From the Guidelines
Yes, people can cough after having a lung transplant. Coughing is actually a normal and important reflex that helps clear the airways of secretions, foreign particles, and irritants. After a lung transplant, patients may experience coughing for various reasons, including irritation from the breathing tube used during surgery, airway inflammation, or as the body adjusts to the new lungs, as mentioned in the education component of pulmonary rehabilitation 1. Some degree of coughing is expected and can be beneficial for clearing secretions. However, new or worsening cough patterns should be reported to the transplant team as they could indicate complications such as infection, rejection, or airway problems.
The management of cough in lung transplant patients is crucial, and patients should follow their transplant team's guidance regarding cough management and report any significant changes in cough pattern, especially if accompanied by other symptoms like fever, shortness of breath, or changes in sputum. It's also important to note that transplant recipients typically take immunosuppressive medications, which can increase susceptibility to infections that may cause coughing, as discussed in the context of bronchiolitis obliterans syndrome 1.
Key points to consider in the management of cough after lung transplant include:
- Monitoring for signs of infection or rejection
- Adjusting immunosuppressive medications as needed
- Implementing secretion clearance techniques, such as those taught in pulmonary rehabilitation 1
- Reporting any changes in cough pattern or other symptoms to the transplant team
- Following the transplant team's guidance on cough management and overall care.
By prioritizing these aspects, patients can effectively manage their cough and minimize the risk of complications after a lung transplant, ultimately improving their morbidity, mortality, and quality of life outcomes.
From the Research
Cough Reflex After Lung Transplantation
- The cough reflex is impaired after lung transplantation due to vagal nerve interruption and sensory airway denervation 2.
- However, studies have shown that the cough reflex can recover over time, with one study finding that cough was present at all sites 12 months after transplantation 2.
- Another study found that functional and structural restoration of the cough reflex occurs 6-12 months after lung transplantation 3.
Factors Affecting Cough Reflex
- Mucociliary clearance is diminished after lung transplantation, but can be improved with inhaled beta(2)-adrenergic receptor agonists such as albuterol 4.
- Swallow and cough dysfunction are possible surgical complications of lung transplantation, with 60% of patients exhibiting laryngeal penetration and 40% demonstrating tracheal aspiration 5.
- Bronchial responsiveness to inhaled substances is altered after lung transplantation, with patients showing hyperresponsiveness to methacholine and improvement with ipratropium bromide 6.
Recovery of Cough Reflex
- The recovery of the cough reflex is a time-dependent process, with studies showing that it can take 6-12 months for the reflex to be reestablished 2, 3.
- The implication of the cough reflex being reestablished in lung transplant recipients provides insight into the dynamic response to airway neural injury that may lead to improvements in allograft tissue repair 3.