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What is a Smoker's Cough?

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Updated April 04, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The chronic hacking of a smoker's cough is something most of us are familiar with, whether it’s experienced personally by people who smoke, or overheard by those who don’t. What causes this cough, and how is it treated? And most importantly, how can you tell if your cough is ”only” related to smoking and not because of something more serious, such as lung cancer?

What is a Smoker’s Cough?

A smoker’s cough is a persistent cough that develops in long-term smokers—"persistent" meaning that it's present for more than 2 or 3 weeks. At first it may be dry (in smokers who haven’t smoked for very long), but over time it usually produces phlegm. This phlegm can be clear, white, yellow, or even green in color. The cough is usually worst upon awakening, and improves over the remainder of the day.

What Causes The Cough?

The airways are lined with cilia: tiny hair-like cells that catch toxins in inhaled air and move them upwards toward the mouth. Smoking paralyzes these cells so they're unable to do their job. Instead of being caught in transit, toxins are allowed to enter the lungs, where they settle and create inflammation. This, in turn, leads to coughing as the body attempts to clear these substances from your lungs. During the night, these cilia begin to repair themselves as they're no longer exposed to the toxins in smoke. As the cilia are called upon to catch and remove the accumulated toxins, the result is an increase in coughing upon arising in the morning.

How Common is It?

There isn’t a lot of information about the frequency of smoker's cough. In one study of young military recruits, 40% experienced a chronic cough with sputum production (vs 12% in non-smokers). Since the cough is more common in long-term smokers, the actual percentage is likely higher than this.

How Can You Differentiate a Smoker’s Cough From a Cough That’s Serious?

Unfortunately, the answer is that you really can’t. Sometimes the only sign that you may have lung cancer (or a serious lung condition such as COPD) is a persistent smoker's-cough-sounding cough. If you have a chronic smoking-related cough, it’s important to see your doctor if it changes in any way: if it becomes more frequent or painful, for example, or if it sounds different to you. Certain signs and symptoms can mean your cough could be due to another medical condition that should be evaluated.

Symptoms and Signs That Suggest Your Cough May Be More Serious Include:

  • Coughing up blood – If you cough up blood—even a small amount on a single occasion—it’s important to make an appointment to see your doctor.

  • Hoarseness – If you have a hoarse voice that lasts more than a few days, or isn’t accompanied by other typical cold symptoms, consult your doctor. Hoarseness in people who smoke can be due to many conditions, not just lung problems.

  • Wheezing – If your cough is accompanied by wheezing, it could suggest asthma; but a common saying in medicine is that “not all that wheezes is asthma.” If you notice new wheezing, have it checked out.

  • Shortness of breath – Does it seem to be harder to catch your breath? Is it harder to climb a flight of stairs? Make an appointment with your doctor if you experience any difficulty breathing.

  • Unexplained weight loss – Most people are delighted if they lose a few pounds, but if you’re not trying, it can be a sign of something serious, so have it checked out.

Possible Causes of Related Respiratory Symptoms:

Social Impact

We tend to focus on the physical effects of symptoms in medicine, but a chronic cough can have significant emotional and social implications as well. Imagine attending a play, or a grandchild’s piano recital, or even just a cocktail party. In addition to annoying others who are trying to enjoy themselves, your cough—if it lasts beyond the early morning—can interfere with activities you enjoy. Of course, leisure time isn’t the only concern: unless you work alone, your co-workers may be affected as much as, if not more than, you are by your cough. If you’ve been living with a cough a long time, you may be accustomed to the sound and disruption. The same may not be true for your boss and colleagues.

Treatment

Of course, the best treatment for smoker's cough is to quit smoking altogether. While your cough may worsen for a few weeks after quitting, it almost always improves in time.

It’s also important to keep in mind that coughing has a function: it’s designed to clean the airways by removing foreign materials that are breathed in. In addition to the irritants in cigarette and cigar smoke, there are other materials in the environment that may be contributing to your symptoms. Whether mold from a wet basement, exhaust from a wood stove or fireplace, or exposures to chemicals at work, check to see if there are any irritants in your environment you should try to avoid to improve your cough. Since coughing has a function, suppressing the cough reflex is not always a good idea. Talk to your doctor before you use any prescription or over-the-counter cough suppressants.

Practices and treatments that may help your cough include:

  • Staying well-hydrated. Drinking 8 8-oz glasses of water per day can help thin secretions in the respiratory tract.

  • Gargling with salt water.

  • Using cough drops or lozenges that soothe your throat.

  • Honey. In one study, a teaspoon of honey was found to be more effective than many over-the-counter cough preparations in reducing cough symptoms. You can enjoy a little honey alone, or add it to a warm tea.

  • Boiling water with mint or eucalyptus leaves, then inhaling the vapors. To do this, some people place a towel over the pot of water to help inhale the vapors. Be careful to avoid burns by maintaining a safe distance from the steam, and always keep the pot on a level surface away from children.

  • Elevating your head when sleeping. When you lie flat, mucous can pool in your throat, making your cough worse when you awaken.

  • Exercise. Exercise can help to remove phlegm, in addition to its other benefits.

  • Eating a healthy diet. While it hasn’t been proven, some people believe that a diet high in fruits and cruciferous vegetables, such as broccoli and cauliflower, can aid the body in detoxifying some of the chemicals breathed in through tobacco smoke.

More About Treatment

Complications

Certainly there are many complications of smoking, but there are a few complications related specifically to coughing. Coughing can cause muscle strains in the chest, and even lead to broken ribs. In women, the abdominal pressure caused by coughing can cause stress incontinence. As noted above, a smoker's cough can complicate your social life, and in doing so, your emotional health as well.

Smoker's Cough and Quitting

Coughing usually begins to diminish within 3 months of quitting smoking. Some people are alarmed that immediately after quitting, their cough increases—something referred to as a “smoking cessation cough.” This is normal and due to damaged cilia that are now repaired and doing their job of removing foreign material from the throat, trachea and airways. It’s important to understand that this worsening of coughing is temporary, and though it may last for a few months, quitting will really help your cough in the long run. If you want to hit two birds with one stone after you quit, consider increasing your exercise program. In addition to helping to clear your cough more rapidly, it can also help with the cravings and emotions that accompany quitting.

As a final reminder: If you have a cough that persists—even if you believe it’s just a smokers cough—talk to your doctor. A persistent cough is one of the most common symptoms of lung cancer, and with lung cancer, the earlier it’s caught, the greater the chances are of being cured. For some people, especially those between the ages of 55 and 74 who have at least a 30 pack-year history of smoking, CT screening for lung cancer might be something you wish to consider.

Sources:

Braman, S. Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006. 129(1 Suul):104S-115S.

Broekema, M. et al. Airway epithelial changes in smokers but not in ex-smokers with asthma. American Journal of Respiratory and Critical Care Medicine. 2009. 180(12):1170-8.

Hamari, A. et al. High frequency of chronic cough and sputum production with lowered exercise capacity in young smokers. Annals of Medicine. 2010. 42(7):512-20.

Sitkauskiene, B., and P. Dicpinigaitis. Effect of smoking on cough reflex sensitivity in humans. Lung. 2010. 188 Suppl 1:S29-32.

Yamane, T. et al. Productive cough is an independent risk factor for the "development of COPD in former smokers. Respirology. 2010. 15(2):313-8.

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