a man coughing violently and holding a tissue

The Reflex... Cough Reflex

The reflex… [insert Duran Duran song from the 80’s here]. No--today we'll be talking about the cough reflex.

I have been having a particularly tough go with coughing. Firstly, this coughing is definitely accompanied by a worsening of other symptoms. I am on it, but it has been a slow struggle. I have changed medications, seen my specialist, and I am in line for a change of biologics. All this, yet for the interim, the cough is still persisting.

What exactly is a cough?

A cough is a defensive reflex. It protects the airways from foreign matter. Generally, a cough is considered important in protecting the airways. It is also a method of making secretion clearance easier.1

More on this topic

Coughs can be dry or productive. A dry cough tends to be in response to an irritant and does not produce mucus. A productive cough produces mucus that the person can then expel, if necessary.1

Fun fact: a cough can become excessive and unproductive. I know this is especially true because I have certainly felt it! It may also be detrimental to airway mucosa.

How does a cough reflex occur?

The mechanism of coughing happens through a cough arc. The cough arc has the following pathways:1

  • Afferent pathway: nerve fibers located in the upper airways
  • Central pathway (cough center): located in the brainstem and pons
  • Efferent pathway: impulses from the cough center to nerves in the diaphragm

The three mechanical phases of a cough are the:1

  • Inspiratory phase: inhaling to produce the cough
  • Compression phase: the larynx closes, muscles contract, and intrathoracic pressure rises
  • Expiratory phase: the glottis will open to help produce the cough sound, then mucus will dislodge from the airways and allow for it to be expelled from the tracheobronchial tree

My own cough reflex

I was super excited to learn about mechanical phases, who knew! This had me thinking about how many times a day that I must perform this action--especially right now when my mucus is all out of whack. At times I have had these significant coughing fits early in my diagnosis and I remember my mum saying, "Can you try not to cough?” I like to believe that this comment was made to keep me from the discomfort of the cough--but it sure was annoying to hear. I wish I had responded with “a cough is a reflex." I can’t really not cough.

Cough reflex is common

As you may have already noticed, a cough reflex in those of us with asthma is common. However, treating cough may not be as simple. First, things first, is the cough related to uncontrolled asthma? Would be a reassessment of symptoms and treatment be warranted? Remember those pesky triggers? Could they be at work here? I know that I reviewed if I had come into another type of trigger. The seasons were changing and with that was a lot more tree allergens floating around. I wondered if my allergies were changing.

Have you experienced bouts of significant cough? What was your experience and how did you get through that patch? I would love to hear your tips and tricks! Share in the comments below.

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