What can be done for excessive coughing due to phlegm?

Management of Excessive Coughing with Phlegm

The most effective way to reduce or eliminate cough with phlegm is to avoid respiratory irritants, particularly smoking cessation which resolves cough in 90% of patients within months. 1

First-Line Approaches

• Simple home remedies should be tried first, including honey and lemon mixtures which provide symptomatic relief before considering medications 1, 2
• Adequate hydration helps thin secretions and makes coughs more productive, improving clearance of phlegm 2
• Guaifenesin helps loosen phlegm and thin bronchial secretions to make coughs more productive 3
• Dextromethorphan is recommended for short-term symptomatic relief of coughing, with maximum cough suppression occurring at 60mg doses 1, 2
• Menthol lozenges or vapor can provide acute, short-lived cough suppression by working through cold and menthol sensitive receptors 1, 2

Respiratory Techniques

• Positive expiratory pressure techniques are recommended as they are effective, inexpensive, safe, and can be self-administered to help clear phlegm 4
• Huffing should be taught as an adjunct to other methods of sputum clearance, particularly effective in patients with chronic bronchitis 4
• Chest physiotherapy can be effective for increasing mucus clearance in conditions causing moist cough 4

Pharmacological Options

• Short-acting inhaled β-agonists (like albuterol) may improve cough in patients with chronic bronchitis 1
• Inhaled ipratropium bromide can help reduce cough associated with excessive phlegm 1
• Combined inhaled long-acting β-agonist with inhaled corticosteroid regimens may improve cough in chronic bronchitis 1
• Hypertonic saline solution can be used on a short-term basis to increase cough clearance 4

Not Recommended

• Antibiotics are not helpful for productive cough due to viral infections, even when phlegm is present 1
• Prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, or chest physiotherapy have no proven benefit for chronic bronchitis 1
• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile 2

When to Seek Medical Attention

• If coughing up blood 1
• If experiencing breathlessness 1
• If having prolonged fever and feeling unwell 1
• If you have underlying conditions like COPD, heart disease, diabetes, or asthma 1
• If you've recently been hospitalized 1
• If symptoms persist for more than three weeks 1

Special Considerations

• Chronic productive cough is associated with increased mortality in smokers with early COPD, particularly from respiratory causes 5
• Excessive mucus can contribute to airflow limitation and worsen airway inflammation with retained inflammatory cells and mediators 6
• In small airways, mucous hypersecretion can lead to plugging and severe airway obstruction over time 7
• For effective cough clearance, high linear velocity of gas through the airways is needed, which may be impaired in obstructive lung disease or muscle weakness 8

Remember that excessive coughing with phlegm may indicate an underlying condition like chronic bronchitis, bronchiectasis, or other inflammatory airway diseases that require proper diagnosis and targeted treatment 7, 9.