Morning cough with phlegm

What is a Cough?

Coughing is relatively painless, but it can be irritating or distracting to others, and the effort of coughing can leave you feeling achy and fatigued.

A cough, is, ahem, your body’s way of responding when something irritates your throat or airways. Coughing, from short throat-clearing to wheezing to full-on hacking, can be voluntary or involuntary, short-term or long-lasting, a symptom of a physical problem or a sign of a psychological disorder.

A cough can signal anxiety. People who cough compulsively for no reason may be experiencing discomfort or stress.

An occasional cough is normal and healthy. A cough that persists for several weeks or one that brings up discolored or bloody mucus may indicate a condition that needs medical attention.

Coughing is relatively painless, but it can be irritating or distracting to others, and the effort of coughing can leave you feeling achy and fatigued. Persistent coughing that doesn’t subside with treatment usually means something is wrong with your health.

Coughing occurs when air is sucked down into the lungs but gets trapped when the epiglottis, the little trapdoor that covers the entrance to your trachea (windpipe), closes. Next, muscles in the belly and chest contract, forcing air out of your trachea, causing the cough.

Causes

Coughs can be either acute or chronic. Acute coughs begin suddenly and usually last for two to three weeks. Acute coughs are the kind most people experience. The most common causes of acute coughs are a cold, the flu, or acute bronchitis. Acute coughs are often productive coughs, meaning they produce mucus or phlegm that comes from the lungs and throat.

Acute coughing fits can be worse in the morning and evening, when phlegm and fluid settle in the lungs.

Causes of acute cough include:

  • Common cold
  • Influenza (flu)
  • Inhaling an irritant
  • Strained or pulled abdominal muscle
  • Whooping cough (very rare)

Chronic coughs last longer than two to three weeks, and some people cough every day. Dozens of conditions can cause a recurrent, lingering cough, but nearly 90 percent of chronic coughs are caused by postnasal drip, asthma, gastroesophageal reflux disease (GERD), chronic bronchitis, and a class of medications called angiotensin-converting enzyme (ACE) inhibitors used to treat blood pressure.

If you don’t have any of these risk factors, and you don’t smoke, check your environment for toxins like mold, irritants, or secondhand smoke, all of which can contribute to chronic coughing. Coughing can also be caused by dry or thin air quality.

A persistent dry, hacking cough may be a side of effect of medication. Up to 20 percent of people who take ACE inhibitors to treat hypertension experience this side effect. Women and racial minorities are more likely to be affected. Because switching brand names isn’t effective, if you take an ACE inhibitor and have an annoying cough that won’t go away, discuss your options with your doctor.

Common causes of chronic cough include:

  • Allergies
  • Asthma (most common in children)
  • Bronchitis
  • GERD (gastroesophageal reflux disease)
  • Postnasal drip
  • Smoking
  • Throat disorders, such as croup, in young children

Other causes of coughing, both chronic and acute, include:

  • Acute sinusitis
  • Bronchiectasis
  • Bronchiolitis (especially in young children)
  • Choking
  • Chronic sinusitisCOPD (chronic obstructive pulmonary disease)
  • Croup (especially in young children)
  • Cystic fibrosis
  • Emphysema
  • Heart failure
  • Laryngitis
  • Lung cancer
  • ACE inhibitors
  • Neuromuscular diseases, such as Parkinson’s, which weaken the coordination of the upper airway and swallowing muscles
  • Respiratory syncytial virus (RSV) (especially in young children)
  • Tuberculosis

Treatment

A cough can be treated in a variety of ways, depending on the cause. For healthy adults, most treatments will involve self-care.

A cough that results from a virus can’t be treated with antibiotics. You can, however, soothe it in the following ways:

  • Keep hydrated by drinking plenty of water.
  • Sip hot liquids, especially tea or water with lemon.
  • Elevate your head with extra pillows when sleeping.
  • Use cough drops to soothe your throat.
  • Gargle hot salt water regularly to remove mucus and soothe your throat.
  • Avoid irritants, including smoke and dust.
  • Add honey or ginger to hot tea to relieve your cough and clear your airway.
  • Use decongestant sprays to unblock your nose and ease breathing.

Persistent Cough

Having a persistent cough is a symptom of chronic obstructive pulmonary disease (COPD). People with COPD have difficulty breathing that is caused by conditions called chronic bronchitis and emphysema.

People often have a short-term cough because of a cold, flu, or other respiratory infection or virus. This kind of cough goes away completely after a few days or weeks. A cough is called “persistent” if it lasts for a long period of time, such as for many weeks or months.

When does a persistent cough occur?

During the early stages of COPD, a person may cough more often in the early morning. During the later stages of the disease, the coughing may happen throughout the entire day. People with COPD may also cough during the night, which can keep them from sleeping well.

Coughing caused by COPD is often productive. This means that the cough produces mucus, which is also called sputum or phlegm. The cough pushes the mucus up through the airways and into the throat and then mouth. For this reason, many people with COPD need to “clear their throats” often, especially in the morning. This mucus can be clear or white, yellow, or green in color. But if the mucus is not clear, it may be a sign of a respiratory infection. 1,2,3

What causes a persistent cough in COPD?

Coughing is a natural function of the body that plays an important role in the breathing system. It helps move extra mucus out of the lungs through the airways. Coughing is also a reaction that helps to remove any kind of irritants that a person might inhale into the lungs. People who are smokers may also have a persistent cough, but it is not always a symptom of COPD.

People with COPD often have a persistent cough because they have chronic bronchitis, which means that their airways are constantly irritated. The irritation is commonly caused by smoking, but it can also be caused by other types of irritants, such as pollution.

The irritation in the airways causes two problems that prevent enough air from passing through to the lungs:

  • The lining of the airways becomes swollen
  • Too much mucus is produced by the lungs

People with chronic bronchitis can have a persistent cough because they have to regularly clear their swollen airways of this excess mucus. 2,4

Is having a persistent cough a common symptom of COPD?

Persistent coughing is very common for people with COPD. One reason is that it is a main symptom of chronic bronchitis. People are diagnosed with chronic bronchitis if they have a persistent cough that lasts for at least three months during two years in a row. Many people with COPD have at least some symptoms of coughing due to chronic bronchitis.3

Can a persistent cough be treated?

Whether or not a cough should be treated with medication or other remedies depends on the type of cough. Patients should consult with their healthcare providers to figure out the best way to deal with their coughing.

Some coughs serve a useful and important purpose of clearing mucus from the airways. In those cases, it can be better not to prevent the coughing.

If the cough is due to mucus that is very thick, then drinking more fluids can help to make it thinner and easier to clear. If this does not work well enough, then there are medicines called “expectorants” that can help make the mucus easier to cough up.

Sometimes the coughing might become painful or difficult to control. In those cases, healthcare providers might recommend cough “suppressants” that keep the body from coughing. These suppressants might also be used for coughs that do not produce mucus.

For people with COPD, coughing can also cause what is called a “bronchospasm” or “spasm.” This happens when the muscles around the airways suddenly tighten up. This narrows the airways and makes it hard to breathe. To help with coughing that causes spasms, healthcare providers might prescribe special types of inhaled medications called “bronchodilators” or inhaled steroids.2

Ten common causes of persistent morning cough, page 1 of 4

By Dr. Al Rowland

Do you have a persistent morning cough that just doesn’t go away? The persistent morning cough can be a frustrating symptom to deal with.

What kind of cough?

What is your persistent morning cough like? A barking cough can mean you have bronchitis. A high-pitched cough can mean you’re having problems with the narrowing of your airways. A wheezing cough can mean you’re suffering from either asthma or bronchitis. A loud gasping cough and trouble taking in air can mean you’re suffering from whopping cough.

The causes

What are the common causes of the persistent morning cough? There are many common causes. And there are several common causes that many people don’t even consider. The ten common causes of the persistent morning cough are as follows:

Asthma

What are the ten common causes of persistent morning cough? Asthma is one of the ten common causes of persistent morning cough. Asthma is often associated with wheezing and shortness of breath. If you have asthma, your cough is more common at night.
What are the ten common causes of persistent morning cough? There is a variant of asthma — sometimes known as cough-variant asthma — that can give you a persistent morning cough that is both dry and non-productive. So, what is one of the ten common causes of persistent morning cough? The cough-variant asthma is one of the ten common causes of persistent morning cough.

Dairy and other denatured foods

What are the ten common causes of persistent morning cough? Consumption of dairy foods is one of the ten common causes of persistent morning cough. Why? Because dairy foods poison your system and produce mucus. (3)
What are the ten common causes of persistent morning cough? Watch out for other denatured foods, too, such as tea, coffee, Coca-Cola, meat, alcohol, tobacco, ordinary sugar, white flour, and white rice. So, what is one of the ten common causes of persistent morning cough? Consumption of dairy and other denatured foods is one of the ten common causes of persistent morning cough. Why? Because denatured foods poison your system and produce mucus. (3) …More >>
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Question: My husband has a problem with his gag reflex. It only happens when he brushes his teeth, but every time he puts the toothbrush past his lips it makes him gag. Any theories?

Answer: If you’re someone who wakes up in the morning worried you’re about to gag up a furball when you stick a toothbrush in your mouth, you are not alone. In fact, you’re one of many people who suffer from an overactive gag reflex. You don’t necessarily have to tolerate it, however.

Most of us understand gag reflex as what happens when the dentist sticks some futuristic whirling device in your mouth — or when the doctor pops in a tongue depressor. In fact, it is relatively common for daily routines to be interrupted by the gag reflex. It’s not abnormal: in fact, it’s actually neurological; related to the nervous system.

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The reaction does not necessarily occur because you are so disgusted that you feel like retching, although this is the common definition of gag and has been infused into North American slang, giving birth to clichéd expressions such as “gag gift” and “gag me.”

The gag reflex is controlled by the brain stem, the part of the brain that prevents choking and aspiration, and ensures normal swallowing. Sometimes, however, the reflex is overactive or impaired.

When the palate is stimulated by an object such as that toothbrush, a sensory message travels to the brain stem where a motor neuron sends a message to raise the palate and cause the throat muscles to contract. This prevents food and drink from entering improper passageways such as the trachea or the nose.

An overactive gag reflex is not life-threatening, and it is possible to correct it or at least alleviate some of the discomfort. Certain individuals experience an overactive gag reflex, which can be attributed to many factors including an oversensitive palate, illness in general, or learned behaviour. In some cases, it is actually a response to fear.

To decrease the activity of a gag reflex, you can apply numbing spray or local anesthetic, available from your local pharmacy, to the back of the throat.

By contrast, an impaired gag reflex can be serious and must be investigated and the consequences addressed. Certain medical conditions can cause individuals to lose control of their motor skills, often making one more prone to a weak gag reflex. Disorders that can affect the gag reflex include stroke, Lou Gehrig’s disease and Guillain-Barré syndrome.

As well, surgical patients and sedated individuals often have sluggish gag reflexes. They cannot protect their own trachea (the tube that connects your mouth and nose to your lungs), and as a result they often aspirate and choke. To compensate for the impaired gag reflex, in such instances, an air tube is inserted to protect the trachea.

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Despite the gag reflex being controlled by the brain stem, some individuals can consciously manipulate the reflex — either suppressing the action or inducing it. For example, sword swallowers learn how to suppress their gag reflex, allowing them to stick a sword down the esophagus toward the stomach. And individuals with bulimia, an eating disorder, may use the gag reflex to purge themselves. The more sensitive their palate, the more likely it is that they will be able to vomit intentionally.

The gag reflex performs an essential role in the body and it is important it works properly. If you think your gag reflex is unusual or abnormal, you should speak to your family doctor or dentist.

— Dr. Allan Gordon, neurologist and director of Wasser Pain Management Centre at Mount Sinai Hospital

Ask The Doctor appears every other Tuesday. E-mail your questions to

Spontaneous gagging can have many causes

The most likely cause is GERD. Gastroesophageal reflux disease is a common condition in which acid backwashes into the throat. Reflux, either chronic or occasional, can be the result of excess acid production; a weak or improperly functioning hiatus (the ring of muscle that connects the esophagus and stomach); hiatal hernia (in which a portion of the stomach slides into the esophagus or alongside it in the chest cavity); diet/lifestyle; etc.

Symptoms can include a burning sensation within the chest, a sour taste in the mouth, dry cough, regurgitation of food or liquids (which may result in gagging), sore throat, chest pain, difficulty swallowing (which may cause gagging) and more. People with reflux do not always experience symptoms, and for some, symptoms may appear unrelated.

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Just because your husband’s gagging does not appear to be related to the acid reflux doesn’t mean that it isn’t. I suggest your husband make some moderate lifestyle changes to see whether his symptoms improve. He should exercise on a regular basis; avoid fatty, greasy and acidic foods; and consume more whole grains, fruits and vegetables. He may also wish to use over-the-counter or prescription medication daily to try to prevent symptoms.

Other possibilities include vagus-nerve impingement, esophageal spasms, smoking and achalasia.

Achalasia is rare, occurring in about one in 100,000 people, so this is not likely the problem. It causes regurgitation and difficulty swallowing, both of which can result in gagging.

Esophageal spasms are abnormal muscle contractions within the throat that typically causes pain and difficulty swallowing.

Vagus-nerve impingement can cause nausea, vomiting, gagging and more, but it is most common in people who have had sinus surgery or head injury.

Smoking is another common cause of gagging that is often overlooked. Smokers, especially heavy smokers, are damaging their lungs with the habit, and as the damage progresses, excess fluid and mucus can accumulate in the lungs and drip down the back of the throat. This situation can cause difficulty breathing, coughing, a choking sensation and gagging until the mucus can be expelled.

© 2010, United Feature Syndicate, Inc.

Coughing at Night? Doctors Explain 7 Possible Causes—and How to Treat Them

Allergies? A cold? Acid reflux? No matter what the cause, there’s a simple reason behind all your hacking: “A cough is a protective mechanism to clear your airway,” explains Jonathan Parsons, MD, a pulmonologist at the Ohio State University Wexner Medical Center.

There are a number of ways doctors can get to the bottom of what’s causing that cough. “First question we’d want to know is: Is cough part of the daytime symptoms as well?” explains Joseph Khabbaza, MD, a pulmonologist at Cleveland Clinic.

While it’s impossible to always pinpoint a cough by how it sounds, there are some key differences to give you clues as to what’s going on. Here’s how to tell what that cough really means.

Postnasal drip

Sounds like: Either a dry or wet cough. It’s caused by mucus dripping down your throat (due to either allergies or a cold), which tickles nerve endings, triggering coughing, Dr. Parsons says.

Sometimes this cough is worse at night. Additionally, a tickly feeling at the back of your throat can be a symptom of postnasal drip. If it’s due to allergies you may also have itchy eyes and sneezing.

If you suspect allergies, try an over-the-counter antihistamine. But if that doesn’t help after a couple weeks, see your doctor, who can refer you to an allergist for skin testing. If it’s due to a residual cold, you can try natural remedies like saline washes and steam to help relieve congestion, but if the cough lingers for more than a week see your doctor to rule out a sinus infection, which might require antibiotics.

RELATED: Your 12 Worst Allergy Mistakes

Sounds like: A dry cough that ends with a rattle or wheeze. People with asthma have inflamed airways, which can cause difficulty breathing as well as wheezing and coughing.

The cough gets worse at night or while exercising. Additionally, chest tightness, shortness of breath, and fatigue might accompany asthma.

To check for asthma, your doctor will most likely order spirometry, a lung function test, Dr. Parsons says. Two types of medications can treat it: quick-relief drugs (bronchodilators like albuterol, which make it easier to breathe) and drugs you take daily to keep asthma under control, such as leukotriene modifiers (like Singulair).

GERD

Sounds like: A dry, spasmodic cough. Short for gastroesophageal reflux disease, GERD is when acid from your stomach backs up into your esophagus. It’s actually the second most common cause of chronic cough, causing about 40% of cases, according to a 2006 review published in Nature.

If you’re only coughing at night, acid reflux could quite possibly be to blame for your cough, Dr. Khabbaza says, since stomach acid can creep up when you lay down to go to sleep at night.

A GERD-induced cough gets worse when you’re lying down or eating. “The classic sign is coughing that starts as soon as you lie down in bed at night,” says Dr. Parsons. About 75% of GERD patients with chronic cough have no other symptoms, but if you do they can include heartburn and hoarseness.

Diagnostic tests may include an x-ray of your upper GI tract and/or an endoscopy (where your doctor inserts a thin, flexible tube down your throat to examine it). GERD is treated with OTC or prescription meds to reduce acid production, like Pepcid AC, Zantac, or Prilosec. Additionally, Dr. Khabbaza says, you might want to consider eating your least meal three or four hours before going to bed to avoid coughing throughout the night.

RELATED: 11 Surprising Symptoms of Acid Reflux

COPD

Sounds like: A chronic, hacking cough that produces a lot of mucus, particularly in the morning, Dr. Parsons says. COPD, or chronic obstructive pulmonary disease, includes both chronic bronchitis and emphysema; the main cause is smoking.

COPD coughing gets better as the day progresses. Patients with COPD also experience shortness of breath, especially with physical activity; wheezing; fatigue; and chest tightness.

Lung function tests such as spirometry and a chest x-ray are used to diagnose COPD. The disease is treated with meds like bronchodilators and inhaled steroids; it’s also imperative to stop smoking. In extreme cases, you may need oxygen therapy.

Medication-related cough

Sounds like: A dry cough. A group of drugs known as ACE inhibitors are commonly prescribed to treat high blood pressure; they can cause cough in about 20% of patients.

A medication-related cough begins a few weeks after starting these meds, Dr. Parsons says.

If your cough is mild, you may be okay switching to a different ACE inhibitor, Dr. Parsons says, but if it’s severe, you’ll want to switch to another type of blood pressure medicine entirely, such as an angiotensin receptor blocker or ARB, like Cozaar.

RELATED: 10 Natural Ways to Lower Blood Pressure

Pneumonia

Sounds like: Initially a dry cough which after a few days turns to a wet cough with yellow, green, and/or red or rust-tinged mucus.

Additional symptoms include fever, chills, trouble breathing, and pain when breathing in deeply or coughing

Your doctor can usually tell if you have pneumonia by listening to your chest with a stethoscope, although she may order an x-ray and blood tests to determine if it’s viral or bacterial, Dr. Parsons says. Treatment for the latter is antibiotics; if it’s viral, the only remedy is rest, OTC cough meds, and chicken soup.

Whooping cough (pertussis)

Sounds like: A severe hacking cough that ends with a whooping sound as you breathe in. While this disease used to be extremely rare thanks to vaccines introduced back in the 1940s, it’s now seeing an upswing—in 2012, there were more than 48,000 cases reported, the most since 1955, according to the CDC.

The first symptoms are similar to the common cold: stuffy, runny nose, watery eyes, fever, and cough. But after about a week the classic coughing signs emerge, with hacking so intense you may throw up or turn red or blue, Dr. Parsons says.

Pertussis is diagnosed with blood tests and a chest X-ray. It’s treated with antibiotics.

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  • By Hallie Levine
  • By Maggie O’Neill

— — intro: Allergies? A cold? Acid reflux? No matter what the cause, there’s a simple reason behind all your hacking: “A cough is a protective mechanism to clear your airway,” explains Jonathan Parsons, MD, Director of the Cough Clinic at the Ohio State University Wexner Medical Center.

While it’s impossible to always pinpoint a cough by how it sounds, there are some key differences to give you clues as to what’s going on. Here’s how to tell what that cough really means.

15 Diseases Doctors Often Get Wrong

quicklist:1 category: title:Postnasal drip url: text: Sounds like: Either a dry or wet cough. It’s caused by mucus dripping down your throat (due to either allergies or a cold), which tickles nerve endings, triggering coughing, Dr. Parsons says.

Other telltale symptoms: The cough is worse at night; there’s a tickly feeling at the back of your throat. If it’s due to allergies you may also have itchy eyes and sneezing.

Diagnosis and Rx: If you suspect allergies, try an over-the-counter antihistamine. But if that doesn’t help after a couple weeks, see your doctor, who can refer you to an allergist for skin testing. If it’s due to a residual cold, you can try natural remedies like saline washes and steam to help relieve congestion, but if the cough lingers for more than a week see your doctor to rule out a sinus infection, which might require antibiotics.

Your 12 Worst Allergy Mistakes

quicklist:2 category: title:Asthma url: text: Sounds like: A dry cough that ends with a rattle or wheeze. People with asthma have inflamed airways, which can cause difficulty breathing as well as wheezing and coughing.

Diagnosis and Rx: To check for asthma, your doctor will most likely order spirometry, a lung function test, he says. To treat it, there are two types of medications: quick-relief drugs (bronchodilators like albuterol, which make it easier to breathe) and drugs you take daily to keep asthma under control, such as leukotriene modifiers(like Singulair).

quicklist:3 category: title:GERD url: text: Sounds like: A dry, spasmodic cough. Short for gastroesophageal reflux disease, GERD is when acid from your stomach backs up into your esophagus. It’s actually the second most common cause of chronic cough, causing about 40% of cases, according to a 2006 review published in Nature.

Other telltale symptoms: Your cough gets worse when you’re lying down or eating. “The classic sign is coughing that starts as soon as you lie down in bed at night,” says Dr. Parsons. About 75% of GERD patients with chronic cough have no other symptoms, but if you do they can include heartburn and hoarseness.

Diagnosis and Rx: Tests may include an x-ray of your upper GI tract and/or an endoscopy (where your doctor inserts a thin, flexible tube down your throat to examine it). GERD is treated with OTC or prescription meds to reduce acid production, like Pepcid AC, Zantac, or Prilosec.

11 Surprising Symptoms of Acid Reflux

quicklist:4 category: title:COPD url: text: Sounds like: A chronic, hacking cough that produces a lot of mucus, particularly in the morning, Dr. Parsons says. COPD, or chronic obstructive pulmonary disease, includes both chronic bronchitis and emphysema; the main cause is smoking.

Other telltale symptoms: The cough gets better as the day progresses; shortness of breath, especially with physical activity; wheezing, fatigue, and chest tightness.

Diagnosis and Rx: Your doctor will usually recommend lung function tests such as spirometry and a chest x-ray. The disease is treated with meds like bronchodilators and inhaled steroids; it’s also imperative to stop smoking. In extreme cases, you may need oxygen therapy.

quicklist:5 category: title:Medication-related cough url: text: Sounds like: A dry cough. A group of drugs known as ACE inhibitors are commonly prescribed to treat high blood pressure; they can cause cough in about 20% of patients.

Other telltale symptoms: Cough begins a few weeks after starting these meds, Dr. Parsons says.

Diagnosis and Rx: Talk to your doctor. If your cough is mild, you may be okay switching to a different ACE inhibitor, he says, but if it’s severe, you’ll want to switch to another type of blood pressure med entirely, such as an angiotensin receptor blocker or ARB, like Cozaar.

quicklist:6 category: title:Pneumonia url: text: Sounds like: Initially a dry cough which after a few days turns to a wet cough with yellow, green, and/or red or rust-tinged mucus.

Other telltale symptoms: Fever, chills, trouble breathing, pain when breathing in deeply or coughing

Diagnosis and Rx: Your doctor can usually tell if you have pneumonia by listening to your chest with a stethoscope, although she may order an x-ray and blood tests to determine if it’s viral or bacterial, Dr. Parsons says. Treatment for the latter is antibiotics; if it’s viral, the only remedy is rest, OTC cough meds, and chicken soup.

quicklist:7 category: title:Whooping cough (pertussis) url: text: Sounds like: A severe, hacking cough that ends with a whooping sound as you breathe in. While this disease used to be extremely rare thanks to vaccines introduced back in the 1940s, it’s now seeing an upswing—in 2012, there were more than 48,000 cases reported, the most since 1955, according to the CDC.

Other telltale symptoms: The first symptoms are similar to the common cold: stuffy, runny nose, watery eyes, fever, and cough. But after about a week the classic coughing signs emerge, with hacking so intense you may throw up or turn red or blue, he says.

Diagnosis and Rx: Pertussis is diagnosed with blood tests and a chest X-ray. It’s treated with antibiotics.

This article originally appeared on Health.com.

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