Chronic obstructive pulmonary disease (COPD) can cause a persistent cough. A person with COPD will produce extra sputum or phlegm, and they will cough to try and clear the airways.

COPD is a group of medical conditions that affect the lungs, including chronic bronchitis and emphysema.

One of the most common symptoms associated with COPD is cough, which can severely impact a person’s quality of life. A COPD-related cough is often productive, which means the person coughs up sputum or phlegm. However, some people with COPD may have a dry cough. This includes those who have COPD and asthma.

Over 16 million people in the United States have a diagnosis of COPD, according to the Centers for Disease Control and Prevention (CDC), and many more people living with COPD do not have a diagnosis.

Causes of COPD include exposure to tobacco smoke, air pollution, and a genetic condition known as alpha-1 antitrypsin deficiency (AATD).

In this article, find out what the link is between COPD and coughing and the treatments available.

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When a person has COPD, their lung tissue becomes inflamed and thickens. The airways lose their elasticity, air cannot easily escape, and it becomes trapped. This means less oxygen can enter the body, and carbon dioxide cannot leave it. So COPD affects the amount of oxygen a person can take in.

A persistent, chesty cough is a common symptom of COPD.

Here are some reasons why a cough can occur with COPD:

  • Changes to and blockages in the airways cause coughing when a person breathes deeply because the air has difficulty moving through the airways.
  • Damage to the cilia — hair-like projections in the lungs — means mucus cannot move easily through the airways.
  • Enlarged mucous glands in the lungs make excess mucus, and damaged ciliary glands struggle to move the mucus, leading to increased coughing.
  • Mucus from the lungs comes up into the airways, causing irritation. A person will cough as a means to move the mucus forward and out.
  • Inflammation of the airways is also likely to stimulate the cough reflex.
  • Past or present exposure to tobacco smoke or other pollutants leads to irritation in the airways, which may react by tightening, resulting in coughing.
  • People with COPD have a higher chance of chest infections, which can involve a cough.

A study published in 2020 looked at how cough affected 5,286 people with COPD. The results showed that around 75% of those surveyed had moderate or high levels of cough and phlegm.

Compared with people who had COPD without high levels of cough or phlegm, those with high levels were also more likely to:

  • experience breathlessness
  • have had a COPD flare within the previous year
  • find that COPD disrupts their social life
  • find it hard to carry out daily physical tasks, such as washing and dressing
  • experience anxiety and depression

How does coughing change with COPD?

Several conditions that affect the lungs, such as asthma, can cause coughing. However, a cough caused by asthma often results in breathing difficulties that come and go, and the person may experience more significant coughing at night. Specific triggers and allergens may worsen the symptoms.

That said, some studies suggest that up to 25% of people with COPD also have some form of asthma. Whatever triggers the symptoms of asthma in these people may also trigger a COPD flare.

Having both conditions can also affect the type of cough and other symptoms the person has. Scientists are looking into whether both conditions may have a similar underlying cause.

A person with COPD may find that their cough:

  • is worse in the morning or upon getting up
  • is accompanied by fatigue
  • is constant or becomes worse during a flare-up
  • is accompanied by thick mucus, often yellow in color
  • does not respond to treatment

A person with COPD may find that their breathing is stable for a time, and then there will be times when their condition gets worse.

During these episodes, called flare-ups, a cough may become more productive, and a person may cough more frequently. A person with COPD may also find that their chest feels tighter.

How does coughing from COPD change over time?

COPD symptoms, including the frequency and severity of the cough, tend to worsen over time. There are four stages of COPD, and some research suggests that the most severe decline happens at stage 2, when the measurement of a person’s forced expiratory volume in 1 second (FEV1) is in the 50–70 range.

However, studies also suggest that if a person quits smoking or stops inhaling the particles that are causing lung inflammation, the rate of decline can go back to that of a normal lung within 5 years.

A person with a severe COPD-related cough may have more frequent flare-ups of COPD symptoms.

Having certain health conditions can also contribute to a cough with COPD. These include gastroesophageal reflux disease (GERD) and a condition called occult bronchiectasis. This is an inflammation of the lung’s airways that causes increased mucus production and can also cause bleeding.

How does COVID-19 affect people with COPD?

There are various ways of treating a cough, but a person with COPD often finds that their cough does not respond to treatment.

Quitting smoking in the early stages of COPD can help reduce coughing in the long term. However, the longer a person waits to quit, the less effective this is likely to be.

Other options that may help relieve a COPD-related cough are mucolytics, such as carbocysteine or acetylcysteine, which make sputum thinner and easier to cough up.

Carbocysteine comes as pills or capsules that a person can take three or four times a day. Acetylcysteine comes as a white powder for mixing with water. A doctor may recommend acetylcysteine if carbocysteine does not help.

Antibiotics can also help if a cough worsens due to a bacterial infection.

Other options that can help manage COPD include:

  • bronchodilators, which are medications that relax the muscles around the airways, making it easier to breathe
  • inhaled corticosteroids to reduce the inflammation that makes airways smaller and harder to move air through
  • supplemental oxygen, if a doctor advises it
  • breathing techniques, such as box breathing

There is some evidence that inhaled corticosteroids may increase the risk of pneumonia. People should speak to their doctor if they have concerns about this.

Other tips that can help are:

  • avoiding anything known to irritate the lungs, such as smoke, pollution, and cold or dry air
  • getting vaccinated against the flu, pneumonia, and pertussis (whooping cough) to prevent illness
  • using special coughing techniques to clear mucus from the lungs
  • participating in a pulmonary rehabilitation program, which can teach people with COPD new ways to breathe
  • seeking palliative care, which can help manage pain and stress as COPD progresses
  • exploring complementary therapies, such as yoga or acupuncture, which may help improve quality of life

Pulmonary rehabilitation therapy involves exercises and techniques to reduce breathlessness and cough and help people build up a better tolerance to physical activity.

There is evidence that pulmonary rehabilitation can:

  • improve lung muscle strength
  • boost quality of life
  • reduce the risk of readmission after spending time in the hospital with COPD
  • reduce the risk of dying from COPD-related complications in those with severe disease

One example of a special coughing technique is “deep coughing.” This involves taking a deep breath, holding the breath for 2–3 seconds, then engaging the stomach muscles before releasing the air. This controlled deep cough method is more effective in clearing the lungs than an irregular, hacking cough according to National Jewish Health.

While these treatments may reduce symptoms associated with COPD, scientists have not yet identified any definitive treatment or cure for coughs related to COPD.

Which treatments can help during a COPD flare?

COPD is a chronic and progressive disease, meaning the symptoms will worsen over time. The time it takes for COPD to get worse varies among individuals, but there are some symptoms that a person with COPD should not ignore.

A person should see a doctor if they have the following symptoms, which can be a sign of COPD:

  • a persistent cough
  • difficulty breathing
  • frequent respiratory infections
  • wheezing
  • excessive sputum production
  • fatigue

People with COPD should seek emergency medical attention if they experience any of the following:

  • difficulty walking or talking due to shortness of breath
  • a worsening of wheezing or other symptoms
  • rapid or irregular heart rate
  • blue- or gray-tinted fingernails
  • fast and hard breathing that does not improve with medication
  • fever
  • chest pain that is new or worsening

Over time, the affected airflow from COPD can cause heart problems that lead to right-sided heart failure. According to the Centers for Disease Control and Prevention (CDC), COPD is the fourth leading cause of death in the United States.

In addition to cough, COPD causes other symptoms that affect a person’s breathing.

Examples include:

  • shortness of breath, usually during everyday activities
  • frequent respiratory infections
  • a blue tinge to the lips or fingernails
  • fatigue
  • excessive mucus production
  • wheezing

If a person experiences these or other symptoms, they should see their doctor. There are many medications and breathing techniques that a person can use to reduce symptoms associated with COPD.

Here, get some tips on how to stop wheezing.

COPD is a lung disease that includes bronchitis and emphysema. Hallmark symptoms include a cough and difficulty breathing. It can be hard to manage a COPD-related cough, as it often does not respond to treatment.

Quitting smoking when a person first has a diagnosis of COPD may help reduce coughing as the disease progresses, and some medications, such as mucolytics, can help manage a COPD-related cough.