9 Tips to Calm Your IPF Cough

“Chronic cough is a common and burdensome symptom of IPF,” says Tejaswini Kulkarni, MD, an associate professor of pulmonary and critical care medicine at the University of Alabama in Birmingham and a senior medical advisor at the Pulmonary Fibrosis Foundation. “It can significantly impair quality of life by affecting physical, psychological, and social functioning.”

There’s no specific treatment that’s been proven to control IPF-associated cough, but it can be managed with a combination of lifestyle adjustments, breathing techniques, and medications.

1. Look for an Underlying Cause

“Before presuming that the patient’s cough is from IPF, a thorough cough history should be performed to look for other causes of cough,” says Corey Kershaw, MD, a pulmonary and critical care physician and a professor of internal medicine at UT Southwestern Medical School in Dallas. “Reversible causes should be eliminated or treated before assigning the cause to IPF.”

• Infection
• Certain medications, such as angiotensin-converting enzyme inhibitors
• Asthma
• Obstructive sleep apnea
• Gastroesophageal reflux disease (GERD)
• Postnasal drip

“GERD is a common and often silent contributor to cough in IPF,” says Jamie Garfield, MD, a medical spokesperson for the American Lung Association. “Even without heartburn, stomach contents reaching the airways can trigger persistent coughing.”

Treatments for GERD include acid-suppressing medications and lifestyle modifications like elevating the head of the bed and avoiding late-night meals, Dr. Garfield says.

2. Avoid Triggers

“Common triggers include strong perfumes or cleaning products, smoke, dust, very cold or dry air, and rapid changes in temperature,” says Garfield. “Keeping a log of what seems to provoke coughing episodes can help identify patterns,” she says.

3. Stay Hydrated

“Sipping water throughout the day keeps the throat moist and can interrupt a coughing episode,” says Garfield. “When the urge to cough strikes, taking a slow sip of water and swallowing deliberately is one of the simplest cough suppression techniques.”

4. Soothe Your Throat

5. Humidify the Air

Dry air can be irritating and trigger coughing. “Using a cool-mist humidifier, especially in the bedroom, may help,” says Garfield. “Consider wearing a scarf or mask over the nose and mouth in cold weather.”

6. Learn Breathing Techniques

7. Consult a Speech Therapist

8. Pace Yourself

9. Ask About Medications

No medications have been approved specifically to treat cough in IPF, but your doctor can suggest some options. “A multifaceted approach using a combination of over-the-counter and prescription cough suppressants, neuromodulatory agents, and narcotic agents may provide some relief,” says Dr. Kershaw.

Kulkarni says cough suppressants containing dextromethorphan can help reduce the urge to cough in some people, but evidence of their effectiveness for IPF is limited. While they aren’t routinely prescribed, she says these medications may help manage your cough:

• Inhalers or nebulizers may be prescribed if there is evidence for coexisting airway conditions, such as asthma.
• Low-dose corticosteroids like prednisone may be considered for a short time in selected patients with a severe cough that doesn’t respond to other treatments.
• Benzonatate (Tessalon Perles, Zonatuss) is a nonnarcotic cough suppressant that works by numbing the sensory receptors in the lungs, which then reduces the nerve signals sent to the brain’s cough center.
• Low-dose opioids such as morphine or hydrocodone may reduce a severe cough that doesn’t respond to other treatments in certain patients under close medical supervision.

Gabapentin, a neuromodulator, is another option. “This drug is better known for its role in treating neuropathic pain and it works in a similar way in chronic cough to dampen the hypersensitive neuropathic cough reflex,” says Garfield.

Kershaw encourages people to look into clinical trials that are investigating new treatments for IPF-related cough. “One promising agent, nalbuphine, showed a reduction in cough secondary to IPF in an early phase trial,” he says.

When to Call the Doctor or Seek Emergency Care

Sometimes you may have symptoms that require immediate medical attention. “If you are experiencing the following, call 911 or go to the emergency room immediately,” says Garfield:

• Coughing up blood
• Sudden, severe breathlessness that doesn’t improve with rest or oxygen
• Chest pain
• Signs of severe infection (high fever, confusion, rapid breathing)

She says to call your doctor for less urgent symptoms, such as:

• The cough changes character, becoming more frequent or severe, or starts bringing up mucus.
• You have new or worsening breathlessness.
• You have fever, chills, or flu-like symptoms.
• The cough is significantly disrupting sleep, eating, or daily activities.
• You have unexplained weight loss.