What causes smoker's cough? Diagnosis, prevention, and treatment

Overview: What is smoker’s cough?

A smoker’s cough is exactly what it sounds like—a cough due to smoking. Inhaling too much smoke can cause irritation to the lungs and cause a smoker’s cough. This cough may even linger after you stop smoking. Most smokers will develop a smoker’s cough. People who are exposed to secondhand smoke may also develop a smoker’s cough. This cough may start out as a hacking, dry cough but becomes more phlegmy as it progresses. Other symptoms may include sore throat, difficulty breathing, chest pain, and wheezing. This cough often worsens in the morning, lessening as the day progresses. 

What causes smoker's cough?

Causes of smoker's cough include:

• Smoking: About 16 million people in the United States have health problems caused by smoking (this includes all types of smoking, including marijuana and vaping). Every time you take a puff of a cigarette, chemicals enter the body and make it harder for the cilia (tiny, hair-like structures that move debris up and out of the airways) to filter out dangerous toxins. Toxins start to build up in the body, causing inflammation and a persistent cough. As the smoker’s cough progresses, the body starts to make thick phlegm (mucus). Over time, this inability to filter out toxins can lead to medical conditions such as chronic obstructive pulmonary disease (COPD, which includes emphysema and chronic bronchitis), lung cancer, COVID-19, mesothelioma, and others.

Other smoker's cough causes include secondhand smoke. This is when people other than the smoker inhale tobacco smoke. Being exposed to secondhand smoke can lead to the same health effects as smoking. 

Risk factors for smoker's cough

You are at higher risk for developing smoker's cough if you are:

• A current or past smoker: this includes any type of smoking (such as cigarettes, cigars, marijuana/cannabis) or vaping and may even affect people who use smokeless tobacco

• Exposed to secondhand smoke

Is smoker's cough serious? When to see a doctor

While smoker's cough may start out as a minor annoyance, symptoms will generally worsen or progress and can lead to various illnesses and medical conditions, including:

• COPD, which includes emphysema (a lung condition often caused by smoking that makes breathing difficult) and chronic bronchitis (long-term inflammation of the bronchi, or airways of the lungs, that causes frequent coughs)

• Rheumatoid arthritis (RA): Smokers have a higher risk of developing RA, a chronic autoimmune inflammatory condition where the body attacks its own tissue, causing pain and inflammation in many joints and in severe cases, internal organs

• Lung cancer

• Mesothelioma: a rare type of cancer that occurs in the lining of the chest wall and lungs, causing symptoms like cough, chest pain, and shortness of breath

• Colds and respiratory infections such as the flu and COVID-19

• Incontinence: Chronic coughing puts a lot of pressure on the pelvic muscles, causing them to weaken. This increases the chance of stress incontinence.

• Bladder cancer

You should see a healthcare provider if your symptoms last more than a few weeks or are severe or otherwise concerning. Also, if you have early symptoms of lung cancer, you should see a healthcare provider right away as lung cancer is very aggressive, so early detection is important. Early symptoms of lung cancer include: 

• Shortness of breath

• A persistent cough

• Losing weight

• Coughing up blood 

• Chest pain 

• Lung pain 

How is smoker's cough diagnosed?

When you visit a healthcare provider, they will start by taking a medical history—asking about any current or past medical conditions, family history, medications you take, and more. They will ask questions about your cough, such as:

• When did your cough start?

• Is the cough dry, or do you have mucus? If you have mucus, what color is it? 

• How often are you coughing? Is it interfering with work or daily activities?

• Is there anything that makes it better or worse?

• Do you notice that the cough is better or worse at certain times of the day?

• Are you coughing up blood?

• Is anyone you know sick with a respiratory infection?

• Do you smoke or vape? If not, are you exposed to secondhand smoke?

• Do you have any other symptoms, like sore throat, shortness of breath, chest pain, or fever?

Your healthcare provider will perform a physical exam and may order tests such as:

• Blood tests

• Mucus tests

• X-ray

• CT scan

• Lung function tests

• Tests to see how reactive your lungs are

Even if you smoke, your healthcare provider will want to rule out other causes of a chronic cough, such as:

• Gastroesophageal reflux disease (GERD)

• Asthma

• Sinus conditions

• Allergies 

• Tuberculosis

If your healthcare provider determines that you have a smoker’s cough, they will advise you to quit smoking right away. They can give you recommendations and support to help you stop smoking. If your smoker’s cough is due to secondhand smoke, your healthcare provider will tell you to stay away from smoke. If you have any other associated complications, your healthcare provider can address those problems as well.

Is smoker's cough curable or preventable?

The first step and best way to get rid of a smoker's cough (and keep it from returning) is to stop smoking. You can also benefit from avoiding secondhand smoke and trying some home remedies for symptom relief.

Stop smoking

The health benefits of stopping smoking don’t end with less coughing and better lung health. Here are just some of the benefits of quitting smoking:

• Better health and quality of life

• Life expectancy increases by as much as 10 years

• Lowered risk for many types of heart problems, lung problems, and many types of cancer

• Helps pregnant individuals and their babies

• Reduces financial burden

• Protects others from breathing secondhand smoke

If quitting smoking seems overwhelming, ask a healthcare provider for recommendations. They can guide you by recommending over-the-counter treatments such as nicotine replacement products or prescribing medication such as bupropion. They can also provide recommendations for other types of support like therapy and free coaching.

Avoid secondhand smoke

Secondhand smoke is no joke—it causes over 7,000 lung cancer deaths every year in people who do not even smoke. It can also cause other lung and heart problems as well as various other illnesses and complications. If you don’t smoke, and you are around others who do, the best case scenario would be for them to quit smoking—however, if they are not ready to quit, then you will need to take steps to avoid exposure to secondhand smoke, such as not allowing anyone to smoke in your home or car (this includes friends, family, visitors, babysitters, and anyone else who works in your home or drives your car).

Home remedies

You can also try some home remedies to soothe your cough while working on other methods like stopping smoking. Here are some tips that can help with symptom relief:

• Drink lots of water: This keeps you hydrated and also helps thin out mucus, making it easier to cough up. Avoid dairy and caffeine, which can worsen coughing. You can also drink warm herbal tea and add some honey, as honey can also help soothe a cough.

• Exercise (as tolerated): You should always consult a healthcare provider before beginning an exercise program. Even taking a few short walks throughout the day can help clear the airways and improve symptoms. 

• Sleep with your head elevated: Place an extra pillow or two under your head to keep it elevated. This will help prevent mucus from gathering in the throat and help you sleep better.

• Use a cool-mist humidifier to keep the air moist, which can provide symptom relief

• Gargle with salt water: Salt water can soothe the throat and reduce swelling 

• Suck on cough drops or sugar-free hard candy to help control a cough

Sources

• What is a smoker’s cough and tips to get rid of it, Banner Health (2023)

• Chronic smoker’s cough, Lung Cancer Center (2023)

• Indoor risk factors for cough and their relation to wheeze and sensitization in Chilean young adults, Am J Public Health (2008)

• Otorhinolaryngological symptoms among smokeless tobacco (maras powder) users, North Clin Istanb (2019)

• Smoking and respiratory diseases, Johns Hopkins Medicine (2023)

• How smoking contributes to incontinence, National Association for Continence (2022)

• Diagnosing and treating cough, American Lung Association (2023)

• Chronic cough, Cleveland Clinic (2023)

• Benefits of quitting, Centers for Disease Control and Prevention (2023)

• How to quit smoking, Centers for Disease Control and Prevention (2023)

• Secondhand smoke - it takes your breath away, New York State Department of Health (2006)

What’s next? Additional resources for people with smoker's cough

Test and diagnostics

• Chronic cough symptoms and diagnosis, American Lung Association

• Diagnosing and treating cough, American Lung Association

• Evaluation of the patient with chronic cough, American Family Physician

Treatments

• Treating and managing chronic cough, American Lung Association

• Chronic cough, Cleveland Clinic

Scientific studies and clinical trials

• Prevalence and incidence of, and risk factors for chronic cough in the adult population: the Rotterdam Study, ERJ Open Research (2020)

• Chronic productive cough is associated with death in smokers with early COPD, COPD (2016)

More information on related health conditions

• COPD treatments and medications, SingleCare

• Bronchitis treatments and medications, SingleCare

• GERD treatments and medications, SingleCare

• Asthma treatments and medications, SingleCare

• Cough, Cleveland Clinic