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7 Causes of a Productive Cough

Coughing up phlegm or mucus is usually a sign of an infection or inflammation in your lungs. Here are the 7 most common causes.

Coughing is a way for the body to clear out the lungs and throat. Sensors that trigger cough are located in the throat and airways of the lungs. Cough can also be triggered by touch, heat, cold, acid, and other irritants.

Mucus is secreted by the airways of the lungs and helps trap invading bacteria and viruses. A productive cough is when you cough up mucus (phlegm). Mucus can also drip down the back of the throat from the nose or sinuses.

New productive coughs are often caused by a viral or bacterial infection. These are often contagious when you cough. Chronic coughs are often caused by smoking. Other common causes of chronic cough are asthma, heartburn/reflux, and allergies that cause post-nasal drip.

Depending on the cause, a productive cough can be treated with over-the-counter cough medicines or honey, and by treating the cause, such as quitting smoking or avoiding allergic triggers.

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1. Bronchitis

Symptoms

  • Sudden onset cough with or without sputum production that has lasted less than 3 weeks
  • No fever, or at most mild temperature elevation (up to 100.3°F)
  • No shortness of breath

Acute bronchitis is when an infection in the lung’s airways causes inflammation. Most cases are caused by a viral infection, though rarely cases may be due to a bacterial infection.

Treatment involves helping improve cough symptoms. Drinking warm liquids (tea with honey and soup), avoiding smoke exposure, and using over-the-counter (OTC) cough medication may help. A doctor might give you an inhaler if you are wheezing.

2. Common cold

Symptoms

  • Cough
  • Nasal congestion or runny nose
  • Sore throat or itchy/scratchy throat
  • No fever or shortness of breath

The common cold is a viral infection of the upper respiratory tract. That includes the nose, mouth, sinuses, throat, and larynx. More than 200 types of viruses can cause the common cold. Rhinovirus is the most common.

You can catch it by being coughed or sneezed on by an infected person or touching an infected person or an object and then touching your face.

Treatment involves reducing your symptoms. Drink warm liquids such as soup or tea with honey. OTC pain medication and cold-relief medication may help.

3. Pneumonia

Pro Tip

A common misconception is that all coughs are contagious. Coughs are caused by a variety of different things. —Dr. Benjamin Ranard

Symptoms

  • Fever (100.4°F or greater)
  • Shortness of breath
  • Coughing often brings up greenish, yellow, or bloody mucus
  • Can also have fatigue, malaise, chest pain when taking a deep breath

Pneumonia is an infection of the lungs. It is most commonly caused by bacteria or sometimes by viruses.

You should always see a doctor if you have symptoms of pneumonia. Treatment often involves taking antibiotics. Depending on how bad your symptoms are, you may need to be treated in a hospital. This is especially the case for young children or adults 65 and older with other chronic conditions.

Pneumonia can lead to dangerously low oxygen levels and can cause a life-threatening infection. Symptoms of serious infection include confusion, fast breathing, and fast heart rate.

4. Chronic bronchitis

Symptoms

  • Cough that lasts more than 2 months
  • Coughing brings up mucus
  • Can develop shortness of breath with exercise

In chronic bronchitis, your airways are inflamed and produce more mucus. This is often from years of tobacco smoking but can have other causes. The small hairs that normally move mucus out of your lungs are damaged, causing the mucus to get stuck in the lungs. That causes more coughing.

Chronic bronchitis is a long-term illness that keeps coming back or never fully goes away. It’s part of the broader condition of chronic obstructive pulmonary disease (COPD).

If you smoke, quitting smoking is the most important step in treatment. Your doctor might give you medications such as bronchodilators or steroids (usually via an inhaler or nebulizer) and you may have to do pulmonary rehabilitation, a type of breathing therapy.

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5. Chronic obstructive pulmonary disease (COPD)

Pro Tip

A common cause of chronic productive cough is smoking. If you smoke, vape, or otherwise inhale tobacco or other products, the best way to improve your cough would be to quit. If the smoking has caused COPD, there are other treatments available that can improve cough. —Dr. Ranard

Symptoms

  • Chronic cough often with mucus
  • Wheezing
  • Shortness of breath with exercise

Chronic obstructive pulmonary disease (COPD) is a progressive inflammation and/or breakdown of the lungs that makes it hard to breathe. It is caused by long-term exposure to irritating gases or dust particles, most commonly tobacco smoke. Symptoms may take years to develop.

COPD cannot be cured but treatment can help reduce symptoms. Regular medical management is crucial in people with COPD because they’re at a higher risk of heart disease and lung cancer.

Quitting smoking is very important.

Your doctor may recommend inhaled medications to reduce the inflammation and open up the airways, as well as pulmonary rehabilitation, and certain vaccinations to prevent respiratory illnesses.

6. Influenza (flu)

Symptoms

  • Fever
  • Chills
  • Headache
  • Body aches
  • Cough
  • Sore throat
  • Fatigue
  • Weakness

The flu is a contagious respiratory illness caused by the influenza virus. It is spread through the air by coughing, sneezing, talking, or by touching contaminated surfaces and then touching your face.

Anyone can get the flu, but people who are very young, over 65, and/or have pre-existing medical conditions are most at risk for serious complications.

There are antiviral medications a doctor can prescribe for high risk patients. But treatment mostly consists of resting, drinking a lot of fluids, and if needed taking over-the-counter pain medications like acetaminophen. Do not give aspirin to children.

7. Post-infectious cough

Symptoms

  • Persistent cough that lasts more than three weeks after recent respiratory infection

Post-infectious cough is one that starts with a cold or other upper respiratory infection. But it doesn’t clear up when the infection does. Instead, it lingers for 3 to 8 weeks.

When to call the doctor

  • Your cough has lasted for more than 3 weeks
  • Fever
  • Coughing up blood or blood in mucous
  • Weight loss
  • Drenching sweats at nights
  • You have a heart or lung disease and are having new cough
  • You have been exposed to a person with active tuberculosis infection

Should I go to the ER for a productive cough?

Seek emergency treatment if:

  • You are having difficulty breathing or breathing quickly
  • You have new chest pain
  • You are coughing up large amounts of bloody sputum (more than a spoon full)
  • You have any of the above symptoms under when to call a doctor but can’t reach a primary care provider
  • You think that an object has been inhaled into the airway (most common in children)

Productive cough treatments

Dr. Rx

An important question to ask your doctor: Could any of my medications be causing my cough? Also, let your doctor know if there is a family history of chronic cough or lung disease. —Dr. Ranard

At-home care

  • Guaifenesin (Mucinex): an over-the-counter expectorant that will thin your mucus, making it less bothersome and easier to cough up.
  • Dextromethorphan: an over-the-counter cough suppressant that helps tamp down your cough reflex.
  • Honey: can be used to improve productive cough symptoms, can add to warm water or tea. Do not give honey to children under 1 year old.
  • Cut back and preferably quit smoking. This includes smoking cigarettes or other substances

Other treatments sometimes prescribed by physicians

  • An oral or inhaled medication to reduce inflammation and open up the airways
  • Prescription cough suppressants
  • Antibiotics to treat a bacterial infection of the airways or lungs
  • Chest physical therapy to help clear the airways for cough from certain conditions that cause excess mucus production (such as cystic fibrosis)
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