A cough is often one of the first symptoms of pulmonary fibrosis. It is usually persistent and gets worse over time. It may be dry or tickly, but in some cases the cough can be productive of mucus. There are on-going clinical trials for cough in PF.

Why do we cough?

Cough is a natural reflex, which protects the lungs from any inhaled foreign matter. But it can be a difficult and debilitating symptom to manage

If your cough is getting worse, it’s a good idea to talk to your medical team, especially as your pulmonary fibrosis progresses. A respiratory tract infection, such as a cold, flu or pneumonia, can aggravate it. Coughing can also occur with other lung diseases as well as viral or bacterial infections.

You may also ask them to check your medication in case any of your treatments are triggering your cough.

Managing acid reflux

Gastric acid reflux or indigestion can make coughing worse. There are some simple things you can do to help reduce acid reflux:

  • Avoid fatty and spicy foods
  • Eat smaller and more frequent meals
  • Try to lose weight if you're overweight
  • Wear loose clothing – avoid tight waistbands
  • Try to find a relaxation technique that suits you. This might be yoga, reading, listening to music or taking a warm bath.
  • Raise one end of your bed 10 to 20cm by putting something under your mattress or pillow – make it so your chest and head are above the level of your waist, so stomach acid does not travel up towards your throat

You can also speak to a pharmacist for advice if you keep getting heartburn. Over-the-counter medicines called antacids can help ease your symptoms. It's best to take these with food or soon after eating, as this is when you're most likely to get heartburn. They may also work for longer if taken with food.

I find my cough both frustrating and embarrassing at times. Talking about my pulmonary fibrosis with friends and family helps. It seems they don't notice it anymore. But when I'm working I often have to mute calls.

Drug treatments for your cough

Your GP may suggest medication if lifestyle changes aren’t helping. These can include:

  • codeine phosphate linctus
  • low dose oramorph (an oral version of morphine)
  • gabapentin (an anticonvulsant medicine).

If your cough is productive of sputum or mucus, your doctor may suggest a mucolytic therapy, such as carbocisteine. These treatments ‘break up’ mucus, making it runnier and easier to cough up and clear from the lungs.

Coping strategies for your cough

Here are a few ideas to help you cope with different types of cough. If your cough is troublesome, then you should speak to your doctor or respiratory nurse for further advice and treatment.  Your medical team can always seek advice from the hospital or community palliative care team, who are symptom control experts.

Dry coughs

A dry, tickly cough is common and can be tiring and irritating both for you and those around you. When there is no phlegm, these cough suppression techniques may help:

  • Take small sips of a warm drink regularly (warm water or warm honey and lemon can be soothing).
  • Suck a sweet.
  • Try to breathe through your nose to warm and moisten the air so that it is less irritating to the airways.
  • Hold your breath for a few moments and try swallowing your saliva.
  • Keep the breathing slow and gentle if you can.
  • Simple linctus or codeine linctus (in a little hot water) helps some people - although there is no clinical evidence that plant-based remedies or inhalations help.
  • Try to avoid going from heat to cold quickly as this can trigger a cough.
  • A scarf pulled up round your nose and mouth on very cold windy days may stop cold air making you cough.

Active cycle of breathing

If your cough produces phlegm, it is better not to use the suggestions above to suppress it. Being dehydrated can make phlegm thicker, stickier and more difficult to cough up.

The active cycle of breathing technique is a five-stage breathing pattern which can help loosen and clear the phlegm. It is good to practise this regularly to clear your chest.

1. Relaxed gentle breathing: through the nose if possible, relaxed shoulders, tummy rising with the breath in.
2. Deep breathing
: slowly through the nose, keeping the shoulders relaxed, holding for a couple of seconds if you can, then letting the breath out gently through the mouth. Repeat three or four times to get air behind any phlegm in the airways and begin to move it upwards.
3. Relaxed breathing
: repeat stage 1.
4. Huffing
: take a medium breath in and then breath out fast through your open mouth, as if misting up a mirror. Repeat with a larger breath but just once, to avoid triggering a coughing bout before the phlegm is in the upper airway.
5. Cough
: if it feels as though there is phlegm to clear, take a deep breath and cough once or twice.

Repeat this cycle until the phlegm is cleared, going back to relaxed breathing each time.

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