Coughing and Swallowing Problems: Risk of Aspiration

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If coughing is already known to be related to swallowing problems/dysarthria, I guess that the big question is, "What are this patient's aspiration risks?" The way to determine aspiration risks is through objective testing, either through FEES or through a Modified Barium Swallow Study in x-ray. An objective measurement can give good information about what is causing the aspiration, the amount of aspiration, the consistency that is aspirated, the recommended diet to prevent aspiration and whether any swallowing strategy can prevent aspiration. This test evaluates a meal situation with liquids and solids. Sometimes a patient does not aspirate thin liquids or other consistencies, but has difficulty with saliva and will cough throughout the day due to difficulty managing and swallowing saliva.

Coughing in and of itself is not dangerous, but is a response to laryngeal penetration or aspiration. Aspiration of liquids or solids is dangerous to the lungs. Coughing is a sign that a patient can sense that something is entering the airway and is a response to eject the material from the airway. Coughing is a positive sign, both sensory and motor, that the body is trying to protect the airway. Many patients with oropharyngeal dysphagia and on a modified diet will cough occasionally and it is a good and positive response to prevent aspiration. I have not known that coughing causes pulmonary problems, but I know that aspiration causes pulmonary problems.

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Heidi Williams has been with the VAMC for 27 years and dysphagia is a large part of her caseload. She has also worked with patients with various communication and cognitive disorders. Heidi recently presented at the National VA Speech Conference in 2009.