Symptoms and Causes of a Smoker's Cough

Is it smoker's cough or another type of cough?

Getty Images/Michael Krasowitz

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 two or three 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 or sputum can be clear, white, yellow, or even green or brown. A smoking-related cough is usually worse upon awakening and improves over the remainder of the day. Of course, there are many exceptions, and you never want to dismiss a morning cough.

Causes of Smoker's 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. (There are several chemicals in cigarettes smoke that do this including formaldehyde). 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.

It's important to note that one of the ways by which smoking may lead to lung cancer is through this paralyzation of the cilia. Since the toxins and chemicals present in cigarette smoke are left in place (because the paralyzed cilia aren't removing them from the lungs) they have more time to cause damage to sensitive lung tissue, including the DNA damage that can lead to lung cancer.

How Common Is a Cough in People Who Smoke?

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

Differentiating Smoker’s Cough

Unfortunately, the answer is that you really can’t differentiate a smoker's cough from a lung cancer cough. 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 

Sometimes a cough is the only symptom that a person has lung cancer, but other times it is the combination of symptoms which raises concern. Other "warning" symptoms that your cough could be more serious include:

  • Coughing up blood: If you cough up blood—even a small amount on only a single occasion—it’s important to make an appointment to see your doctor. Coughing up blood is the first symptom of lung cancer for 7 percent of people with the disease. In addition, coughing up blood can be very serious. Coughing up as little as a teaspoon or two of blood is considered a medical emergency (it can cause aspiration).
  • 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. Many people note that their first symptom of lung cancer is simply a vague sensation of greater difficulty catching their breath with activity.
  • Unexplained weight lossMost 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.
  • Pain with breathing: Pain with breathing, also referred to as pleurisy or pleuritic chest pain, often suggests that the lining of your lungs (the pleura) may be affected. Since smoking alone doesn't usually damage these membranes, a visit to your doctor is a must.
  • Pain in your lungs, your shoulders, or your backIt's not uncommon for symptoms such as shoulder pain, back pain,  pain in the shoulder blades, or pain between the shoulder blades to be the only symptom (in addition to a cough) when someone develops lung cancer.

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 a Smoker's Cough

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 that may help your cough include:

  • Staying well-hydrated. Drinking eight 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 cup of warm tea. Better yet, a cup of green tea. Several studies have found green tea to be associated with a lower risk of lung cancer.
  • 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, mucus 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 researchers 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. Check out these superfoods which may reduce the risk of lung cancer.

Complications of a Smoker's Cough

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.

Why Smoker's Cough Increases After 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.

A Word From Verywell

As a final reminder: If you have a cough that persists—even if you believe it’s just a smoker's 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. A 2016 study found that people who smoke are less likely than non-smokers to seek medical attention for "alarm" symptoms of lung cancer—symptoms such as a cough or hoarseness. Don't wait.

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. Learn more about lung cancer screening.

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