An Overview of Smoker’s Cough
Sanja Jelic, MD, is board-certified in sleep medicine, critical care medicine, pulmonary disease, and internal medicine.
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. But what causes this cough, and how is it treated?
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?
Smoker’s Cough Symptoms
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.
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.
We tend to focus on the physical effects of symptoms in medicine, but the 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 for a long time, you may be accustomed to the sound and disruption. The same may not be true for your boss and colleagues.
Coughing After Quitting
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 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 ease the cravings and emotions that accompany quitting.
The airways are lined with cilia, tiny hair-like cells that catch toxins in the 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 cigarette 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. In other words, a morning cough in people who smoke can be a good thing.
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.
There isn’t a lot of information about how often people who smoke develop a 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.
Since cough is so common in people who smoke, yet it’s the most common symptom of lung cancer people are told to watch for, how can you tell if your cough is only due to smoking, or instead something else?
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 another serious lung condition such as chronic obstructive pulmonary disease (COPD) is a persistent smoker’s cough.
If you have a chronic smoking-related cough, it’s important to see your doctor if it changes in any way.
For example, you should see your doctor if your cough becomes more frequent, is uncomfortable, or if it sounds different to you. There are other signs and symptoms that might indicate your cough could be due to another medical condition that should be evaluated.
Sometimes a cough is the only symptom that a person has 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:
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% 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).
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.
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.
Sometimes people don’t even notice that they are feeling short of breath, but rather notice that they are no longer participating in activities (such as taking a long walk) that might cause shortness of breath.
Unexplained Weight Loss
Most people are delighted if they lose a few pounds, but if you’re not trying, it is often a sign of something serious. It’s thought that around a third of people who lose weight for no reason have underlying cancer. Since smoking is associated with many cancers, not just lung cancer, it’s important to talk to your doctor.
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, Shoulders, or Back
It’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.
In addition to the symptoms noted above, it’s important to note that the symptoms of lung cancer in women often differ from those found in men. These symptoms are often vague and atypical, and for that reason, the diagnosis is more frequently missed early on in women.
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.
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. Also, certain practices that may help your cough include:
- Stay well-hydrated. Drinking eight 8-ounce glasses of water per day can help thin secretions in the respiratory tract.
- Gargle with saltwater.
- Use cough drops or lozenges that soothe your throat.
- 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. Several studies have found green tea to be associated with a lower risk of lung cancer.
- Boil water with mint or eucalyptus leaves, then inhale 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.
- Elevate your head when sleeping. When you lie flat, mucus can pool in your throat, making your cough worse when you awaken.
- Exercise can help to remove phlegm, in addition to its other benefits.
- Eat 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.
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.
Poulose V, Tiew PY, How CH. Approaching chronic cough. Singapore Med J. 2016;57(2):60-3. doi:10.11622/smedj.2016028
Friedemann smith C, Whitaker KL, Winstanley K, Wardle J. Smokers are less likely than non-smokers to seek help for a lung cancer ‘alarm’ symptom. Thorax. 2016;71(7):659-61. doi:10.1136/thoraxjnl-2015-208063
Broekema, M., ten Hacken, N., Volbeda, F. et al. Airway Epithelial Changes in Smokers but Not in Ex-Smokers with Asthma. American Journal of Respiratory and Critical Care Medicine. 2009. 180(12):1170-8.
Learn about smoker's cough, including some signs and symptoms that mean your cough might be something more serious like lung cancer.