Cough, and Keeping Your Airways Clean

Health Professional

Phlegm. Secretions. Sputum. Mucous. Yuck Whatever you call it, that junk in your lungs is yet another part of having COPD that's not a lot of fun. Yet, it's one of those things that as a person with COPD, you just have to deal with - and if you learn how to handle it, you'll breathe easier.

What's the role and function of sputum in the lungs?
Before we talk about getting rid of excess phlegm, we need to understand why it's there in the first place. Mucous has two important functions when it comes to lung health.

The mucous in your lungs provides protection by stopping unwanted particles and trapping them before they get too deep in your lungs. Lining the airways (the breathing tubes, bronchi and bronchioles) is a thin layer of mucous called the "mucous blanket." Just underneath this mucous blanket are cilia, millions of tiny little hair-like structures. The cilia move like a wave to help propel the mucous - carrying trapped dust, bacteria, and other substances upward, where they can be coughed out. This is how your lungs keep themselves clean.

Mucous performs another important function - humidifying the air you breathe. As your air makes its way through your bronchial tubes, it passes over the mucous, picking up moisture and keeping air passages from being too dry.

Dirty lungs
Remember the cilia, the little sweepers in your airways that help keep your lungs clean? Cigarette smoke and other irritants in the environment can destroy or paralyze them, causing the cilia to stop functioning. When this happens your lungs are not able to clean themselves as they should. Along with this the breathing tubes can become chronically (all the time) or acutely (suddenly and temporarily) swollen and inflamed. As a result, the airways can produce thicker and stickier mucous secretions.

With the loss of your normal cleaning mechanism as well as a tendency towards thicker, stickier secretions and swollen airways, you can see why breathing with COPD can be so difficult. And with all this going on, your lungs have to figure out another way to get rid of excess mucous and that's why you may have a frequent, productive cough. If you cough on most days, producing sputum, even when you do not have an acute infection, you probably have chronic bronchitis. Ask your doctor about this.

Certainly, all this sticky mucous can make it even difficult to breathe, and cause more coughing, making you tired and even more breathless. But here's another reason why it's important to keep your lungs clear. If sputum is not cleared from the lungs, it can cause ongoing inflammation, which can lead to further lung damage and a further deterioration in lung function. You must keep your lungs as clear as possible to maintain lung health.

What can I do to keep my lungs clear?

Drink two quarts of water a day if approved by your doctor.

  • Take an expectorant or mucolytic. This can be ordered by your doctor, or you can take a non-prescription expectorant if your doctor says it's okay.

  • Use proper cough technique. Sit up straight, but bending slightly forward with elbow support. A straight chair with armrests works well.

  • If at all possible, do not lie down when coughing. Coughing is much more effective when sitting up.

  • Use the Huff Cough technique. Ask a respiratory therapist to show you.

  • Ask your doctor if Percussion and Postural Drainage might help. If so, a respiratory therapist can train a family member or caregiver this technique.

  • Use an airway clearance device if directed (see below).

  • Take time for your bronchial hygiene each day, just as you take time to wash your face or brush your teeth.

Keep your lungs clean and clear of excess mucous and you'll breathe easier!

Your doctor or respiratory therapist might recommend the use of a hand-held mechanism that vibrates and loosens the mucous to make it easier to cough out. There are several devices available, all requiring a prescription. The most common are Acapella® and** Flutter ®**, although there are others. The** Acapella ®** shakes your mucous loose when you blow into it. It must be dialed to the proper setting by someone who is trained it is in use. It will work if you are laying down.** The Flutter ®** works in a similar way but you must be sitting or standing up straight to use it. Ask your doctor if the use of an airway clearance device would be appropriate for you. Then, if you are prescribed a device, be sure to have a respiratory therapist teach you how to use it. It might seem simple, but proper training will help you get the most benefit from your device.

Coughing up mucous, unpleasant as it is, is essential when you have COPD. Do all you can to clear that junk from your lungs this fall and winter so you can stay as healthy as possible with COPD.

Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of and author of Breathe Better, Live in Wellness and Live Your Life With COPD, scheduled for release Spring, 2011.