Client: A 42-year-old female presents with a persistent, dry cough that has been ongoing for over 8 weeks. She describes the cough as non-productive and worse at night and early in the morning. The client also notes a frequent sensation of throat clearing. She denies any significant history of asthma but has had recent respiratory infections which she recovered from a few weeks ago. There is no associated fever, wheezing, or chest pain. The cough is affecting her sleep and work productivity.
She works as a high school teacher and is indoors all day. Her diet includes a variety of vegetables, meat, and grains, but she reports frequent heartburn and occasional postnasal drip, particularly during seasonal changes. She is not on any long-term medications but takes the occasional Quick Eze for reflux relief.
Key factors considered
Post-viral cough: Persistent cough after a recent respiratory infection may be due to lingering inflammation and airway hypersensitivity.
Allergy response: Seasonal postnasal drip and throat clearing point toward allergic rhinitis or non-allergic rhinitis as a trigger.
Reflux: Reported heartburn with symptoms worsening at night, could be a contributing factor to her cough being worse in the morning and evening.
Environmental triggers: Being inside dry, heated air can irritate the upper respiratory tract, exacerbating the cough, especially if there is a lot of dust.
Cough hypersensitivity: Occupational vocal strain, particularly as a teacher, along with reflux and postnasal drip, could cause laryngeal irritation and cough reflex hypersensitivity.
Herbal Formula:
Liquorice (Glycyrrhiza glabra): Demulcent and anti-inflammatory; soothes irritated mucosa of the upper respiratory tract and supports adrenal health.
Marshmallow root (Althaea officinalis): Rich in mucilage; coats and calms inflamed throat tissues and helps reduce coughing.
Thyme (Thymus vulgaris): Antitussive and antimicrobial; useful in post-infectious cough and dry, spasmodic coughing.
Chamomile (Matricaria chamomilla): Mild anti-inflammatory and sedative; supports digestive comfort and reduces cough-related anxiety and sleep disruption.
Liquorice 80 mL
Marshmallow root 120 mL
Thyme 100 mL
Chamomile 100 mL
Total: 400 mL
Dosage: 5 mL three times daily between meals.
Additional Recommendations
Dietary Modifications:
- Reduce reflux triggers: Avoid spicy foods, caffeine, chocolate and alcohol, as these may aggravate reflux and nighttime cough. Address the reflux and then reintroduce these foods slowly.
- Avoid late meals: Recommend stopping eating food 2-–3 hours before bedtime to minimise reflux symptoms during sleep.
- Hydration: Ensure 2-2.5L water per day to thin mucus secretions and soothe the throat.
Respiratory and throat support:
- Manuka honey: Take 1 tsp before bed to coat the throat and reduce coughing.
- Steam inhalation: Use essential oils (Thyme or Eucalyptus) in steam to loosen mucus and calm irritated airways in the evening. They can also be used in the shower by adding a few drops to the bottom of the shower.
- Saline nasal rinse: Daily saline rinse to reduce postnasal drip and inflammation.
Lifestyle Modifications:
- Sleep positioning: Elevate the head of the bed or use 1–2 extra pillows to prevent reflux-induced cough.
- Stress and relaxation: Engage in stress-relieving practices such as breathing exercises, meditation, or gentle yoga to reduce cough reflex sensitivity. Stress can exacerbate reflux and the cough reflex.
Follow-Up: After 4 weeks of implementing the herbal protocol and dietary/lifestyle adjustments slowly so they became sustainable, the client reported a noticeable reduction in nighttime coughing, decreased throat clearing, improved sleep and daytime energy levels, less frequent heartburn and postnasal drip.
Adjusted Plan: To continue supporting mucosal healing and address residual throat sensitivity.
Add-on Support: Deglycyrrhizinated Liquorice (DGL): Tablets before meals to support oesophageal lining and reduce GERD symptoms.