Calling Dr. Bauer

Dear Dr. Bauer,

I was diagnosed with COPD over ten years ago. There is one question which has continued to puzzle me. I see frequent references to “a lot of coughing,” “excessive mucus,” or similar terms. Yet, I have never coughed a lot, nor do I produce mucus, let alone a significant amount! Stephen R., The Villages, FL

The surface of our trachea and larger bronchial passages are lined with cells that produce thick, sticky mucus – about three teaspoons a day in healthy non-smokers. Smoking causes inflammation in the lung resulting in a marked increase in mucus production. In fact, cough is just a natural reflex of the lung to rid itself of excess mucus (sputum). Every person’s course with respiratory disease is different, even though you may have the same diagnosis. You are lucky to have one less thing to cope with! What can we do to get that nasty stuff out of our lungs? First off … stop smoking if that is an issue. Chronic bronchitis (daily cough and sputum) is a natural response to smoke and other inhaled respiratory irritants. Inhaled bronchodilators (albuterol as a good example) can open up air- ways and make cough efforts more efficient. Sometimes inhaled steroids can result in decreased inflammation and less sputum. This is especially true for asthma/allergy inflammation. Viral infections usually just need to “run their course”, but bacterial infections, including pneumonias, typically need antibiotics to decrease purulent (thick, dark green) mucus.

Drug stores have aisles lined with products that claim to help cough and mucus. Most are very safe to use … most, at best, result in only very slight benefit. High dose guaifenesin (Mucinex and other similar products) are commonly recommended but help only slightly. Responses to over- the-counter medications can be very individualized. I almost never tell my patients not to try them, but to always reassess whether they think they are helpful or not.

Sometimes people with severe reductions in breathing capacity can benefit from use of small hand held cough assist devices such as the acapella® or AEROBIKA®. These products, when used properly, result in an oscillating back pressure in the lung airways that can loosen up mucus and make is easier and more comfortable to cough it out.

Best wishes to all my Pulmonary Paper readers as Spring and Summer 2017 get underway!