Coughing up mucus is usually the result of a cold, a respiratory infection, or a lung condition. The mucus comes from the windpipe or lungs and is also called sputum. In general, the complaint goes away on its own. Persistently coughing up a lot of mucus or a clear change in the mucus sometimes requires further evaluation.

What is mucus?

The mucous membranes on the inside of the airways continuously produce a thin layer of mucus. This mucus keeps the airways moist and traps, among other things, dust particles and bacteria. Tiny cilia move the mucus toward the throat. Most of the time you then swallow it without noticing.

With irritation or inflammation the airways produce more mucus. The mucus is sometimes also thicker and stickier. As a result, it remains more easily in the airways and triggers the urge to cough to expel it.

What is sputum?

Sputum is mucus that comes up from the windpipe or lungs and exits through the mouth. Sputum is therefore different from snot. Snot originates in the nose and sinuses, while sputum comes from the lower airways.

Coughing helps remove excess mucus from the airways. It is therefore a natural cleaning reaction of the body.

What does coughed-up mucus look like?

The amount, color, and thickness of sputum differ per person and per cause. The mucus may be:

Clear or white.
Yellow or green.
Thin and watery.
Thick, tenacious, or sticky.
Foamy.
Mixed with a small amount of blood.

Clear or white mucus fits with normal mucus production or mild airway irritation. Yellow or green sputum occurs, among other things, with inflammation. Color alone does not tell whether bacteria or viruses are the cause. Therefore, green mucus does not automatically mean that antibiotics are needed. A small amount of blood sometimes arises from damage to a small blood vessel after forceful or prolonged coughing. Coughing up a lot of blood always requires contacting the (family) doctor.

Possible causes of coughing up mucus

Common cold or respiratory infection

A viral infection is a common cause of coughing up mucus. The mucous membranes become irritated and produce extra mucus. There are often other symptoms as well, such as a sore throat, a stuffy nose, fatigue, or a low-grade fever.

Acute bronchitis

In acute bronchitis the larger airways are inflamed. Frequent coughing and producing mucus are the main features. In addition, there may be a wheezing breath, shortness of breath, fatigue, or a burning feeling behind the breastbone. Most symptoms decrease within a few weeks. The cough sometimes lasts longer.

Pneumonia

A pneumonia causes coughing with thick yellow or green mucus. Other possible symptoms are fever, shortness of breath, chest pain, chills, and severe fatigue. Symptoms sometimes start suddenly, but can also develop gradually.

Asthma

In asthma the airways are hypersensitive and regularly inflamed. This leads, among other things, to coughing, shortness of breath, a wheezing breath, and extra mucus. Symptoms often vary in severity.

COPD

People with COPD (chronic obstructive pulmonary disease) have long-term problems with coughing and mucus. Especially in the morning, sputum frequently comes up. During a worsening of symptoms (exacerbation) coughing, the amount of mucus, and shortness of breath suddenly increase.

Smoking and other irritants

Tobacco smoke damages the cilia in the airways and stimulates mucus production. As a result, mucus remains present longer. Vaping, air pollution, dust, and chemical fumes also irritate the airways.

Bronchiectasis

With bronchiectasis parts of the airways are permanently widened and damaged. Mucus therefore remains behind more easily. People with this condition cough up larger amounts of sputum daily and regularly have respiratory infections.

What helps with stubborn mucus?

Drinking enough keeps the mucous membranes moist. Regularly drinking water or tea sometimes makes thick mucus easier to cough up. Moving and regularly changing position support the drainage of mucus.

Try to avoid smoke, dust, and strong odors as much as possible. Also ensure fresh air indoors. Smoking and secondhand smoke irritate the airways and increase mucus production.

Cough up the mucus gently when it loosens. Frequent and forceful coughing irritates the airways and may actually cause more coughing triggers. In chronic airway or lung conditions a physical therapist may teach breathing or coughing techniques to remove mucus more effectively.

When to contact the family doctor?

Contact your family doctor if:

There is blood in the coughed-up mucus.
Shortness of breath or breathlessness is increasing.
There is chest pain.
High fever or persistent fever occurs.
There is drowsiness, confusion, or signs of severe illness.
Coughing lasts longer than a few weeks.
There are repeated episodes with a lot of sputum.
There is a clear and lasting change in the amount, color, or thickness of the mucus.
There is unexplained weight loss.
There is a long-standing productive cough in someone who smokes or used to smoke.

Call your family doctor or the emergency number immediately if there is severe shortness of breath, rapid deterioration, or coughing up a larger amount of blood.

Examination

The family doctor asks, among other things, about the duration of the symptoms, the amount of mucus, and accompanying symptoms. The doctor then usually listens to the lungs.

Depending on the symptoms, additional testing sometimes follows. This may include a pulmonary function test, blood test, an X-ray of the lungs, or examination of the sputum. In sputum testing, a laboratory looks, for example, for the presence of bacteria or other pathogens.

Treatment

Treatment depends on the cause. A viral infection usually clears on its own. Rest, drinking enough, and avoiding smoke support recovery.

With asthma or COPD, medications aim to reduce inflammation and open the airways. Antibiotics only help with certain bacterial infections and are not needed for most respiratory infections.

With long-standing mucus build-up, special breathing and coughing techniques may help. A physical therapist teaches how to remove mucus from the airways with as little effort as possible.

Coughing up mucus