Coughing and Choking

For some people with MND the chest muscles can become weaker and this can lead to being unable to cough effectively. If this happens the person may find it more difficult to clear their throat and this could lead to more frequent coughing. Difficulty coughing and clearing the throat can put some people with MND at a greater risk of a chest infection.

A referral to local physiotherapist for an assessment of the breathing muscles and to learn breathing techniques can help the person cough more forcibly. One such technique is called breath stacking, whereby the person is taught to take 3 breaths in without exhaling, therefore expanding the lungs with more air and then exhaling all at once. A step on from this is assisted breath stacking using a lung volume recruitment bag. Moving more air though the throat will help eject foreign bodies / sputum that may have been causing the irritation.

Some people with MND find it useful to use a machine called a mechanical insufflation-exsufflation machine, sometimes known by the brand name CoughAssist – see Breathing. It clears secretions by applying a positive pressure to the airway, followed by negative pressure. This rapid shift simulates a natural cough and can help to reduce the risk of recurrent respiratory infections.

A small number of people with MND may occasionally experience unexpected coughing or choking episodes brought on by spasm in stiff throat muscles. This can be frightening when it happens but it will pass. It is important to note that there is no evidence that people with MND die from choking or coughing and making sure that the person with MND and their carers know this reduces unnecessary anxiety. If coughing or choking occurs, sit the person down, open the window or doors to get a breeze going past the person or use a fan to achieve this. Help the person sit forward slightly so that any secretions in the mouth can drain out. Remain calm and treasure that this will pass in a few minutes.

Understandably, struggling to cough and choking episodes can be very frightening and cause increased anxiety. Anxiety further affects breathing and makes the air ways a little tighter increasing the work of breathing. It may be worth exploring the use of an appropriate anti-anxiety medication such as Lorazepam with the person’s GP which can will help to keep the person with MND calm during severe choking episodes.

MND Just in Case Kit

The MND Association Just in Case Kit is a great resource designed to hold medication for the relief of anxiety and breathlessness. Having it to hand means people with MND and carers can see that fears have been addressed. For the GP and district or community nurse it provides guidance on symptom management and storage for the prescribed medications. Once the need for a kit has been discussed and agreed with the person with MND and their carer:

  • the GP orders a kit from MND Connect telephone number 0808 802 6262 for a named person with MND. The kit is supplied free of charge.
  • the GP and district or community nurse agree on a plan to advise and support the carer in the use of the kit.
  • the GP prescribes medication to be supplied with the kit.
  • the GP, or community or district nurse, gives the kit to the person with MND and ensures the carer knows how it can be used.