Immediate Assessment and Action Required
Given your history of asthma or COPD, you need to determine if this represents a COPD exacerbation requiring antibiotics, versus a self-limiting viral infection that needs only symptomatic care. Brown mucus alone does not automatically indicate bacterial infection requiring antibiotics. 1, 2
Critical Decision Point: Is This a COPD Exacerbation?
Antibiotics are only indicated if you meet at least 2 of these 3 criteria (Anthonisen criteria): 3
- Increased breathlessness beyond your usual baseline
- Increased sputum volume (producing more phlegm than normal)
- Development of purulent sputum (yellow, green, or brown mucus)
If you have only the brown mucus and sore throat without worsening breathlessness or increased sputum volume, this is likely a viral upper respiratory infection that does not require antibiotics. 3
When You DO Need Antibiotics
If you meet 2 or more Anthonisen criteria above, you should receive amoxicillin-clavulanate (Augmentin) 875mg twice daily for 5-7 days. 3 This provides appropriate coverage for the bacteria that commonly cause COPD exacerbations (S. pneumoniae, H. influenzae, M. catarrhalis). 3
Red Flags Requiring Immediate Medical Evaluation
Seek urgent medical attention if you develop any of these: 1, 2, 3
- Fever >38°C (100.4°F) persisting beyond 3 days from symptom onset
- Tachypnea (rapid breathing >25 breaths/minute)
- Tachycardia (heart rate >100 bpm)
- Worsening breathlessness despite using your usual inhalers
- Hypoxemia or feeling like you cannot get enough air
- New focal chest findings or chest pain
These signs suggest possible pneumonia or severe COPD exacerbation requiring chest X-ray and potentially hospitalization. 1, 2, 3
If This Is Just a Viral Upper Respiratory Infection
Most viral upper respiratory infections resolve within 3 weeks, though cough can linger for 3-8 weeks as a post-infectious phenomenon. 1 For symptomatic relief: 1
- Use honey and lemon as your primary treatment—this is as effective as pharmacological treatments and costs nothing 1
- Dextromethorphan 30-60mg (not the standard lower OTC dose) if you have severe dry cough 1
- Avoid antibiotics, expectorants, mucolytics, antihistamines, or routine cough suppressants—these show no benefit for viral infections 1
- Do NOT use codeine or codeine-containing products—they have no greater efficacy than dextromethorphan but significantly more adverse effects 1
Optimizing Your Chronic Disease Management
Up to 45% of acute coughs lasting more than 2 weeks in COPD or asthma patients represent exacerbations of underlying lung disease rather than new infection. 2 Ensure you are: 2
- Using your maintenance inhalers as prescribed
- Not confusing a viral infection with poor baseline disease control
- Monitoring for wheezing, prolonged expiration, or increased use of rescue inhalers
When to Return for Reassessment
Return to your doctor if: 1, 2
- Cough persists beyond 3 weeks
- Fever persists beyond 3 days
- Symptoms worsen despite initial management
- New concerning symptoms develop
At that point, alternative diagnoses should be considered including pertussis, Mycoplasma/Chlamydophila pneumoniae, undiagnosed or poorly controlled asthma/COPD, post-nasal drip, or gastroesophageal reflux. 1, 2
Common Pitfalls to Avoid
Do not assume brown or colored mucus automatically means bacterial infection requiring antibiotics. 1, 3 Purulent nasal discharge does not predict bacterial infection in otherwise stable patients with upper respiratory symptoms. 3 The color of mucus reflects inflammatory cells and is normal even in viral infections. 1, 2
Do not reflexively take antibiotics for every cough episode—this contributes to antimicrobial resistance and provides no benefit for viral bronchitis. 1, 2 Focus on the Anthonisen criteria to guide antibiotic decisions. 3