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
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
(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.
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.
Donald A. Mahler, M.D.