Written by: Marilyn Abrahamson, MA,CCC-SLP, CBHC Speech-Language Pathologist and Amen Clinics Certified Brain Health Coach
INTRODUCTION: You may be surprised to be reading an article about a topic that involves gastroesophageal reflux written by a brain health coach. I also have 36 years of experience as a medical speech-language pathologist treating individuals with GERD and LPR, giving me the expertise to speak on this topic.
Laryngopharyngeal reflux (LPR) is a result of Gastroesophageal Reflux Disease(GERD). GERD happens when stomach acid flows back up into your throat, into the area that houses the vocal cords, and even into your upper airway. With GERD, the acid can feel like a liquid, however, with LPR, this acid rises up from your stomach as an acidic gas. As a gas, it’s easy to inhale, irritating your upper airway and vocal cords. That irritation is what triggers the need to clear your throat or cough persistently, which becomes disruptive and uncomfortable over time and can also cause vocal cord damage.
First things first, learn all you can about GERD and LPR. In order to improve any medical condition, it’s important to become thoroughly educated about the condition itself. That’s why you should always begin by talking to your doctor. Education will help you to understand the condition, as well as the rationale behind recommendations offered by your doctor or speech pathologist, or even the techniques offered in this article. Take the time to research LPR and its triggers, especially to understand the connection between reflux and cough.
Eight techniques you can do to help suppress persistent cough and throat-clearing with LPR:
Force yourself to wait it out: Think of a cough as you would an itchy mosquito bite. Everyone knows how scratching the itch feels helpful in the short term, but the itch is back with a vengeance only a few seconds later - and then you’re scratching it again. If you have the discipline to sit on your hands and resist the increasingly desperate urge to scratch the mosquito bite, the desire to scratch it will begin to gradually fade away within a very long minute or two. A cough with LPR can often feel the same way. Resisting the urge is difficult, but doable. Try this technique on its own, or add one or more of the following suggestions as well.
Just breathe: By learning how to breathe through the desire to cough or throat-clear, you can essentially shut down the trigger. As soon as you feel the need to cough or clear your throat building, try inhaling through your nose using a slow and controlled breath, swallowing at the top. Then, exhale just as slowly, again through your nose. Focus on this breathing technique, continuing for as long as it takes for the cough trigger to fade.
Swallow the cough: Another cough suppression technique involves taking a swallow or sip of water whenever you feel the urge to cough, as swallowing can help suppress the cough reflex.
Mind your voice: Coughing and throat-clearing can give your vocal cords a beating, especially when it’s happening throughout the day, every day. This can cause your voice to become hoarse or raspy from the irritation, and put you at a higher risk for developing vocal nodules or polyps. With symptoms of LPR, it’s important to learn to use the "easy onset" technique for speaking. That means keeping your voice soft and even so you don’t irritate your vocal cords while talking. Also, it’s important to avoid forceful throat clearing, as it can exacerbate the irritation.
To further protect the vocal cords from persistent throat-clearing, it’s important to learn about controlled throat-clearing methods. This is important because sometimes, throat clearing is necessary to clear mucous from the upper airway. Mucous is formed as a barrier protection, so the more coughing you do, the more mucous you will ultimately need to clear. For controlled throat clearing, try doing a gentle, voiceless throat clear that lasts about 1 second, and is done repeatedly until the mucous is cleared. A trained, speech-language pathologist can demonstrate this for you.
Stand up straight: Maintaining proper posture and body alignment is essential to reduce pressure on the stomach and minimize reflux. When seated, position yourself in a chair with your shoulders back and your shoulder blades pressed down. When standing, stand with your back straight, shoulders back, and pressed down. Healthy body alignment can help promote good digestion and reduce the likelihood of reflux-related symptoms.
Watch what you’re eating: Collaborate with a dietitian to develop a reflux-friendly diet plan that’s right for you. Certain foods and beverages can trigger reflux, leading to coughing episodes and throat-clearing. These can include citrus fruits, tomato sauce, red wine, and many more. By identifying and avoiding the foods and beverages that act as triggers for you, you may be able to reduce the frequency of the need to cough and clear your throat. In addition, a healthy diet can also foster a more healthy weight, which may reduce symptoms of GERD and LPR as well.
Stay hydrated: Adequate hydration can help alleviate throat irritation caused by LPR, so be sure to drink plenty of water throughout the day, which can help keep the throat moisturized and soothe irritation.
Coat your throat: If it helps, you may also supplement the use of these techniques with throat lozenges, sprays, or warm, non-caffeinated liquids to provide temporary relief and soothe the throat. These products can help create a protective coating over the irritated tissues, reducing the urge to cough.
Final thoughts: It's important for you to work closely with your doctor, which may include a gastroenterologist or otolaryngologist, to ensure a comprehensive and effective treatment plan. Remember, everyone’s situation is unique, so the techniques you use should be tailored to your specific needs. A speech-language pathologist can help you implement the techniques and suggestions that are most appropriate for you.
MARILYN ABRAHAMSON, MA, CCC-SLP-CBHC : As a Brain Health Education Specialist at Ceresti Health, Marilyn offers initiatives that support the education and empowerment of family caregivers. Her latest endeavor is co-owner of BrainThrive Consulting and co-creator of the ©Long Live Your Brain program, a fun and friendly online group brain coaching and training program for people striving for more reliable memory, attention, and clearer thinking. Marilyn's prior work is as a NJ Licensed Speech-Language Pathologist since 1987 and is an Amen Clinics Certified Brain Health Coach.