What’s Causing This Productive Cough?

A productive cough, also known as a wet cough, is one that brings up mucus (phlegm). These coughs are common with colds and other respiratory tract infections. Chronic lung diseases like COPD and cystic fibrosis can also cause a productive cough.

In contrast, a nonproductive (dry) cough does not bring up phlegm and is more common with asthma, allergies, flu, COVID-19, and medication side effects.

This article describes the common causes of a productive cough, as well as how the symptoms are treated and when it is time to see a healthcare provider. 

What Does Having a Productive Cough Mean?

A productive cough is one that brings up phlegm or saliva mixed with phlegm (sputum). It is often called a “chesty” or “wet” cough because you can hear a gurgling or rattling sound while you are coughing.

A productive cough usually happens when something irritates the lungs or airways, causing inflammation. With inflammation, tissues of the respiratory tract will swell and produce excess mucus. Coughing is a way for the body to expel the accumulated mucus.

Respiratory infections, chronic lung diseases, and inhaled irritants can trigger inflammation. Depending on the cause, the symptom may be acute (sudden, severe, and generally short-lived) or chronic (long-lasting or recurrent).

What Causes a Productive Cough?

A productive cough is a symptom of many diseases, infections, and medical conditions. Some are relatively mild and others can be potentially serious.

Possible causes of a wet cough include:

• Bronchiectasis: The permanent enlargement of the airways by many causes
• Bronchitis: Inflammation of the large airways of the lungs (bronchi)
• Bronchiolitis: Inflammation of the smaller airways of the lungs (bronchioles)
• Common cold: An upper respiratory infection caused by a variety of viruses
• Chronic obstructive pulmonary disease (COPD): A progressive lung disease strongly associated with cigarette smoking
• Croup: A group of conditions in children that cause breathing problems and a barking cough
• Cystic fibrosis: A genetic disease that causes the excesses production of mucus in the lungs and other parts of the body
• Pneumonia: A lower respiratory infection that causes the air sacs of the lungs (alveoli) to fill with mucus and fluid
• Postnasal drip: The drainage of mucus from the nasal passages to the airways caused by allergies and upper respiratory infections
• Toxic exposure: Caused by the inhalation of smoke, industrial fumes, and other aerosolized toxins
  
• Whooping cough: A childhood bacterial respiratory infection, also known as pertussis
  

People with COVID-19 or the flu may also develop a wet cough if the infection moves into the lungs and cause pneumonia.

How to Get Rid of a Rattly, Productive Cough

The treatment of a productive cough varies according to the cause.

Even so, many cases can benefit from an over-the-counter (OTC) expectorant that helps loosen and thin mucus so that it is easier to cough up. Guaifenesin is the most common expectorant used in OTC medications like Mucinex and Robitussin.

Wet coughs can often be treated at home with remedies like:

• Humidifiers or vaporizers to increase air moisture and ease chest congestion
• Steam inhalation in a shower or over a steaming pot of water to help loosen phlegm
• Warm tea with honey to help ease coughing
• Cough drops containing menthol, eucalyptus oil, or honey 
• OTC pain relievers like Tylenol (acetaminophen) or Advil (ibuprofen)
• OTC antihistamines like Chlor-Trimeton (chlorpheniramine) to ease postnatal drip
• OTC decongestants like Sudafed (pseudoephedrine) to ease chest congestion

If these don't help (or your symptoms are chronic or severe), your healthcare provider may recommend prescription drugs, including:

• Cough syrups containing the opioid drug codeine and the antihistamine promethazine
• Antibiotics to treat bacterial infections
• Bronchodilators like albuterol to open narrowed airways
• Oral or inhaled corticosteroids (steroids) to reduce lung inflammation
  

Chronic coughs associated with COPD and cystic fibrosis may require ongoing treatment with bronchodilators, inhaled steroids, oxygen therapy, and pulmonary rehabilitation.

If a Productive Cough Is Not Getting Better

A productive cough from a cold or minor respiratory infection typically lasts a week or two and can often be treated at home. However, it is important to see a healthcare provider if:

• Your cough is severe
• Your cough lasts longer than three weeks
• You cough up yellowish-green phlegm (a sign of a severe lung infection)
• You cough up pink or red sputum (a sign of bleeding)
• You have a fever over 103 degrees F

To diagnose the cause of your cough, the healthcare will review your medical history and perform a physical exam, paying close attention to lung sounds on their stethoscope.

Other tests may be ordered, including:

• Complete blood count (CBC): A blood test that can check for signs of infection
• Arterial blood gas (ABG): A blood test that checks oxygen levels in the blood
• Sputum culture: Used to identify specific infections or respiratory diseases
• Chest X-ray: Used to check for signs of inflammation, bleeding, or pneumonia
• Pulmonary function tests (PFTs): A battery of breathing tests that help analyze and measure the volume and strength of your lungs
  

Summary

A productive (wet) cough is one that produces phlegm. Common causes include colds, COPD, and pneumonia. Mild cases can usually be treated at home with over-the-counter expectorants and steam inhalation. Severe or chronic coughs may require prescription drugs and other therapies.