Clearing Mucus Out Of The Chest
What Are The Treatment Options?
Dear Dr. Mahler:
I am 67 years old and have been bothered by mucus in my chest for years. I find it hard to cough it out and have tried every over-the-counter medication without any help.
A Physician Associate diagnosed me with “moderate COPD” two years ago and prescribed Advair Diskus twice a day and ProAir to use when needed. I quit smoking two years ago when I was told of COPD. In the morning, I cough out clear-gray mucus from my chest after breakfast and my 2nd cup of tea. However, there is still “rattling” in my chest afterwards which seems to last throughout the day. I try to cough out more mucus as the day goes, but it is quite difficult. I know that there is more mucus down there, but it is hard to get it out despite coughing jags.
I typically have a chest infection every winter and still work selling real estate, although I work fewer hours than I used to. Any advice is appreciated.
Victor from Topsham, UK
Dear Victor:
Based on the information that you provided, you have chronic bronchitis type of COPD. The glands that line the inner lining of your airways are stimulated to produce mucus, likely due to previous cigarette smoking.
Mucus inside airways in someone with Chronic Bronchitis
Mucus blocks the flow of air inside the airways and also causes irritation that leads to coughing. Daily coughing can be annoying to you as well as others. It requires a lot of energy and can cause fatigue.
Mucus that stays in the lungs also provides an ideal environment for bacteria to multiply and thrive – causing frequent chest infections which may lead to long-term damage to the lungs.
Victor – it sounds like you have already tried over-the-counter expectorants. Some contain a medication called Guaifenesin which is thought to help loosen and thin bronchial secretions and make cough more productive. However, the scientific evidence to support these proposed benefits is limited.
Treatment Options: What can be done for clearing mucus out of the chest?
Drink a lot of water. This helps to hydrate the mucus, making it “thinner” and easier to cough out of the chest.
Ask your physician associate to consider prescribing an inhaler with a liquid medication that might also help to liquify and loosen the mucus. Pressurized metered-dose inhalers and slow mist inhalers provide an aerosol/mist that may help to hydrate the mucus compared with the powder medication in Advair Diskus.
Start deep breathing exercises and/or an exercise program that will make you breathe deeper. This will help you to cough and clear out mucus.
Ask you physician associate about an airway clearance device. These include the Flutter, Positive Expiratory Pressure (PEP) mask, lung flute, incentive spirometry, and external chest wall oscillations. The Flutter is commonly used and combines oscillations with using an internal steel ball that vibrates during exhalation.
Internal components of the Flutter with steel ball. The green marks represent vibration during exhalation.
How does the Flutter work?
When you exhale (breathe out) through the Flutter, your breath will cause the steel ball to rise up and down under the protective cover. Each time you breathe out through the device, the following happens:
Vibrations loosen the mucus sticking to the airways
A slight increase in pressure helps to keep your airways open
The vibrations act to ‘shake loose’ the mucus that has been clinging on to the walls of the airways (much like shaking apples from the tree). By keeping even the smallest airways open, the loosened mucus can then start to move. Doing this while breathing out means the secretions start to move out of the lungs.
Victor – I encourage you to consider all of the four options that are described above.
Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.
Sincerely,
Donald A. Mahler, M.D.