Cough Cycle Recommendations J. David Cunningham, MD; Timothy Heffron, MD; Frances E. Marchant, MD; Ernest L. McKenna, Jr., MD Many times chronic coughing is related to previous coughing. If coughing becomes persistent, despite the initial respiratory trigger of the cough, patients may be caught within the “cough cycle.” Cough cycle related cough is manifested by persistent dry, nonproductive cough, which is initiated by a sensation of a tickle in the throat. The cough response creates an irritation in the cough centers of the throat and creates the tickle for the next coughing. As a result, such coughing tends to frequently occur during the day and much less during sleeping hours when coughing is not voluntarily initiated. The cough is in some ways like a mosquito bite in that, if you scratch it, it gets itchier. In this regard, therapy for cough cycle manifested cough is related to ways that coughing can be minimized. Recommendations for cough cycle cough include voluntary swallowing at the onset of the throat tickle rather than coughing. Cough suppressant medication such as Robitussin DM or, if required, a stronger cough suppressant, which has codeine, is often helpful in suppressing the central cough region. Lozenges, which help to stimulate swallowing rather than coughing, are also helpful. It is recommended that patients who have chronic coughing carry a water bottle with them constantly for 24 to 48 hours so that they may have some water to sip on at each throat tickle to minimize the amount of time coughing. As the amount of coughing decreases, the irritation in the throat that stimulates the next cough decreases and progressively the cough is turned off and the patient is able to get out of the cycle. There may be other factors that your doctor will discuss with you that also could be triggering coughing such as gastroesophageal reflux, chronic sinus disease, or reactive airway problems which may additionally require therapy.