Causes of productive cough
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Common Causes of Productive Cough
A productive cough, also known as a "wet" cough, is characterized by the presence of mucus or phlegm. Several respiratory and non-respiratory conditions are frequently associated with this symptom. The most common causes include bronchiectasis, chronic bronchitis, asthma, eosinophilic bronchitis, chronic rhino-sinusitis, chronic obstructive pulmonary disease (COPD), and, less commonly, immunodeficiency and protracted bacterial bronchitis (PBB) in adults 12347.
Respiratory Tract Disorders and Productive Cough
Bronchiectasis and Chronic Bronchitis
Bronchiectasis and chronic bronchitis are leading causes of chronic productive cough. Both conditions involve persistent inflammation and damage to the airways, resulting in excess mucus production and frequent coughing to clear the airways 127.
Asthma and Eosinophilic Bronchitis
Asthma and eosinophilic bronchitis can also present with a productive cough, especially when airway inflammation leads to increased mucus secretion. These conditions are often treatable and may overlap with other causes 124.
Chronic Obstructive Pulmonary Disease (COPD)
COPD, which includes chronic bronchitis and emphysema, is a significant cause of productive cough, particularly in smokers and those exposed to environmental pollutants. The presence of frequent productive cough in COPD is linked to worse symptoms and a higher risk of future exacerbations 47.
Upper Airway and Non-Respiratory Causes
Chronic Rhino-Sinusitis
Chronic rhino-sinusitis is a common but sometimes overlooked cause of productive cough, especially in young adults. Mucus from the upper airways can drip down the throat (post-nasal drip), triggering a cough reflex and leading to persistent symptoms 34.
Infections and Immunodeficiency
Acute and chronic infections, including bacterial infections like whooping cough (pertussis), can cause a productive cough. In pertussis, specific bacterial toxins and host responses lead to excessive coughing. Immunodeficiency can also predispose individuals to recurrent infections and chronic productive cough 16.
Environmental and Lifestyle Factors
Smoking and Pollutant Exposure
Tobacco smoking and exposure to environmental pollutants are strongly associated with productive cough. These factors contribute to airway inflammation and mucus overproduction, increasing the likelihood of chronic symptoms 47.
Special Considerations
Protracted Bacterial Bronchitis (PBB)
In adults with idiopathic chronic productive cough who respond to low-dose macrolide therapy, an adult version of protracted bacterial bronchitis (PBB) may be considered as a diagnosis .
Conclusion
Productive cough is most commonly caused by respiratory tract diseases such as bronchiectasis, chronic bronchitis, asthma, COPD, and chronic rhino-sinusitis, but can also result from infections, immunodeficiency, and environmental exposures. Recognizing the underlying cause is essential for effective management and improving patient outcomes 123467.
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