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.

The Perils of Hookah Smoking: Results of New Study

Light-use, Hookah Only Smokers Have Symptoms and Reduced Lung Function

Background: The hookah, also called a waterpipe, shisha, or narghile, is used for smoking fruit-flavored tobacco by millions of people worldwide. Tobacco is placed in a bowl surrounded by burning charcoal. When the smoker inhales, air is pulled into the bowl holding the tobacco. The resultant smoke is bubbled through water, carried through a hose, and inhaled. It typically includes tobacco products equivalent in a single bowl waterpipe session over 45 – 60 minutes to one pack of cigarettes together with carbon monoxide and charcoal components.

Hookah in restaurtant in Nepal

Hookah in restaurtant in Nepal

Components of a hookah

Components of a hookah

While hookah smoking is commonly associated with the Middle East, the use of waterpipes is becoming more common in the United States. For example, 9 – 20% of young adults in the US report that they have used waterpipes, and hookah “bars” are common in many US cities. Many smokers believe that the water filters “toxins” from the smoke, making it safer than smoking cigarettes. However, this is a myth.

Study: Researchers from the Weil Cornell Medical College studied 19 never smokers and 21 self-reported hookah smokers only from the general population of New York City by posting advertisements in local newspapers, eletronic bulletin boards, and waterpipe bars. All subjects answered questions, performed breathing tests, had a high-resolution CT scan of the chest, and had samples obtained from the lower breathing tubes by bronchoscopy (having a scope passed into the mouth and deep into the lungs). The study was published in the September 1, 2016, issue of the American Journal of Respiratory & Critical Care Medicine.

Findings: Compared with nonsmokers (average age = 33 years), the waterpipe smokers (average age = 25 years) had: more cough and sputum (mucus); reduced transfer of gas across the air sacs and blood vessels (called the diffusing capacity); and abnormal cells in the lower lung.

Conclusions: Young. light-use, hookah only smokers have multiple lung abnormalities suggesting that even limited use can have serious consequences.

My Comments: Two factors have increased  the popularity of hookah or waterpipe smoking among school-aged children and young adults throughout the world. One is the introduction of different flavors (lemon, apple, orange, cherry, etc.). Two is as the belief that waterpipe smoking is safe as it filters all noxious substances because it passes through water.

Studies have compared the effects of a single session of waterpipe smoking with smoking one cigarette. The inhaled smoke volume is 123 times greater with hookah smoking and is associated with 2.3 times more inhaled nicotine and 25 times more inhaled tar.

Once again, any type of smoking can damage the lungs and should be avoided for lung health.