Chronic obstructive pulmonary disease (COPD) is usually associated with these four main symptoms:
- shortness of breath, especially with activity
- wheezing or producing a gasping, whistling sound when you try to breathe
- feeling tight or constricted in your chest area
- coughing that produces large amounts of mucus or sputum
Of all these symptoms, people tend to find coughing the most embarrassing and disruptive. Coughing can interfere with social events, like going to the movies, and it can prevent you from falling asleep at night. Many people go to their doctor or an urgent care center seeking relief from the chronic coughing associated with COPD.
Why You Cough
As annoying as coughing may be, it actually serves a useful function. Deep coughing clears the mucus that clogs your airways, allowing you to breathe more easily. Some pulmonologists actually 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 soothe coughing, as a clear airway means easier breathing in the long run.
Factors Leading to Increased Coughing
If you’ve had COPD for a while, you probably know what your baseline is when it comes to coughing. If you find yourself coughing more than usual, or coughing up sputum that looks different than it normally does, it may be time to go to the doctor just to make sure you’re not having a flare-up or an exacerbation.
An increase in coughing can have several causes. One is an increase in the amount of sputum or mucus your body is producing. Another is an exposure to irritants—especially cigarette smoke or harsh fumes. Finally, you may be coughing more because you’ve developed a co-morbidity, another illness that exists alongside your COPD. Examples of co-morbidities include infections like pneumonia or influenza, or issues like gastro-esophageal reflux disease (GERD). When you lie down to sleep, GERD can propel stomach acid into your throat and mouth, causing you to cough.
If your increased coughing is caused by a co-morbidity, antibiotics or medications can be used to get you back to your baseline. Don’t make any assumptions, though—speak to your doctor, who will make a diagnosis and prescribe you the right medication.
Medications/Treatments That Don’t Help
There are a few medications that have proved ineffective against COPD-related coughing.
Corticosteroids such as prednisone, for instance, don’t have any effect on coughing. They don’t hurt, but they don’t help either. Since corticosteroids can lead to a depressed immune system and weakening of your bones, most doctors use them sparingly and avoid prescribing them when there’s no clear value.
One class of common COPD medications actually seems to make coughing worse. Long-acting anticholinergics such as Spiriva can make the cough reflex more sensitive. Anticholinergics are a type of bronchodilator, a medication that relaxes the airways and makes it easier for you to breathe. People who can’t tolerate anticholinergic medications sometimes do better with beta-agonists, which produce similar benefits without increased coughing.
Medications/Treatments That May Help
Long-acting inhaled beta-agonists such as salmeterol sometimes decrease coughing. Beta-agonists are another 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 have been unable to reproduce that result. Using cough syrup and codeine to control coughing is a decision for you and your doctor to make together.
Finally, smoking cessation will put an end to the “smoker’s cough,” the dry, hacking cough common among people who smoke tobacco. This dry cough, however, may be replaced by a deep, productive cough that clears the airways of mucus.
Although coughing is a primary symptom of COPD, surprisingly little research has been done on controlling it or even on whether or not it should be controlled. If coughing is interfering with your quality of life, talk to your doctor and work with them to find different treatment options.
Can You Have COPD Without a Cough?
Usually, COPD results in coughing and excess mucus production, but not in the case of emphysema.
Emphysema is one of the diseases classified as COPD. It’s a progressive disease in which the air sacs (alveoli) in your lungs begin to collapse. Healthy air sacs look like bunches of grapes. In emphysema, the small sacs’ walls break down and lose their elasticity. The damaged sacs lower your ability to exhale properly and completely.
Emphysema may have no symptoms other than shortness of breath. Many of those who develop emphysema may have no cough or excess mucus production. Some people have both emphysema and chronic bronchitis. Chronic bronchitis will result in a cough and excess mucus in addition to intense shortness of breath.
Emphysema is a serious disease with the potential for severe complications. If you have shortness of breath during even simple activity, see your doctor for an evaluation. You may have a form of COPD, even without an annoying cough.