People who have ABPA tend produce a lot of mucous in their airway which can become compacted and cause obstructive plugs. These plugs can occasionally be coughed up, which can cause quite intense bouts of coughing.

Managing coughing in an ABPA patient involves addressing both the inflammation caused by Aspergillus and reducing the mucus production that exacerbates coughing. Here are some effective ways to manage coughing with ABPA
https://www.nhs.uk/conditions/cough/
https://www.asthmaandlung.org.uk/symptoms-tests-treatments/symptoms/phlegm

Cough is a prevalent and often distressing symptom for Allergic Bronchopulmonary Aspergillosis (ABPA) patients, driven by airway inflammation, excessive mucus production, or bronchospasm. Here’s how to manage it effectively:

1. Treat the Underlying Cause

  • Corticosteroids:
    • Systemic steroids like prednisone reduce inflammation in the airways.
    • Inhaled corticosteroids (e.g., budesonide, fluticasone) may help if the cough is due to airway inflammation.
  • Antifungal Medications:
    • Itraconazole or voriconazole can decrease the fungal load, reducing the immune response and associated cough.
  • Bronchodilators:
    • Short-acting beta-agonists (e.g., salbutamol) or long-acting bronchodilators can alleviate airway tightening and ease coughing.

2. Mucus Management

  • Hydration:
    • Drink plenty of water to thin mucus, making it easier to expel.
  • Mucolytics:
    • Medications like carbocisteine or N-acetylcysteine can break down mucus.
  • Airway Clearance Techniques:
    • Chest physiotherapy: Tapping on the chest to loosen mucus.
    • Devices: Flutter valves or Acapella can help mobilize mucus.
  • Steam Inhalation:
    • Inhaling steam with or without essential oils (like eucalyptus) can loosen mucus and soothe irritated airways.
  • Humidifiers:
    • Keep indoor air moist to prevent drying of the airways.

3. Reduce Triggers

  • Allergens:
    • Identify and avoid allergens like dust, mold, and pet dander that can exacerbate coughing.
  • Environmental Irritants:
    • Minimize exposure to smoke, strong odors, and air pollution.
  • Dietary Triggers:
    • Avoid foods that might worsen reflux, as acid reflux can trigger cough.

4. Symptomatic Relief

  • Cough Suppressants:
    • If the cough is dry and unproductive, medications like dextromethorphan can be used for short-term relief.
  • Honey and Warm Fluids:
    • Honey in warm water or tea can soothe the throat and reduce coughing.
  • Lozenges:
    • Sucking on lozenges can provide temporary relief for throat irritation.

5. Breathing Exercises

  • Controlled Coughing:
    • Sit upright, inhale deeply through your nose, and cough from your diaphragm to clear mucus effectively.
  • Pursed-Lip Breathing:
    • Helps maintain open airways and reduces irritation.

6. Gastroesophageal Reflux Management

  • Acid Reflux Treatment:
    • If acid reflux contributes to the cough, medications like antacids or proton pump inhibitors (e.g., omeprazole) can help.

7. Monitor for Infections

  • Early Intervention:
    • Treat bacterial or viral respiratory infections promptly, as they can worsen coughing.
  • Sputum Analysis:
    • A persistent productive cough may require sputum culture to rule out infections like Pseudomonas or Aspergillus superinfection.

8. Psychological and Supportive Care

  • Stress Management:
    • Stress can worsen coughing. Practice mindfulness, meditation, or other relaxation techniques.
  • Pulmonary Rehabilitation:
    • A structured program can teach breathing techniques and build lung resilience.

9. Dietary Adjustments

  • Anti-Inflammatory Foods: Foods rich in antioxidants, omega-3s, and vitamins may help reduce inflammation, potentially decreasing cough frequency. Include berries, leafy greens, fatty fish, and nuts.
  • Avoid Mucus-Producing Foods: Some people find that milk can worsen mucus production, so reducing dairy intake might help. Studies suggest that this does not happen but there is a sensation while drinking cold milk that makes it feel like it does. If you prefer to steer away from dairy in your diet please ensure that you replace the calcium and vitamins (D and B12) contained in milk with an alternative eg. oily fish and leafy greens.

10. Regular Follow-Up

  • Frequent assessments by a healthcare provider ensure optimal treatment and adjustment for any worsening symptoms.