Cooking Ideas for When Someone Coughs During Meals: Cooking Matched to Eating Ability (Coughing and Choking)

Written by: 稲山 未来 (Registered Dietitian)

This is the “coughing and choking” installment of our series on cooking matched to eating ability.

They eat the same meals as the rest of the family, but lately they seem to cough more often during meals. Have you experienced this?

Coughing is a protective reaction in which the body tries to expel, along with air, foreign matter that is about to enter the windpipe, so it is not bad in itself. But if someone coughs frequently during meals, the meal may contain “something” that is hard to swallow. Let’s think about what it is and what can be done about it.

Is coughing a bad thing?

As I explained at the start, coughing itself is a protective reaction, so it is not a bad thing. Coughing does not automatically mean aspiration, and it does not mean the person will automatically develop aspiration pneumonia.

As proof, my father, now in his late 60s, has coughed a lot during meals since about his 40s (perhaps even earlier), yet I can remember him running a fever only about once.

That is because coughing stops foreign matter at the last moment before it enters the windpipe, and because he is healthy and has good immunity, so even if something does reach the lungs, it doesn’t cause serious inflammation.

Still, by carefully observing when someone coughs and on what, you can tell which function has weakened. Once the cause is clear, you can plan what to do. From here, I’ll explain measures for each type of food that tends to cause coughing.

1. Coughing on thin liquids

When someone starts coughing more often, they may be told to thicken their drinks. Liquids flow through the throat quickly, so it is hard to time the swallow, and people whose throat muscles have weakened and whose swallow has slowed can no longer keep up with the speed of liquids.

Let’s think about this. We thicken drinks. But what about food? Surprisingly, food also contains thin liquids.

Watch out for broth released when chewing

Take koya-dofu (freeze-dried tofu) as an example. Like a sponge, it soaks up delicious dashi broth, which floods the mouth when you bite into it. And that broth… isn’t it thin and watery?

Because liquid suddenly appears before the person is ready to swallow, it is especially hard to time the swallow.

In this case, thickening the broth with potato starch during cooking helps. Slowing the speed at which the broth spreads through the mouth reduces coughing and makes swallowing easier.

Cut juicy fruit into small bites

As this shows, care is needed with foods that release liquid when chewed. Besides koya-dofu, fresh fruit is another example. Watermelon and similar fruits are very watery and release lots of juice when you bite into them.

But you can’t thicken fruit juice the way you can thicken broth for koya-dofu, so with fruit, adjust the size of each bite. A large piece releases more juice when chewed. Small amounts are easier to handle, so if fruit juice causes coughing, cut the fruit into smaller pieces.

2. Coughing on crumbly foods that don’t hold together

When we chew and swallow food, we use the tongue to gather the chewed food into a single mass, send it to the throat and swallow. So foods that are hard to gather into a mass are hard to swallow.

Cookies are a good example. You can imagine that if you ate a dry cookie after running a marathon, when your mouth was parched, it would be hard to swallow even for a healthy person. Saliva production decreases with age, so it may help to think of an older person’s mouth as being in that post-marathon state all the time.

The crumbs of a chewed cookie spread all over the mouth, and even after you think you’ve swallowed, bits remain here and there. If these scattered crumbs are drawn toward the throat, for example along with a breath, they come close to entering the windpipe and cause coughing.

Cookies hold together better when moistened, so having a drink before or during the snack helps.

Bind crumbly dishes with a thick sauce

Cookies aren’t the only food that crumbles in the mouth. What about fried rice, for example? Its loose, separate grains are what make it delicious, but like cookies, it is a dish that is hard to gather into a single mass in the mouth.

If you still want to enjoy fried rice, top it with a thickened sauce (ankake). The sauce helps the grains of rice hold together.

3. Coughing on thin, flimsy foods

Finally, thin, flimsy foods. What do you think they are? The answer: nori seaweed, lettuce, wakame seaweed and the like.

These thin foods tend to cause coughing because their thinness makes them likely to stick to the throat. When someone chews them into small pieces and swallows, if their swallowing strength is weak, they can’t swallow everything, and thin pieces stay stuck to the throat. That leaves an uncomfortable feeling in the throat, and the person ends up coughing.

Alternating swallows with liquids

The measure I recommend is to alternate with liquids so that whatever has stuck to the throat can be swallowed. This method is called alternating swallowing: you alternate between swallowing foods that are hard to swallow and foods that are easy to swallow.

For example, suppose a piece of wakame is left in the throat. If you then drink something easy to swallow, such as tea or miso soup, the piece of wakame is washed down with the liquid and the throat feels clear. People who tend to cough on liquids should use thickened drinks or jelly instead.

Small changes in dressings and ingredients

If coughing continues even so, make some small changes at the cooking stage.

Rather than a light dressing, toss lettuce with mayonnaise or sesame paste; this makes it smoother and helps it hold together, so it is easier to swallow.

Sheets of nori stick easily, so you could switch to nori tsukudani (nori simmered into a paste), and replace wakame with mekabu, the slippery, easy-to-eat base of the wakame plant.

Summary

Foods that tend to cause coughing and are hard to swallow fall into three groups: thin and runny (sara-sara), crumbly (para-para) and thin and flimsy (pera-pera). Keep an eye on these foods, and think about which ones are hard for the person to eat and how they could be made easier.

Being able to eat the same meals as the rest of the family, safely and with enjoyment, also supports mental well-being. Please give these ideas a try.

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About the author: 稲山 未来 (Registered Dietitian)

This article is a contribution from a medical or care professional, re-edited by our editorial team. It provides general information as of the time of writing, and symptoms and circumstances differ from person to person. For specific decisions, please consult your doctor, dentist, pharmacist or another professional.

This is an English translation of a column originally published in Japanese by Next Co., Ltd.

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