those minority who are voice therapy trained probably are.
Through self-awareness exercises and therapy, patients are often able to decrease laryngeal sensory hyper-responsiveness leading to such symptoms. The SLP therapy program has several components that include behavior modification, cough suppression behaviour, and vocal hygiene training. This treatment should be differentiated from voluntary symptom suppression which does not appear to be helpful. For more info, see references below.
Described here is one behavior modification program patients with chronic cough or laryngospasm can start at home, though ideally such patients should work with a qualified SLP to address all necessary components to alleviate a hyper-irritated voicebox successfully. When performing these exercises, it is not just the motions, but also the self-awareness of how everything feels (much like what one experiences when performing yoga or meditation) that is just as important.
• Quiet rhythmic breathing: Exhale with shoulders relaxed. Abdominal movement should go in and out consistent with continuous exhalation and inhalation.
• Breathing with vocal resistance: Exhale while sustaining /sh/, /f/, /z/ for increasing lengths of time
• Pulsed exhalation: Produce pulse of air using /ha/ or /sha/ followed by sniffing in through the nose with closed mouth
• Abdominal focus at rest: Lie flat with small book on stomach. Focus on elevation of book with inhalation and lowering of book with exhalation. When successful, straw breathing initiated to increase resistance while focusing on abdominal movement. These exercises are than expanded to include sitting and standing.
Additional patterns of modified respiration are than introduced.
1) In and out through the nose
2) In through nose, out through pursed lips
3) In and out through pursed lips
4) In through nose and out through a straw
5) In and out through a straw
6) Sniff in x 2 and out through pursed lips or straw. Vary length and bore of straw to increase or decrease resistance as needed
7) With time, introduce swallows (saliva, liquids, wet snacks, etc.) while performing above breathing patterns
All exercises should be practiced in one-minute increments. Exercises #1-5 should be practiced 2x per day for 3 weeks. Exercise #6 should be practiced 10x per day for 3 weeks.
During the first week, exercises should be performed in isolation without any distractions; always sitting down using a clock as a timing device. Emphasize slow emptying of lungs during exhalation before repeating sequence to minimize risk of hyperventilation. Monitor # of repetitions achieved in one minute.
Pattern of sniff and blow transitioned into activities of daily living (not driving at this time). Focus now on practicing number of repetitions at least 10 separate times throughout the day. Maintain focus of complete exhalation before beginning new repetition.
As above, but pattern can now be practiced while driving.
Week #4 and beyond
Patient begins to experiment with all of the above techniques during episodes of cough. Determine which strategy is most effective in managing episodes of cough.
As a reminder, this respiratory retraining is most effective within the context of other therapeutic maneuvers under the guidance of a voice therapist, self-awareness practiced at all times, and diligence in performing every day.
- Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough. Cough (London, England), 6, 5. http://doi.org/10.1186/1745-9974-6-5. Link
- Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy. Thorax. 2006; 61(12): 1065–1069. Link
- Chronic Cough : A tutorial for speech-language pathologists. Journal of medical speech-language pathology, Vol. 15, no.3, 2007, pp. 189-206
- Speech pathology for chronic cough: a new approach. Pulm Pharmacol Ther. 2009 Apr;22(2):159-62. doi: 10.1016/j.pupt.2008.11.005. Epub 2008 Nov 21. Link
- Review series: chronic cough: behaviour modification therapies for chronic cough. Chron Respir Dis. 2007;4(2):89-97. Link
- Chronic cough and laryngeal dysfunction improve with specific treatment of cough and paradoxical vocal fold movement. Cough. 2009 Mar 17;5:4. doi: 10.1186/1745-9974-5-4. Link
- The role of voice therapy in the management of paradoxical vocal fold motion, chronic cough, and laryngospasm. Otolaryngol Clin North Am. 2010 Feb;43(1):73-83, viii-ix. doi: 10.1016/j.otc.2009.11.004. Link
- The Relationship Between Chronic Cough and Paradoxical Vocal Fold Movement: A Review of the Literature. Journal of Voice 20: 3, 466-480 (2006) Link
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