What Causes Smoker’s Cough?
Your lungs are lined with tiny hairs that are damaged by tobacco smoke
Smoker’s cough is caused by exposure to tobacco smoke. Your airways are lined with tiny hair-like structures, known as cilia. These tiny cilia rotate upwards together, helping your lower and upper airways clear bacteria, debris and toxins. Several compounds in tobacco smoke (such as formaldehyde) paralyze, shrink, or plain-out destroy the cilia lining your airways, preventing you from being able to effectively keep your lungs clean. Without effective cilia clearing your lower lungs, you must rely on coughing to keep them clear. Smoking also irritates the lungs, which can cause the dry cough that is often the beginning of chronic smoker’s cough. After you smoke, your cilia don’t work, so you must cough to shake loose and expel toxins and mucus from your lungs.
Your lung cilia are also responsible for the cough you might get when you quit smoking. As your cilia regain their function after you quit, they will gently sweep phlegm and debris up from deep inside your lungs, causing you to cough as it this foreign matter is finally cleared out of your airways.
What is Smoker’s Cough and What Does it Sound Like?
If a cough has persisted for more than three weeks, it is known as smoker’s cough. Smoker’s cough begins as a dry cough in individuals who do not smoke often, as the airways are irritated by tobacco smoke. This eventually progresses into a phlegm-producing cough as the airways never have a chance to recover and fully clear themselves, causing phlegm and foreign material to build up. While a cough from a cold starts in the throat and upper airways, a smoker’s cough originates from the lungs and lower airways, places your cilia are responsible for keeping clean.
Difference Between Smokers Cough and Regular Cough
Smoker’s cough sounds different to a regular cough. It is wet, accompanied by wheezing, hacking, and cracking noises as phlegm is forcefully brought up your chest. Generally, coughing episodes are worst in the morning, provide the sufferer with little satisfaction, and can hurt your chest and throat.
Symptoms of Smoker’s Cough
Along with a persistent, wet or dry cough, other symptoms of smoker’s cough include:
- Phlegm that is clear, yellow, green, or white
- Coughing up blood in phlegm
- A crackling sound in the chest when breathing
- Chest pain
- Shortness of breath
- Sore throat
- Postnasal drip – when mucus leaks into your throat from your nose
The Chronic Smoker’s Cough
A chronic smoker’s cough can also have a significant impact on someone’s emotional and social health. Coughing episodes can be embarrassing, interfering with daily life, people around you, and activities that you might enjoy. Confidence may be reduced in people with smoker’s cough, as colleagues and friends can be distracted and irritated by the sound and disruption brought on by a coughing episode.
Types of Smoker’s Cough
There are several different variants of smoker’s cough. How smoker’s cough manifests will differ depending on how frequently someone smokes, and how long they have smoked for.
People who have not smoked for very long, or smoke infrequently, will often develop a dry cough. A dry cough is associated with lung irritation as the airways become inflamed through exposure to cigarette smoke.
Chronic smoker’s cough
As someone continues to smoke for a longer period of time, their lung cilia will have been damaged and non-functioning for an extended amount of time. More phlegm has been produced over time and become trapped deep in the airways, without the help of the cilia to sweep it out. As your lungs try to expel this phlegm and debris, this results in the wet, hacking, wheezing cough known as chronic smoker’s cough.
Some smokers will find their cough more incessant in the morning, improving as the day continues. This increased coughing in the morning can be considered (relatively) as a good thing. As the person has not smoked throughout the night, their cilia have had a chance to heal and regrow, allowing them to catch and expel mucus, increasing the clearance capacity of a smoker’s lungs in the morning. Many smokers find their symptoms improve after their first cigarette of the day; any cilia function and increased lung clearance will now be inhibited again .
How Long Will Smoker’s Cough Last?
Smoker’s cough will persist as long as you continue to smoke. However, even if your lung cilia have been completely destroyed after several years of heavy smoking, they are surprisingly resilient. They will begin the process of regrowth and recovery in a matter of hours after your last cigarette. After several days smoke-free, they will have fully regenerated, and it can take around 6 months for them to reach their normal function.
When It Will Disappear?
Your cough will fully disappear in time after you quit smoking, but this process can take days, weeks or months. Smoker’s cough can also be expected to get worse temporarily after you quit. This is because your lungs are finally able to clean themselves effectively, after an extended period without a good clearance system, so there will be a lot of mucus and debris that needs to be cleared out. Smoker’s cough will eventually disappear, even if you choose to use e-cigarettes as a nicotine replacement therapy.
Treatment of Smoker’s Cough
No treatment of smoker’s cough will be fully effective until you stop smoking.
There are several ways you can ease the symptoms, and speed up recovery after you quit:
- Stop smoking, and avoid situations where you may inhale second hand smoke
- Stay hydrated. This helps thin any mucus in your respiratory tract, making it easier to clear
- Use throat lozenges to soothe a sore throat
- Inhale steam of eucalyptus oil in hot water – this is proven to have antibacterial effects and soothe your lungs 
- Use an extra pillow at night to elevate your head. This prevents mucus buildup in your throat, making you cough less in the night and morning
- Exercise. This will open up your lungs and increase phlegm removal
- Don’t suppress your cough reflex unless you have to. Coughing is your body’s natural way of aiding lung clearance, and it’s likely you have a build-up of foreign material that you need to get rid of
- Salbutamol inhalers can help open up the lungs, limiting intense and unproductive coughing fits 
Complications and Dangers
Complications associated with a smoker’s cough includes
- increased risk of bacterial or viral chest infection, as your body struggles to clear phlegm from your lungs, and;
- changes to your voice, such as hoarseness.
The biggest medical concern for individuals with a chronic smoker’s cough is that these symptoms are also considered the early symptoms of several lung diseases caused by smoking, such as COPD, chronic bronchitis and lung cancer. Smoker’s cough will subside over time after you have quit smoking, but diseases such as lung cancer are far more dangerous. In these cases, the symptoms will persist and progressively worsen.
There is very little distinguishing smoker’s cough from the early symptoms of these fatal lung diseases, leading to these diseases potentially going undiagnosed until it is too late.
If you have not already visited the doctor about your cough, it is high time you booked an appointment if these symptoms occur:
- If you see any change at all in the symptoms of your smoker’s cough
- If it is accompanied by symptoms such as chest pain, shortness of breath, or coughing up large volumes of mucus
- Sudden weight loss – this is a classic symptom of cancer
- Coughing up any amount of blood, or blood-tinged mucus
- Symptoms do not change after you quit smoking
If you cough up blood, even once, it is very important to visit your doctor. Getting screened early for lung diseases can drastically reduce your risks and improve your prognosis.
The only effective way to cure smoker’s cough is to stop smoking. Outlook for smoker’s cough is generally positive, with all symptoms disappearing after a period of time smoke-free. How long it takes for symptoms to fully disappear depends on how long you have smoked for, and how many you smoked a day. As long as your chronic cough is not the early symptoms of a dangerous lung disease, masquerading as smoker’s cough, you can expect all symptoms to disappear after you quit smoking.
Smoker’s cough is a frustrating effect of smoking tobacco long-term. The constant hacking cough can be irritating for smokers and those that surround them, and more dangerously, smoker’s cough can mask the early symptoms of severe and potentially fatal lung diseases associated with smoking. In itself, prognosis for smoker’s cough is very good, however, misdiagnosis of smoker’s cough can be a fatal mistake. Around 65% of people diagnosed with lung cancer have a chronic cough at diagnosis, and it’s often the reason that people initially visit a physician .
1. Pulm Pharmacol Ther. 2004;17(3):127-31. Effect of salbutamol on smoking related cough.
Mulrennan S1, Wright C, Thompson R, Goustas P, Morice A.
2. Elaissi A, Rouis Z, Salem NA, et al. Chemical composition of 8 eucalyptus species’ essential oils and the evaluation of their antibacterial, antifungal and antiviral activities. BMC Complement Altern Med. 2012;12:81.
3. Chest. 2006 Jan;129 Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines. Kvale PA.