Cough With COPD: What's Normal and What's Not?
Last updated: June 2023
A chronic cough is one of the primary symptoms of COPD.1 Other symptoms can include:
- Breathlessness, especially with activity
- Chest tightness
However, many people have COPD and don't realize it for a time, because the symptoms tend to show themselves only as the disease worsens.1 It's not uncommon for a cough to be one of the first symptoms to be noticed.
With COPD, the cough tends to be one we call "productive." That means it producesmucus, or phlegm, in your airways that a cough tries to clear. At times, the COPD cough may be more of a dry, hacking cough, but the productive, or wet, cough is more common.
A "normal" wet COPD cough
Part of the disease process with COPD is that your airways are chronically inflamed. The degree of inflammation can wax and wane over time. This inflammation affects your breathing in these ways:1
- Both the airways and the tiny air sacs at the end of your airways become much less elastic.
- The walls between the tiny air sacs, called alveoli, break down and deteriorate.
- The airway walls become thicker and their passages narrower.
- The airways make excess mucus, which further clogs the passages.
The mucus your airways make, when COPD is fairly stable, tends to be clear or whitish and not too thick. It should not have a strong odor. A cough that brings up this type of mucus would be considered "normal" for COPD. Of course, there are degrees of normality. While a cough can be bothersome, and can occasionally trigger shortness of breath temporarily, it should not be constant. If the cough begins to interfere with daily life in a regular, big way, that may not be normal and you should talk with your health care team about it. You may need an adjustment to your treatment regimen.
When a wet cough becomes "abnormal"
So you may be wondering when to be concerned about a wet cough if you have COPD, since it's such a common symptom. If you notice that you absolutely can't clear the mucus in your airways when you cough, don't panic, but do pay attention.
When mucus builds up in the airways, it greatly increases your risk of respiratory infection.2 So, if possible, you want to avoid that scenario. If the nature of the mucus you are coughing up changes, that can also be cause for concern. Be on the watch for:
- Much thicker, stickier mucus
- Change in color from clear or white to yellowish or greenish
- Mucus that is blood-tinged or pink
- Phlegm that has an odd or unpleasant smell
You might also start to hear changes in the sound of your breath. While wheezing, or a whistling sound, is common in COPD, other sounds may suggest something else is going on.2 You or your caregivers might notice bubbling, popping, or rattling sounds that we call “crackles.” Or, some people have continuous, low-pitched, snore-like sounds, that we call “rhonchi.” Both of those types of breath sounds are cause for concern and should be reported to your health care team as soon as possible.
Another possible reason for an increase in the amount of fluid in your airways and lungs could be congestive heart failure or CHF for short. This chronic heart condition is fairly common in people with more advanced COPD.3
Don't ignore changes in your wet cough
When your usual COPD cough changes, be on the lookout for other signs of respiratory infection because that is likely what is going on. If not already, it may soon develop. Common respiratory infections that can cause a wet cough may include:2
- The common cold
- Acute bronchitis
If you also develop a sore throat, fever/chills, or feel more tired than usual, that is more evidence that an infection may be in play. Don't wait to report your symptoms to your health care team. The sooner they know, the sooner treatment can be started before things spiral out of control.
Treating COPD cough, whether "normal" or "abnormal"
The important thing to understand is that suppressing your cough is not the answer. If you have liquid, mucus or phlegm in your airways, you need to do your best to bring it up and out. Not doing so can cause the mucus to build up in your airways, and as stated above, that makes them ripe for infection.
The first step is to make sure your COPD treatment is on point. Have you been using your prescribed medications exactly as your doctor directed? If you use supplemental oxygen, are you ensuring the right flow rate and frequency? In most cases, your COPD treatment plan should keep your COPD under control, unless something else, like a respiratory infection, is going on.
The next step, if your doctor does diagnose an infection, will probably be to take an antibiotic or even an antiviral medicine. If your doctor prescribes one of these, be sure to take it when and how you are told to do so.
Other measures can either help you have a more effective cough or decrease the amount of mucus:2
- Gargling with salt water. This simple home remedy might decrease the mucus in the back of your throat. Just mix a half teaspoon of table salt with 8 ounces of water. Then gargle with it a few times a day.
- Expectorants. This type of medicine, for instance in cough syrup, can help you cough more effectively.
- Mucolytics. This type of medicine helps to thin the mucus, making it easier to cough up.
- Diuretics, sometimes called "water pills." These medicines would only be used when you have been diagnosed as having CHF. They help your body shed water throughout.
None of the above should be added to your treatment regimen without the express consent of your healthcare team. You want to be sure anything you add will not interfere with your overall COPD treatment plan.
There are also airway clearance devices, such as the oscillating positive expiratory pressure (PEP) device that can be useful. This type of device uses pressure and vibration to move mucus out of your airways as you exhale.2 Studies show that PEP devices can improve the effectiveness of your cough.
Keep an eye on the cough
When you have COPD, coughing is part of everyday life. It can be easy to blame everything to do with a cough on COPD and then to become complacent. However, subtle changes in your cough or the phlegm you are coughing up (or trying to) can be a key sign that something beyond day to day COPD is starting. That can be a sign that your COPD may not be as controlled as you would like it to be and an adjustment in treatment needed.
Don't hesitate to contact your health care team to report what is happening and to get advice on how to proceed.
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