COPD and Mucus
The coughing associated with COPD produces large amounts of a slimy substance called mucus. The increase in the production of mucus and secretions are due to an excessive amount of mucus-producing cells (called goblet cells), and oversized mucus glands in the airways compared with those found in the lungs of healthy people. This can result in a chronic cough. As we know, a cough is the body's defense mechanism in an effort to clear the airways of this mucus. Mucus may also be referred to as sputum and/or phlegm and it can become prevalent in the airway and lungs during illnesses. Unfortunately, people with COPD can have difficulty clearing the excess mucus because of ineffective cough as well as other aspects of the condition.
Although other terms for conditions with excess mucus include chronic mucus hypersecretion or chronic sputum production, in COPD the condition is typically called "chronic bronchitis." A diagnosis of chronic bronchitis usually requires the presence of a chronic, productive cough with sputum production for at least three consecutive months in two consecutive years.
Factors that contribute to excess mucus
- acute and chronic viral infections
- bacterial infections.
Smoking, by far, is the biggest factor in COPD and specifically, chronic bronchitis. Studies show that cigarette smokers with both chronic bronchitis and a limited airflow have an increased number of goblet cells and inflammatory cells in their airway. Infections, whether viral or bacterial, are characterized by the production and presence of mucus in the airway and lungs, and even excessive secretions in the nose.
How does mucus affect one’s health?
COPD, with excessive mucus production, can impact a person's health. This manifests itself in a variety of ways.
- Lung Health: Chronic mucus production over time and through the years is related to a decline in lung function. This can be quantified with pulmonary function testing ordered by a physician.
- Quality of Life: COPD patients with chronic bronchitis often have more physical activity limitations and a worse quality of life than those who don't have excess mucus and cough. People find coughing and mucus production to be the more disruptive and embarrassing of COPD symptoms to deal with on a day-to-day basis.
- Flare-ups: COPD and chronic bronchitis may increase the number of exacerbations and consequently, hospitalizations. People with COPD dread the exacerbations as they fear the acute flare-ups may result in a lengthy hospital admission.
Coughing to bring up mucus
As has been mentioned, people with COPD often produce a large amount of mucus or sputum. If the mucus is allowed to collect in the airways, breathing may become more difficult and there is a greater risk of developing an infection.
Techniques to remove mucus are often done after using an inhaled bronchodilator. The medication helps to both loosen the mucus and also to open the airways. This makes the techniques to expel the secretions more effective. The patient with COPD should bear this in mind as being compliant with medication regimens combined with coughing techniques can insure a more successful maneuver.
Start by taking a deep breath. Hold the breath for 2-3 seconds. Use your stomach muscles to forcefully expel the air. Avoid a hacking cough or just simply trying to clear the throat. A deep cough is less tiring and more effective in clearing mucus out of the lungs.
Huff coughing or ‘huffing’ is an alternative to deep coughing when you have trouble clearing the mucus from your lungs and throat.
- Take a breath that is slightly deeper than normal.
- Use your stomach muscles to make a series of three rapid exhalations with the airway open, making a "ha, ha, ha" sound.
- Follow this by controlled diaphragmatic breathing and a deep cough when you feel the mucus moving.
Techniques to help clear mucus
If, in your condition, a large amount of mucus is produced, your health care provider may recommend other techniques to help clear the mucus.
- Adjunct airway clearance devices have proven to be successful for some patients in assisting to cough out residual secretions and mucus. Examples of these include the Acapella, Aerobika and Flutter devices, among others on the market. In general, they are small individual devices through which you exhale. The theory is that exhalation through the device results in oscillations of expiratory pressure and airflow, which vibrate the airway walls loosening the mucus. It’s also thought they decrease the collapsibility of the airways through the back pressure that is generated which can help to accelerate airflow. This can facilitate movement of mucus up through the airway.
- Chest Physical Therapy (CPT) and postural drainage are techniques that use physical intervention and gravity to promote drainage of mucus from the lungs. CPT with bronchial drainage is the standard treatment for mobilization and removal of airway secretions in many types of respiratory dysfunction, especially in chronic lung disease, such as COPD and bronchitis. CPT has been shown to be effective in maintaining pulmonary function and prevention or reduction of respiratory complications in patients with chronic respiratory diseases.
- High Frequency Chest Wall Oscillation (HFCWO) provides positive pressure air pulses which are then applied to the chest wall. This can be done utilizing an inflatable vest and an air pulse generator. The generator produces therapeutic pressures at prescribed frequencies which are delivered via a pneumatic vest which surrounds the thorax. These air pulses oscillate the chest and the vibrations reportedly cause flow increases in the airways, loosening mucus and producing cough-like sheer forces.
We have used these in a hospital setting for some COPD patients who are then discharged to their home environment. The device can then be prescribed as medical equipment for use in the home environment. Some patients find these devices to be extremely helpful.
- Simple exercise alone or combined with a scheduled pulmonary rehabilitation program is also a good way to help bring up mucus in the lungs.
Each technique can be ordered and demonstrated by your health care provider. You may consider discussing these available techniques with your health care team to determine if they are suitable for you.
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