What Is Smoker's Cough?

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Smoker's cough is a persistent cough that results from damage to the airways—the bronchi and bronchioles that lead to the lungs—caused by toxins in cigarette smoke. Over time, smoker's cough can lead to hoarseness and chest pain, and can be among the signs and symptoms of lung cancer. The most effective way to treat smoker's cough is to kick the habit. Once this is accomplished, simple measures such as gargling with salt water, sleeping with your head propped up, and sucking on throat lozenges can help relieve smoker's cough until it subsides.

Incidence of Smoker's Cough

In one study of young military recruits, 40% experienced a chronic cough with sputum production versus 12% in nonsmokers. Since a smoker's cough is more common in long-term smokers, the actual percentage is likely much higher than this.

Smoker's Cough Symptoms

As with any type of cough, a smoker’s cough is, in basic terms, a forceful expulsion of air to clear an irritant from the airways. However, there are certain characteristics that can make a smoker's cough unique:

  • Persistent and nagging, lasting more than two or three weeks
  • Wheezing or crackling sound
  • Wet and productive, meaning phlegm or sputum, a mucousy substance that can be clear, white, yellow, or even green or brown, may be expelled. Note, however, that in the early stages of smoker's cough or in people who haven't been smoking long, the cough may be dry.
  • Worse upon awakening, with a tendency to lessen over the course of the day


A 2016 study found 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.

There are few complications associated with smoker's cough. That said, repeated hard coughing can strain chest muscles and even lead to broken ribs. Women with a persistent smoker's cough may experience stress incontinence.

Coughing usually begins to diminish within three 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—tiny hair-like cells that catch toxins in inhaled air and move them towards the mouth to prevent them from reaching the lungs—that are now repaired and are working to remove foreign material from the throat, trachea, and airways. Smoking cessation cough is temporary, though it may last for a few months.

Causes

The damage to the cilia lining the airways is caused by certain chemicals in tobacco smoke, such as formaldehyde, which paralyze the delicate structures and render them unable to capture toxins. As a result, the toxins are able to enter the lungs, where they settle and create inflammation.

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.

Since the toxins and chemicals present in cigarette smoke are left in place, they have time to cause damage to sensitive lung tissue, including the DNA damage that can lead to lung cancer.

Diagnosis

A smoker's cough can be diagnosed based on symptoms and a history of smoking. However, it's virtually impossible to differentiate a smoker's cough from a lung cancer cough.

If you have a chronic smoking-related cough, it’s important to see your doctor if it changes in any way—becomes more frequent, is uncomfortable, or starts to sound different.

You also should be aware of certain changes that may be warning signs of lung cancer:

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

Hemotypsis (coughing up blood): This is the strongest predictor of lung cancer, although only a fifth of people with this disease have this symptom. Even a small amount of blood is a cause for concern and should be evaluated by a doctor as quickly as possible.

Coughing up as little as a teaspoon or two of blood is considered a medical emergency (it can cause aspiration).

  • Hoarseness that lasts more than a few days, or isn’t accompanied by other typical cold symptoms.
  • Wheezing, which isn't always an indication of asthma
  • Shortness of breath, which often manifests as trouble catching your breath with activity
  • Unexplained weight loss
  • Pleurisy or pleuritic chest pain: Pain with breathing that can suggest damage to the lining of lungs (the pleura)
  • Pain in the upper body, specifically the lungs, shoulders, between the shoulder blades, or back

Lung Cancer Screening

Certain people who smoke—regardless of whether they have a chronic cough, are advised to have a yearly low-dose computerized tomography (CT) scan of the lungs, which is the best way to detect lung cancer in the earliest possible stage. Screening is recommended for those who:

  • Are between 50 and 80
  • Have a 20 pack-year or more history of smoking
  • Currently smoke or have quit within the past 15 years

Treatment

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.

how to ease a smoker's cough
Verywell/Emily Roberts

It’s also important to keep in mind that coughing has a function—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 contribute to a cough, such as household mold, exhaust from a wood stove or fireplace, or exposure to chemicals in the workplace.

Coughing has a function, so suppressing the cough reflex isn't always a good idea.

Talk to your doctor before you use any prescription or over-the-counter cough suppressants, and first consider other measures that may help:

  • Stay well-hydrated: Drinking eight 8-ounce glasses of water per day can help thin secretions in the respiratory tract.
  • Gargle with saltwater.
  • Suck on cough drops or lozenges to soothe your throat.
  • Drink tea. In one study, just half a teaspoon of honey was found to be more effective than many over-the-counter cough preparations in reducing cough symptoms.
  • Inhale eucalyptus: One way to do this is to place fresh leaves of either herb into a bowl and pour boiling water them. Drape a towel over your head to contain the vapors and lean over the bowl just close enough to breathe them in.
  • Elevate your head during sleep: This will prevent mucus from pooling in your throat.
  • Exercise can help to remove phlegm, in addition to its other benefits.
  • Eat a healthy diet: Although unproven, some researchers believe including lots offruits and cruciferous vegetables, such as broccoli and cauliflower, can help the body to detoxify some of the chemicals in inhaled tobacco smoke.

Frequently Asked Questions

Can lungs be repaired after quitting smoking?

Yes! Lungs are a self-repairing organ, and smoking cessation will immediately begin the process. In addition to diminished smoker's cough, in only a few months, lung function can dramatically improve. After one year, the risk of heart attack and stroke drop by half, and that risk continues to drop each year thereafter.

If what appears to be smoker's cough turns out to be lung cancer, what are the survival rates?

The five-year relative survival rates for lung cancer depend on how far it spreads. Localized lung cancer that has not spread outside the lungs has a five-year survival rate of 63%. Lung cancer with regional spread, meaning it has spread to nearby lymph nodes or structures, has a five-year survival rate of 35%. Lung cancer with distant metastasis, or cancer that spread to distant parts of the body like the brain or liver, has a 7% five-year survival rate.

A Word From Verywell

If you're a smoker and you have a cough that persists—even if you believe it’s just a smoker's cough rather than a symptom of lung cancer—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.

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