I sometimes cough and splutter when I eat or drink

Coughing and/or spluttering when you eat or drink happens to us all sometimes.  A bit of food or fluid goes down the wrong way and enters our airway, and we have to cough to get it to go away.

For some people, this happens more frequently, and that can be a sign that they have difficulty swallowing. If you think this may be happening to you, please speak to a doctor or nurse, who can refer you for a swallowing assessment by a speech and language therapist (SALT).

When we swallow normally, food, drink and medications go from the mouth down into the tube that leads to the stomach (oesophagus).

When someone has a swallowing problem, food and drink may ‘go down the wrong way’. This means that things may go down the tube that leads to the lungs (trachea) instead.

Food and drink ‘going down the wrong way’ is called aspiration. It may cause coughing and choking, but sometimes you may not even be aware that it is happening. If food, drink or medication get into the lungs they can cause a chest infection (aspiration pneumonia).

SwallowingIt is very important that we carefully manage any swallowing problems to:

  • Reduce the risk of coughing and choking with food and drink
  • Try and prevent aspiration pneumonia
  • Make eating, drinking and taking medication as comfortable and enjoyable as possible
  • Ensure enough food and drink is taken to maintain general health
  • If you lose weight or lack variety in your diet you may benefit from referral to a dietitian. Please discuss this with your GP.

These are some of the symptoms you may be experiencing, as you are drinking or just afterwards:

  • coughing
  • spluttering
  • eyes watering
  • feeling short of breath.

This can mean that some of your drink is going into your airway instead of your food pipe, and it may be continuing into your lungs.  If that happens regularly, it can cause you to get chest infections, as your lungs try to fight off the foreign substance. 

Here are some things you can try, to avoid this happening:

  • make sure you are sitting upright, preferably in a chair at a table
  • drink from a wide rimmed cup or glass and avoid tilting your head back
  • take one sip at a time, rather than ‘glugging’ your drink
  • concentrate while you’re drinking; try to avoid any distractions
  • have a thicker drink, e.g. a Horlicks or a milkshake, and see if you swallow it better.

These are some of the symptoms you may be experiencing, as you are eating or just afterwards:

  • difficulty chewing certain foods
  • effort required to swallow the food down
  • coughing
  • choking
  • food getting stuck or moving slowly
  • food coming back up.

You may find you are avoiding some foods you used to enjoy, e.g. nuts, biscuits, steak or salad. Try to avoid High Risk Textures and see if that makes a difference. 

Adding moisture to your foods (e.g. gravy, sauce, cream, custard) can often help it go down.  Here is some more advice to make swallowing safer and easier.

If you feel you can swallow, but have difficulty chewing your food because of problems with your teeth, please see a dentist.

If you are able to swallow food and drink, but find tablets difficult, try speaking to a pharmacist.  They can advise you on whether the particular tablet/s causing you trouble can be e.g. crushed or taken with a spoonful of yogurt.  Your GP can also help, and may be able to prescribe a dispersible version of the medication.

Unless you also have difficulty swallowing food or drinks, a speech and language therapist cannot help you with this.

Dysphagia recipe book 

 

General guidelines for helping with eating, drinking and swallowing

 

If you are concerned about your swallowing, follow our general advice for safer and more comfortable swallowing while you wait to be referred for an assessment.

The golden rule of swallowing (PEARS)

 

Once the SALT department has received a referral from your doctor or another medical professional asking us to look at your swallowing, we will contact you via telephone or send you a letter so you know you are on our waiting list. The letter will have our contact details and may include advice leaflets about your specific concerns. 

If you are particularly concerned about your difficulties, you can call 01202 307766 (weekdays 2-4pm) for advice while you wait for an assessment.

You will be sent an appointment letter when you get to the top of our waiting list.

 

Swallow assessments may be carried out via a video link, using the secure NHS platform, Attend Anywhere. For this, you will need a device with a camera and microphone, such as an iPad or a laptop. You may be offered an outpatient appointment at a local venue or a therapist may visit you at your home.

During the assessment, the therapist will need to see you eating and drinking in order to be able to advise you on how best to manage your swallowing difficulty.

Preparing for swallow assessment via Attend Anywhere

Attend Anywhere instructions for secure video consultations

 

This guide is designed to help reassure and give advice around eating and drinking towards the end of life. It describes some of the changes that can take place, however every person is different, so if you have any questions about what is happening and why, please do ask one of our clinical team.

Our priority is to provide the right support to our patients and their carers, families and friends. We tailor our care to the specific needs of the person being cared for. Everyone involved is an important part of the caring team; your views should always be heard and where possible, acted upon. We will be able to respond to your worries around possible discomfort and distress.

Decreasing appetite

It is very common for a decline in appetite to happen as the body cannot digest food as it once did. Weight loss may happen no matter how much is eaten. Taste changes may occur and your loved one may only want fluids.

Help with eating

In addition to having little or no appetite, the person may not have the energy to eat.

Helpful tips:

  • offer small snacks throughout the day
  • ensure food is cut into small pieces so less effort is required
  • if chewing is difficult, offer textures that are softer and easy to chew or puree food
  • finger foods can help maintain a level of independence
  • they may find drinking easier than eating, offer sips of smoothies, soups, hot or cold drinks
  • allow time for the person to swallow
  • never force someone to eat and drink
  • if the person coughs or chokes frequently when eating and drinking, they may need to see a speech and language therapist for advice
  • make sure the person is sitting upright when eating.

Help with fluids

It is important to avoid dehydration as this can cause weakness, confusion and restlessness.

Helpful tips:

  • have fluids close at hand
  • offer frequent sips
  • use ice lollies to keep the mouth moist and fresh
  • try a spill free cup if lips no longer fit tightly around the rim of a glass. Be aware that it may be difficult to drink from a spout
  • your loved one may forget to swallow, if they allow, stroking the side of the throat may help to stimulate swallowing. You can also gently prompt the person to swallow, offer an empty spoon, or take a cup to their mouth without giving them more fluids. This will help to trigger their swallow
  • sometimes, thicker fluids can be easier to swallow e.g. smoothies or milkshakes. Ask a speech and language therapist for further advice with this
  • very cold or warm drinks may be easier to swallow.

End of life

When a loved one is approaching the end of life, the desire or need for food and drink lessens and typically their body will no longer be able to get the usual benefits from it. This can be hard for loved ones to accept and they often worry and wonder if the dying person is thirsty, hungry or suffering.

The disease process can alter the desire to eat, the interest in food and the ability to digest food. When a loved one is approaching the end of life, it is expected that they will eat and drink very little, may refuse all food and drink or may be unable to swallow well. It is thought that a natural analgesic (pain relieving) effect is produced by not eating and drinking near the end of life.

Eating and drinking less or not at all is usually due to one or many of the following: difficulties with swallowing, nausea, reduced appetite, little energy, less engagement, or decreasing consciousness.

Normal body functions are responding to the disease process and are slowing in preparation for death. This is natural and expected.

 

What can you do that will comfort?

Comfort can be given in lots of other ways:

  • spend time together by reminiscing; give your loved one a hand or foot massage, lie together, listen to music or just sit quietly.

People approaching death usually do not feel thirsty when their mouth is kept moist:

  • apply lip balm to the lips, moisten and clean the tongue, lips and mucous membranes in the mouth with a mouth sponge or very soft toothbrush
  • moisten the mouth as regularly as needed with water from a teaspoon. 

Our support

When a loved one is dying it is likely to be a very difficult time. It can be hard to know what to do, what to say and how to cope. Remember that we are always here to help and support you. Please do talk to your nurse, therapist or doctor about how you are feeling and any concerns you may have.