How Can I Stop Coughing Up Mucus Each Day?

Are There Treatments To Reduce Mucus?

Dear Dr. Mahler:

I am tired of coughing up “junk” everyday and find it disgusting. It takes me a good hour or two in the morning to clear it out of my lungs and then I can breathe better. My PA has called it different names, including mucus, phlegm, and sputum. Do you have any suggestions for getting rid of it? A few years ago I was told that I had COPD with chronic bronchitis. I used to smoke, but quit soon after the diagnosis. I take Advair twice a day and ProAir a few times a day when needed. Thanks for your help.

Janice from Hagerstown, MD

Dear Janice:

Before reviewing possible treatments, let me start by describing how and why the lungs make this material.

What Is Mucus?

It is a liquid made by goblet glands located inside the breathing tubes

Goblet cells produce mucus

View of the lining of the breathing tubes from a microscope. The Goblet cells are dark blue and secrete mucus. Cillia are hair-like that carry mucus toward the throat.

(airways) (similar glands are also found in the intestines). Its purpose is to protect the lining inside the breathing tubes. The problem occurs when there is too much production. Cigarette smoking is a common cause of mucus being produced in the breathing tubes.

Other irritants can stimulate mucus production include dust, air pollution, chemicals, as well as bacteria and viruses. The purpose of the excess mucus is to capture these irritants and them get out of the lungs by coughing. However, too much mucus can cause a chronic cough that doesn’t go away.

Here is a picture of chronic bronchitis which is one of the types of COPD.

Chronic bronchitis with mucus

At the bottom is a breathing tube which has mucus inside. This is common in those with chronic bronchitis.

As you can see, thick yellow mucus is inside the breathing tube and narrows the opening causing shortness of breath.

Are There Treatments?

First, it is great that you quit smoking years ago. Second, it is important that you avoid inhaling irritants in the air including second-hand smoke, air pollution, and anything else in the air that makes you cough. And third, keep well hydrated by drinking water. This helps to thin the liquid material and make it easier to cough it out of the lungs.

The two major types of treatment are expectorants and mucolytics. An expectorant works by signaling the body to increase the amount of water in secretions. This results in clearer secretions and also lubricates the irritated lining of the breathing tubes. Guaifenesin is one of the most common expectorants and is available over-the-counter without a prescription required.

Mucolytics are medicines that thin mucus, making it less thick and sticky and easier to cough up. Acetylcysteine is a prescription medication that is used to thin mucus in people with certain lung conditions such as chronic bronchitis, cystic fibrosis, and bronchiectasis. It is liquid inhaled from a nebulizer machine. Your health care professional will decide whether to use the 10% solution (dose is 6 to 10 mLs) or 20% solution (dose is 3 to 5 mLs) usually 3 – 4 times a day.

How Effective Are Mucolytics?

In 2015, there was a review of all studies published in medical journals to determine whether treatment with mucolytics was helpful for chronic bronchitis or COPD (Cochrane Database Systematic Review July 29, 2015). The authors stated that, “We are moderately confident that treatment with mucolytics may produce a small reduction” in flare-ups and a small benefit on overall quality of life.

In 2017, Dr. Mario Cazzola performed an analysis (called a meta-analysis) of a mucolytic pill called erdosteine (published online in Pulmonary and Pharmacologic Therapeutics December 9, 2017). Based on 10 studies involving 1,278 patients, erdosteine improved the clinical score of those with chronic bronchitis and COPD and also reduced the chances of a flare-up (called an exacerbation). It also reduced how long the flare-up lasted. The usual dose is 300 mg twice a day.

Although erdosteine is approved for use as a treatment of COPD with chronic bronchitis in over 50 different countries, it is not currently approved for use in the United States.

Janice – I hope that this information is helpful to you. Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.

Best wishes,

Donald A. Mahler, M.D.

Damp, Moldy Homes Are Associated with Sinus Problems and Bronchitis

Damp, Moldy Homes Tied to Respiratory Symptoms

Background: Many individuals believe that exposure to mold in their apartment or house contributes to breathing complaints, including cough, shortness of breath, and chronic bronchitis. Although dampness at home has been associated with respiratory conditions in children, there is little information about damp, moldy homes and chronic respiratory symptoms in adults.

Evidence of damp, moldy homes

Mold on wall behind couch

Study: Dr. Caroline Pind and colleagues at Uppsala University sent questionnaires to residents of four cities in Sweden about respiratory symptoms, smoking, education, and environmental exposures. The questionnaire identified dampness by asking about visible water damage, floor dampness, or visible mold in the home during the last 12 months. The study results were published on-line on July 11, 2017, in the journal Clinical & Experimental Allergy (DOI:10.1111/cea.12976).

Evidence of damp, moldy homes

Black mold on ceiling due to leaky roof

Results: Over 26,000 adults living in Sweden answered the questionnaire. Overall, 11% reported signs of dampness. Dampness was more common in humid or mild climates compared with areas of the country with longer, colder winters. Compared with non-smokers with no signs of any dampness, 90% of non- smokers with any dampness in their home were more likely to have nighttime shortness of breath, while 67% were more likely to have chronic bronchitis. There were higher rates of wheezing, nighttime coughing, and asthma in the group with signs of dampness at home.

Conclusions: The study showed an association between dampness at home and chronic respiratory symptoms in adults. The authors suggested that these findings support reducing indoor dampness. Dr. Jouni Jaakkola of the University of Oulu in Finalnd commented that, “I found it interesting and alarming that the adverse effects were stronger among people of low socioeconomic status due to limited possibilities for moving to a better home or making needed renovations.”

My Comments: This study points out the ill health effects of exposure to mold where you live. It is important to locate moisture problems, removing molds, and controlling excessive water and condensation at home. Leaky pipes and roofs are often the problem. The U.S. Environmental Protection Agency has information on controlling mold on-line: as does the U.S. Centers for Disease Control and Prevention on (

N-acetylcysteine (NAC) Reduces Exacerbations

Meta-analysis Shows Benefit of n-acetylcysteine (NAC)

Dr, Mario Cazzola and colleagues published a review of 13 studies which examined the effects of n-acetylcysteine (abbreviated NAC) in preventing COPD exacerbations. Exacerbations are worsening of COPD symptoms usually shortness of breath and cough typically due to a chest infection (acute bronchitis or pneumonia). The review was published in September 2015 issue of the European Respiratory Review (volume 24; pages 451-461).

Dr. Mario Cazzola

Dr. Mario Cazzola of the University of Rome Tor Vergata

What is NAC? It is a antioxidant that is available as a health supplement in the United States, typically in capsule form. Antioxidants are widely used to protect cells from damage induced by reactive oxygen species.

Results: Those with COPD who had chronic bronchitis (coughing up mucus most days) had significantly fewer exacerbations with NAC compared with placebo (inactive).  There was a 35% reduction in exacerbations for 635 patients based on four studies at a dose of at least 1,200 mg of NAC each day. The authors states that NAC was well tolerated.


My Comment:  This report is called a meta-analysis which means it combines all published studies on a particular topic.  Why do this?  Many individual studies may not include enough subjects to show a difference in treatment. However, a meta-analysis includes a larger group although the studies are not usually identical in design.

NAC is not a prescription medication. It is typically available at health food stores or can be ordered on line. Based on this meta-analysis, a dose of 600 mg capsules taken twice a day is recommended IF you have the chronic bronchitis type of COPD. Certainly, you should discuss the use of NAC with your health care provider before starting this supplement. There is no evidence that NAC will help those with the emphysema type of COPD.

Example of one product of n-acetylcysteine

Example of one product of n-acetylcysteine


Another NAC product

Another NAC product

NAC is also used to treat an overdose of acetaminiphen (Tylenol) and to loosen thick mucus as can occur in those with cystic fibrosis and COPD.

What are Chronic Bronchitis and Emphysema?

Dear Dr. Mahler:

I was recently diagnosed as having COPD by my primary care doctor. She mentioned both chronic bronchitis and emphysema, but I didn’t quite understand what she meant by these terms. Can you explain?

Jack from Tacoma, WA

Dear Jack,

I assume that you had breathing tests (called pulmonary function tests) in order for your doctor to diagnose COPD. COPD consists of two types: chronic bronchitis and emphysema. The figure below shows that the breathing tubes (airways) divide many times and end in air sacs (alveoli).

The breathing tubes (bronchus) divide many times and end in air sacs (alveoli).

The breathing tubes (bronchus) divide many times and end in air sacs (alveoli).

If inhaling cigarette smoke and other irritants mainly damages your breathing tubes, then the airways become red and swell (inflammation) and glands that line the inner lining of the tubes produce a thick substance called mucus. It is usually white or gray in color. Most people with this condition cough up mucus most days, especially in the morning. This is called chronic bronchitis. It is diagnosed if you report coughing up mucus most days for three months over a two year period. A cough productive of mucus is a common complaint or symptom.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

If inhaling cigarette smoke and other irritants mainly damages your air sacs (alveoli), these areas are destroyed. This is called emphysema. It is usually diagnosed by a specific type of breathing test called diffusing capacity. In emphysema, the diffusing capacity is lower than normal. Emphysema can also be diagnosed if you have a CT scan of the chest that shows typical changes. Shortness of breath with activities is the most common complaint or symptom.

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

It is possible that you have a combination of both chronic bronchitis and emphysema which is quite common.

At the present time, treatments for COPD are the same whether you have chronic bronchitis or emphysema.

I suggest that you ask your doctor the same question that you asked me for more specific information about your condition.


Donald A. Mahler, M.D.