Coughs are prominent symptoms of pneumonia. Pneumonia cough can be very distressful, but at the same time, coughs are an important defense against pneumonia. While personally treating thousands of hospitalized patients with pneumonia in the last 15 years, patients and their families have asked me questions about pneumonia cough. In this article, I will answer common but important questions like those about coughs with pneumonia. This article is based on my personal experience as well as a review of relevant medical journals.
What causes pneumonia cough?
The cough reflex is your body’s most important weapon against pneumonia. People who can’t cough properly are at a higher risk of getting pneumonia in the first place.
You need three things for a cough:
- Cough-triggering sensors
- A cough center in the brain
- Nerves and muscles actually needed to cough
Cough-triggering sensors are in the back of the throat, airways, stomach, diaphragm, and the lining of your heart. Pneumonia cough is mainly triggered by sensors in your upper and lower airways.
When you are suffering from pneumonia, your airways are inflamed. You have increased secretions in your airways caused by the immune system. You also have germs causing the pneumonia and dead cells that need to be replaced. All these things act as triggers for the cough sensors.
The cough reflex happens suddenly, and you can’t stop it once it is triggered. Cough sensors activate the cough center in the brain, triggering three events in order:
- Drawing a deep breath
- Blocking and compressing air
- The rapid release of air by suddenly opening the airway
Compressing air in the second step can produce a very high pressure, similar to that created by water 13 feet deep. The rapid release can blow air as fast as 500 miles per hour. This force can clear away germs and irritants.
How long does pneumonia cough last?
Most coughs from pneumonia last for 2 weeks. Some people have significant coughs for 3 weeks. About 20% of people may have lingering coughs for a month. It is very uncommon for pneumonia cough to last longer than six weeks. If you still have coughs six weeks after pneumonia, you need to see your doctor to make sure you haven’t developed anything else.
With regular community-acquired pneumonia, early coughs are usually associated with lots of phlegm. When pneumonia is active, there is significant inflammation inside your lungs. White blood cells (WBCs) and fluids rush to your lungs to fight the infection. Your cough helps get rid of these waste products in the form of thick, yellow phlegm. After about a week, your cough may produce more of a rusty-colored phlegm, as WBCs decrease while dried blood and dead cells increase. As more time passes, you may have more dry coughs than coughs with phlegm.
How can I help pneumonia cough?
First of all, it is important to understand that coughing helps end pneumonia faster. It is important to keep coughing and clearing your airway, especially in the first few days of pneumonia.
Instead of trying to suppress the cough, it is better to try to make your cough more effective so that your airway clears faster. When your airway starts to clear up, your cough will naturally get better.
Most people can simply cough to get rid of phlegm. Others may benefit from learning simple techniques to help make their cough more effective. One such technique is called forced expiratory technique, or FET, also known as huff cough.
Here are the steps:
- Sit down in a comfortable chair
- Relax and take 2 to 3 slow and deep breaths using your belly muscles
- Take another breath in. This time, pause for 2 seconds when your lungs are about 3/4th full.
- Exhale forcefully but slowly with an open throat. Imagine you are trying to fog up a mirror in front of you.
- Repeat steps 3 and 4 twice.
- Take 2 more deep breaths
- Relax and breathe normally
Too many coughs can be stressful, and may cause some problems in some people. It is understandable that people want to reduce their cough under certain situations. Here are some potential but uncommon complications of too many coughs:
- Hernia formation: Parts of the intestines may squeeze through a weak spot in your belly wall and get stuck.
- Rib fracture: The high pressure created while coughing may actually break your ribs.
- Tearing your food pipe: Too much pressure and jerking movements inside your chest may tear your food pipe and cause bleeding.
- Fainting: Some people may faint from coughing too much.
- Rupture of a surgical wound: Forceful coughs after surgery may tear open the sutured wound
If you are at risk of these complications, you may want to try to reduce your cough. Unfortunately, there are no truly effective treatments to reduce coughs in everyone. You may need to try a few things and see what works for you.
Simply drinking warm beverages may help soothe cough receptors in some people, improving their cough. Some people find throat lozenges helpful in controlling the impulse to cough. A teaspoon of honey may ease coughs for others.
If you are a smoker, it is very important to stop smoking in order to recover quicker from pneumonia. When you stop smoking, your pneumonia cough might also improve.
If you are a non-smoker, it is important to avoid environments that may irritate your airways. Do not let anyone smoke near you, and do not go to dusty places. If you have a history of asthma, you need to be extra careful to avoid triggering your asthma.
If none of these things help your cough, you can try over-the-counter cough medications that have one or both of these ingredients: dextromethorphan or guaifenesin. They may help some but not all people.
If you are still having trouble with your cough and are worried about any complications, you can call your doctor and decide if prescription cough suppressants would be useful. Prescription cough suppressants are discouraged in most people with pneumonia.
Why is pneumonia cough worse at night?
Some people find pneumonia cough especially worse at night. Some possible reasons for pneumonia cough worsening at night are:
- Ineffective phlegm removal: During the day, you are more active. You may have been coughing at regular intervals, keeping your airways clean. At night, phlegm may accumulate, potentially waking you up with forceful coughs.
- Post-nasal drip: Some people get more mucus in the back of the nose and throat when they have pneumonia. During the day, mucus stays down due to gravity and you clearing your throat from time to time. At night, mucus may accumulate in the back of your throat, making you cough.
- Acid reflux: Stomach acid usually increases during sickness and stress. When you lie down at night, stomach acid may flow backwards to your throat, making you cough.
There are no clear-cut ways to help reduce pneumonia cough at night. Sometimes, keeping your head higher with a propped pillow may help. If you have increased mucus, an antihistamine such as Benadryl may help. If you have other symptoms of acid reflux, you can try an OTC acid reducer. Call your doctor if your symptoms worsen.
In conclusion, coughs are a very important defense against pneumonia. You need to regularly cough to keep your airways clear so that you can recover from pneumonia. In certain situations, too many coughs can cause problems. There is no clear-cut solution to help pneumonia cough. Try a few options and see what helps you.