COPD and Cough: What You Need to Know

Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung condition that makes it difficult to breathe due to obstructed airflow. The most common symptoms include shortness of breath, wheezing, chest tightness, and a persistent cough.

Smoking is the most common cause of COPD. It damages the airways and lung tissue over time, leading to chronic inflammation, reduced lung function, and increased mucus production. Other causes include long-term exposure to air pollution, occupational dust and chemical fumes, and rare genetic conditions such as alpha-1 antitrypsin deficiency.

The risk increases with the number of years and quantity of cigarettes smoked. Even passive exposure to smoke can contribute to lung damage. Quitting smoking is the single most effective step to slow the progression of COPD and reduce the frequency and severity of symptoms. That cough—especially when productive—is often one of the clearest early signs.

In the UK, around 1.2 million people have been diagnosed with COPD, though many more may be living with it unknowingly. Early signs are often brushed off as age or lifestyle-related changes.

Cough is a common symptom in COPD, but many other conditions, such as asthma, reflux, rhinitis, and bronchiectasis, can also cause a chronic cough. Focusing specifically on the relationship between cough and COPD helps us better understand how to approach care and treatment.

How are COPD and cough related?

Coughing can be triggered by many different conditions:

• viral infections like the cold or flu

• allergic rhinitis (nasal drip)

• asthma

• acid reflux

• environmental exposures

• chronic lung conditions such as COPD

A persistent, chesty cough is common in COPD, though not everyone experiences it. The presence and nature of the cough often depend on the dominant type of COPD:

• chronic bronchitis is typically associated with a daily, productive cough

• emphysema, a component of COPD, is more often linked to breathlessness, with less frequent coughing

What is a COPD cough like?

• long-standing and often worse in the morning

• produces thick, sticky mucus

Why does COPD cause coughing?

• inflammation and airway narrowing

• damage to the tiny hair-like structures (cilia) that clear mucus

• enlarged mucus glands producing excess phlegm

• structural blockages that make clearing the lungs harder

If you’re coughing up a lot of phlegm, testing a sputum sample can help rule out any hidden infection. Similarly, a CT scan can help identify issues like bronchiectasis, which can coexist with COPD.

Symptoms and severity of COPD

COPD symptoms can range from mild to severe and often progress over time. Common symptoms include:

• persistent cough (often with phlegm)

• shortness of breath, especially with exertion

• wheezing

• chest tightness

• frequent chest infections

The GOLD staging system (Global Initiative for Chronic Obstructive Lung Disease) is used to classify COPD severity based on spirometry results and symptom burden:

• GOLD 1 (mild): minor airflow limitation; few symptoms

• GOLD 2 (moderate): worsening airflow and increasing symptoms

• GOLD 3 (severe): marked airflow limitation, frequent symptoms and exacerbations

• GOLD 4 (very severe): severe airflow limitation, possible respiratory failure

Understanding the stage of COPD helps guide treatment decisions and monitor progression.

How are COPD and a cough diagnosed?

Getting to the root of a chronic cough means looking at the full picture – what’s driving the cough, and whether COPD or something else is at play.

Common investigations include:

• spirometry – a simple breathing test that measures airflow obstruction to assess lung function

• sputum culture – checks for infection or unusual bacteria in your mucus

• blood tests – assess oxygen levels and look for signs of inflammation or anaemia

• chest X-ray – offers a general overview of the lungs and can help identify potential issues such as infections or structural changes

• CT scan – provides more detailed lung images to detect scarring, mucus build-up, and anatomical abnormalities. It also helps assess for features of emphysema (a component of COPD) and detect coexisting conditions like bronchiectasis.

What treatments are available?

There’s no one-size-fits-all solution – but with the right combination of approaches, cough and COPD can be well managed.

Self-care tips:

Some small changes can make a big difference:

• stop smoking – still the most important step to take

• avoid pollutants and dust – be aware of local air quality by using apps like London Air, and consider interventions like purifiers or masks on high-pollution days

• keep moving – regular activity helps maintain lung health and preserve muscle strength, which can ease symptoms and improve daily function

• stay well-hydrated – this can help thin mucus

• try breathing exercises – such as pursed-lip breathing or diaphragm work

Medical treatments:

At Welbeck, we take a personalised, evidence-led approach to managing both COPD and chronic cough:

• inhalers and bronchodilators – open up narrowed airways for easier breathing

• Inhaled corticosteroids – reduce inflammation; often combined with bronchodilators in a single device

• oral steroid tablets – typically used short-term during flare-ups or lung attacks

• finding the right inhaler – choosing the appropriate device matters; factors like inhaler type (dry powder or pressurised), ease of use, and inspiratory flow rate all play a role

• antibiotics – if a bacterial infection is present

• mucolytics – medicines that make mucus easier to cough up

• pulmonary rehab – improves symptoms, breathing, and quality of life

• chest physiotherapy – useful for people struggling to clear mucus

• treating coexisting conditions – like reflux, asthma or nasal inflammation

• ongoing follow-up – to adapt treatment as needed

There aren’t treatments developed specifically to stop a COPD-related cough, but managing the underlying disease and clearing the airways effectively can go a long way.

New and emerging COPD treatments

There’s growing interest in improving outcomes for people with COPD, especially those who struggle with mucus build-up and recurrent infections. While no treatment currently exists to target cough directly, several new therapies are being investigated. These options are still in clinical trials and not yet available to all patients:

• biologic therapies – used in asthma, now being trialled in select COPD patients with high eosinophil counts to help reduce exacerbations

• mucus-focused treatments – research is exploring the role of excess mucus in symptom severity and how it may be addressed more effectively in future treatments

Cutting-edge inhaler technologies:

These advanced inhaler types are in development or early use and may expand options for COPD care:

• breath-triggered inhalers – automatically release medication upon inhalation, reducing technique-related errors

• next-generation dry powder inhalers – enable delivery of complex medicines such as biologics directly to the lungs

• soft mist and adaptive aerosol systems – improve drug deposition deep in the lungs with minimal effort

• smart inhalers – integrate with mobile apps to monitor usage, track adherence, and provide feedback

• low-carbon propellants – developed to reduce the environmental footprint of pressurised inhaler devices

The final say

A persistent, productive cough shouldn’t be ignored. It may be due to COPD, but equally, it could stem from something else. Getting the diagnosis right is crucial, so the treatment can be too.

There are many ways to help. Whether that’s ruling out other causes like bronchiectasis, improving your inhaler regimen, or getting the right support from a chest physiotherapist. Even if we can’t stop the cough completely, we can usually make it far more manageable.

Take the first step toward better breathing – make an appointment to see a Welbeck respiratory specialist today.