Why Am I Coughing So Much?
Different Causes Should Be Considered
January 20, 2020
Dear Dr. Mahler:
I am 63 years old and was diagnosed with COPD about 4 years ago. For the past 3-4 months, I have been coughing more than usual. Most days I cough up white stuff, but lately there is more of it. I haven’t noticed any yellow color. It seems to come from my chest and I feel more short of breath until I cleared it out.
I told my doctor about it, but he blamed it on my smoking. I am trying to quit, but can’t cut down any more then 10 – 12 cigarettes a day. My COPD medications are Serevent Diskus twice a day and ProAir puffer 1 – 2 times a day when I feel that it is hard to breathe.
Any help is appreciated.
Bill from Avon, CT
Dear Bill,
Cough is the 2nd most common complaint among those with COPD – after shortness of breath. Many smokers consider their daily cough to be “normal” because they have been coughing for years. Some even refer to it as “my smoker’s cough.” If the “cough is productive of mucus on most days for at least three months for two years in a row,” it is called chronic bronchitis. Based on your comments, it appears that you have chronic bronchitis.
Coughing serves two important purposes:
Protects airways from inhaled noxious substances (like dust, fumes, and smoke)
Clears excessive bronchial secretions (called mucus)
Many people find that coughing is both annoying and disruptive. It certainly takes a lot of energy to cough multiple times in an hour. Here are the five steps of the cough reflex:
Sensors (receptors) are stimulated ⇒
Sensors send signals by nerves to the cough center ⇒
Information is processed in the cough center ⇒
Cough center sends signals to the glottis and breahting muscles ⇒
Three phases of coughing
Expiratory phase of coughing.
After a person inhales, the glottis opens and the increased pressure in the chest forces air out causing a cough.
Bill – It appears that something happened to increase your coughing frequency in addition to your chronic bronchitis. The three most common causes are upper respiratory congestion with postnasal drip from sinus infections or allergies, gastroesophageal reflux disease (GERD), and asthma – may also be called reactive airways.
Other less common causes of chronic cough are taking a medication called an angiotensin converting enzyme (ACE) inhibitor used to treat high blood pressure, inhaling irritants in the air, passage of liquids or food into the lungs during swallowing (aspiration), heart failure, whooping cough (Pertussis), bronchiectasis, interstitial lung disease, lung cancer, and psychological disorders.
Bill – as you are coughing up white mucus, it does not appear that you have a bacterial infection which usually causes yellow or green mucus. I encourage you to discuss your concerns with your doctor again. If he cannot help you figure out the cause, then you might consider asking for a referral to a lung specialist (pulmonologist).
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.