Managing Coughing in CPA

Chronic Pulmonary Aspergillosis (CPA) often causes persistent coughing due to lung damage, inflammation, and fungal infection. Managing or minimizing coughing is important for improving comfort and quality of life. Here are strategies to help reduce coughing:

  1. Medical Management – talk to your doctor about these options:
    1. Optimize Antifungal Treatment:
      • Effective Antifungal Therapy: Ensure consistent use of antifungal medications (e.g., itraconazole, voriconazole) to control fungal growth, which may reduce coughing over time.
    2. Treat Coexisting Conditions:
      • Bronchodilators or Inhalers: Use medications that open airways (like salbutamol) to reduce airway irritation.
      • Corticosteroids (if prescribed): May help reduce inflammation but should be used cautiously due to side effects.
    3. Mucolytics and Expectorants:
      • Mucolytic agents (like acetylcysteine) can help thin mucus, making it easier to clear and reducing the need for coughing.
      • Expectorants (e.g., guaifenesin) can loosen mucus, facilitating its expulsion.
  2. Manage Environmental Triggers:
    1. Avoid Irritants:
      • Dust and Mold: Use air purifiers, vacuum with HEPA filters, and maintain a clean home environment.
      • Smoke and Pollution: Avoid smoking or exposure to secondhand smoke and reduce exposure to air pollution.
    2. Control Humidity:
      • Monitor the relative humidity (rh) in your home using a relative humidity meter
      • When necessary (<30%rh), use a humidifier to keep indoor air moist, which can soothe irritated airways.
      • Try to minimise excessive humidity (>60%rh) to prevent mold growth in your home, which can worsen CPA symptoms. NOTE in the UK humidity in the home is strongly driven by the humidity levels outside. This tends to be low in the winter (cold) and higher in the summer as air temperature controls rh. Avoid maintaining high levels in your home by ensuring ventilation is adequate to allow warm, moist air to quickly leave your home eg usually after showering/bathing/cooking/laundry.
  3. Breathing and Cough Control Techniques:
    1. Controlled Coughing:
      1. Sit upright and relax your neck and shoulders.
      2. Take a deep breath in through your nose.
      3. Hold your breath for a few seconds, then cough forcefully from your abdomen.
      4. Repeat only as needed to clear mucus efficiently without prolonged coughing fits.
    2. Pursed-Lip Breathing: Inhale slowly through the nose and exhale through pursed lips to control breathing and reduce the urge to cough.
    3. Huff Coughing: Take a deep breath and exhale forcefully but gently, as if trying to fog up a mirror. This technique clears mucus without causing violent coughing fits.
  4. Lifestyle Modifications:
    1. Stay Hydrated: Drink plenty of water to keep mucus thin and easier to expel.
    2. Nutrition and Diet:
      • Avoid foods that may cause reflux, such as spicy or acidic foods, as gastroesophageal reflux disease (GERD) can trigger coughing.
      • Eat smaller meals and avoid eating close to bedtime.
  5. Complementary Approaches:
    1. Honey and Warm Fluids: Warm drinks like herbal teas with honey can soothe the throat and reduce coughing.
    2. Steam Inhalation: Inhaling steam from a bowl of hot water or using a steam inhaler can help loosen mucus and reduce irritation.
    3. Lozenges and Throat Soothers: Use sugar-free lozenges or hard candies to keep the throat moist and reduce the urge to cough.
  6. Monitor for Complications:
    • Coughing up Blood: If you notice hemoptysis (coughing up blood), contact your healthcare provider immediately. NHS guidelines suggest that if you cough up more than a few streaks of blood you should seek medical advice rapidly ie A&E. Discuss with your doctor about an action plan if this persists.
    • Frequent or Severe Coughing: Persistent coughing despite these measures may require further evaluation for complications like bronchiectasis or infection.
  7. Regular Follow-Up:
    • Routine Checkups: Regular visits with your healthcare provider can help adjust treatment plans if coughing persists.
    • Pulmonary Rehabilitation: Participation in pulmonary rehab programs can provide breathing exercises and techniques to manage coughing.

Summary: To reduce coughing with CPA, focus on optimizing antifungal treatment, managing mucus with hydration and mucolytics, avoiding environmental triggers, and using controlled breathing techniques. Complementary remedies like honey, steam inhalation, and lozenges can also help. Regular monitoring and communication with your healthcare team are essential for managing persistent symptoms. Don’t ignore coughing up blood, especially if it is more than a few streaks in phlegm, seek medical advice quickly (A&E).

Useful NHS resources:

Coughing up blood

Common causes of coughing & what to do