Is your annoying cough stressing you out?

Maybe you can relate to this. A few years ago I had a horrible virus. It left me months after recovery, with a dry, tickly and frankly irritating cough. I know that’s not unusual, but what I started to recognise was that the cough seemed to appear more if my mind was racing or if I felt nervous. So I began to wonder….……

Is there such a thing as a stress cough? And if there is, what causes it and more importantly what can be done about it?

Let me say before going any further that if you have a wracking, crackling or wet, phlegmy cough then please get it checked out by your doctor. It may be nothing, but getting it checked out will give you peace of mind.

For the rest of us, let’s get back to looking at the possible stress (or behavioural) cough. Does it even exist? Here are some great insights to help us.

What is a cough?

A cough is primarily a reflex action. It’s activated when our immune system reacts to something it recognises as ‘foreign’. Therefore, something that’s not supposed to be in the body. We see the foreign matter (which can sit in the throat, upper lungs or airways) as an irritant, but to our immune systems it represents a stressor. It’s a possible ‘danger or threat’. Therefore, it must be combatted or expelled. Simple right, but there’s more……….

We’re told that coughing can be a) voluntarily, thereby an action we induce at will. Or, it can be b) an automatic reflex, made seemingly involuntarily. But a third grey area which is really interesting relates to c) a behavioural component. It supposes that whilst we cough from the lungs, the reflex actually originates in the medulla of the brain.

Have you ever heard someone cough and had the same reaction? Doesn’t this suggest more of a brain than body action?

A paper by Chung et al (2013) suggests that the behavioural cough is not the first cough that we have, but a secondary sensory cough. And this secondary cough can occur when our sensory nerves are consciously or voluntarily activated. So what does this mean exactly?

Again Chung et al (2013) suggest that the behavioural (secondary) cough is actually related to residual damage from the first cough. This then creates inflammation around the alimentary tract. If this is the case then we can address it through our diet. But could there be more to it? What of their sensory reactive claims?

The behavioural cough has often been dismissed because it can be confused with a tic, or the remnants of a nasal drip at the back of the throat or just throat clearing (Irwin et al, 2006). But Chung et al (2013) give us more. They suggest that a number of seemingly small factors from air temperature to scent and sprays and even talking on the phone, yes seriously ‘phonation’ can activate particularly sensitive cough reflexes!

What’s interesting is our brain’s remarkable capacity to remember the cough and our response to perceived danger. If this is the case, a pattern or a conditioned response may emerge. It could mean that we develop a greater susceptibility to coughing. So, the more we cough, the more we’ll cough, unless the pattern can be broken.

So what do we now know?

There’s not a definitive answer. But a cough could have a behavioural component brought about by sensitivity or nerves. Possibly stress or anxiety. Or it could be due to an infection or an irritant or even a mixture of the two. Here are a few things that may help:

Learn to breathe well – It’s easy when we become stressed or anxious to change our breathing patterns. We can either over-breathe sometime to the extent of hyperventilating or conversely breathe too shallowly. Both of these increase stress by distorting the amount of oxygen the brain needs. Try this BREATHE.

Tuning in and turning down – One of the problems with waiting until the stress cough appears is that we have less control. Learning how to relax can help. Just by identifying if we’re comfortable or not means that we’re tuning in. We’re not trying to push the uncomfortableness  away, ignore it or even shut it down. Instead when we locate where we feel uncomfortable, we’re able to breathe into it or just sit with it. Meditation can also be useful. We can use it to help our brains be less reactive, especially to any stress that may be activating a cough. This does require regular practice but can be done at home, in a group or even on a walk.

Body work – Anything that opens up the lungs and encourages you to breathe more fully can increase oxygen to your brain. This is great because it also signals to your brain that you’re not in danger and reduces the stress response. These practices can help you to tune in to your body but also release stress. Think of yoga, qi-gong, running, swimming, singing or practicing a wind instrument from recorder to flute or even a harmonica.

Stay hydrated

Coughs are made worse by a dry throat as bacteria can invade more readily in chapped or damaged tissue. In addition, when we’re stressed the body uses fluid rapidly. Just by staying regularly hydrated means that your throat is supple and not susceptible to infection and resulting inflammation.

Befriend your B vitamins

B vitamins are a complex of several micronutrients which are essential for energy. Certain components have also been shown to work in the function of a healthy nervous system, nerve transmission, developing neurotransmitters, lifting low mood, the development of healthy cells and even as a muscle relaxant.

Zapp it with zinc

The mucus produced when we cough removes damaging cells or harmful foreign matter. But the inflammation (a protective mechanism) which is also contained within the mucus can develop in an unhealthy way. Zinc plays a crucial function in the formation of white blood cells and a healthy immune function. It may also help to stave of colds and sore throats in the first place.

Vitamin C

This key micronutrient not only fights off colds and infections, but is also important in the formation of nerve message transmission.

Be persistent and consistent in resolving the cough

Although having a ‘nervous, stress or behavioural cough’ may not mean that you need to take time off work or stop daily activities, BUT it can have other costs. It can create an unhealthy pre-occupation with the cough. It can make us self-conscious. It can also knock our confidence and lead to a further cycle of coughing and anxiety.

If anything you’ve read resonates with you and you’d like to talk it through, do call for a 15 minute free consultation.


Chung, KF., McGarvey and Mazzone, JB (2013) Chronic cough as a neuropathic disorder. The Lancet [online] Available at:

Irwin, RS., Glomb WB and Chang AB (2006) Habit cough, tic cough and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest [online] Available at:





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