Not "Just" a Cough?

Chronic obstructive pulmonary disease (COPD) is a term that is used to describe a group of lung conditions that, among other things, make it difficult to breathe well. The four most common symptoms associated with COPD are:

• shortness of breath, especially with some kind of activity,
• wheezing,
• feeling a tightness, pressure or constriction in the chest area, and
• coughing - which may produce varying amounts of mucus or sputum.

People seem to find coughing to be the most disruptive and embarrassing of these symptoms. They can interfere with social situations, like eating out, or going to the theater or movies. Coughing can also interfere with falling asleep or staying asleep at night, which can lead to fatigue and lethargy during the day.

What is a cough?

A cough is the body’s natural response when something irritates the throat or airways. An irritant stimulates nerves which then sends a signal to the brain. The brain then tells muscles in the chest and abdomen to push air out of the lungs to expel and get rid of the irritant. Coughing consumes a lot of energy, takes a lot of strength, and can be very forceful. It can be exhaustive for people with COPD.

Although coughing can be annoying, coughing helps the body to heal and protect itself. As annoying as coughing may be, it actually serves a useful function. Deep coughing clears the mucus that clogs the airways, allowing one to breathe more easily. Some doctors teach their patients how to cough and encourage them to do so often. Some experts even go a step further and advise against doing anything to stop the coughing, as a clear airway means easier breathing in the long run.

Types of cough

A cough may be acute, sub-acute, or chronic, depending on how long it lasts.

• Acute coughs typically last less than three weeks and usually are caused by the common cold or other infections.
• Sub-acute coughs typically last three to eight weeks and remain after the initial cold or respiratory infection is over.
• Chronic coughs typically last more than eight weeks and can be caused by any number of
  diseases, like COPD or asthma.

A nonproductive cough is dry and does not produce mucus. This type of cough has also been referred to as a dry cough or a hacking cough.

A productive cough produces phlegm or mucus. This type of cough should not be suppressed because its function is to clear mucus from the lungs. We are most familiar with the cough that produces varying amounts of mucus or sputum. The amount, consistency, and type of mucus is largely dependent on the disease. For example, chronic bronchitis is characterized by an excessive amount of sputum production whereas emphysema typically is not. Coughs that are productive can help with diagnoses as well. As an example, infection can be characterized by yellow or greenish sputum, whereas blood-tinged sputum may be considered commonplace or more critical depending on the cause.

Coughing and COPD

If you've had COPD for a while, you are keenly aware of how much you usually cough and whether you produce mucus. If you find yourself coughing more than usual, or coughing up sputum that looks different than it normally does in your condition, it may be time to see your health care provider to make sure you’re not having an exacerbation or a flare-up.

An increase in coughing may be indicative of other causes. The body may be experiencing an increase in the amount of sputum or mucus it produces. Exposure to irritants, especially cigarette smoke or harsh fumes, can also increase coughing. Coughing may also be caused by other comorbidities which may have developed. A comorbidity is another illness that exists alongside COPD. Examples of comorbidities with COPD may include infections like pneumonia or influenza and gastro-esophageal reflux disease (GERD).

Coughing and GERD

When lying down, GERD can result in coughing by pushing stomach acid/contents into the throat and mouth, which then prompts a cough.

Coughing and Pneumonia

If the increased coughing is due to a comorbidity such as pneumonia, antibiotics or medications can be used which may help to bring you back to a more 'normal' level of coughing for your COPD. It would be prudent not to make any assumptions, though. It's best to speak with your health care provider who can then evaluate your current condition and prescribe the correct medication.

Treatment for Coughing

Long-acting inhaled beta-agonists, (LABA), such as salmeterol or formoterol, sometimes decrease coughing. Beta-agonists are a type of bronchodilator. They help open your airways and get more oxygen into your lungs.

Some researchers have studied the effectiveness of cough syrup with codeine. Although a few small studies showed a significant reduction in coughing, other studies were unable to reproduce that result. Using cough syrup and codeine to control coughing is a decision for you and your physician to make together.

Finally, if a person smokes, it's crucial to stop smoking to put an end to “smoker’s cough,” the dry, hacking cough common among people who smoke tobacco. A deep, productive cough that clears the airways of mucus may replace this dry cough once smoking is stopped.

Managing coughs on your own

To be proactive, there are steps one can take to ease the coughing. You may want to consider these tips:

• Use cough drops or hard candies. They may ease a dry cough and soothe an irritated throat.
• Take honey. A teaspoon of honey can help to loosen a cough.
• Moisturize the air. Some people find relief in the use a vaporizer or a steamy shower.
• Stay hydrated. Liquid helps thin the mucus in your throat. Warm liquids, such as broth or tea, may soothe your throat.
• Avoid tobacco smoke. Smoking or breathing secondhand smoke can make your cough worse.

Under normal conditions, cough plays an important protective role in the airways and lung architecture. Cough is frequently seen as a symptom of COPD. During an exacerbation or due to comorbidities, coughing symptoms may worsen. In some situations coughing may become excessive. It can also be considered to be troublesome and potentially harmful to the airway mucosa. As always, if symptoms persist or deteriorate, the importance of contacting one's health care provider is the key to successful management.