Treatments & Procedures

Controlled Coughing

COPD can cause your lungs to produce excess mucus, leading to frequent coughing. Not all coughs are effective in clearing excess mucus from the lungs. Explosive or uncontrolled coughing causes airways to collapse and spasm, trapping mucus.

The effective, or controlled, cough comes from deep within the lungs and has just enough force to loosen and carry mucus through the airways without causing them to narrow and collapse. Controlled coughing saves energy and therefore, oxygen.

Controlled coughing technique

To cough effectively:

  • Sit on a chair or on the edge of your bed, with both feet on the floor. Lean slightly forward. Relax.
  • Fold your arms across your abdomen and breathe in slowly through your nose. (The power of the cough comes from moving air).
  • To exhale: lean forward, pressing your arms against your abdomen. Cough 2-3* times through a slightly open mouth. Coughs should be short and sharp.
    * The first cough loosens the mucus and moves it through the airways. The second and third cough enables you to cough the mucus up and out.
  • Breathe in again by sniffing slowly and gently through your nose. This gentle breath helps prevent mucus from moving back down your airways.
  • Rest.
  • Perform again if needed.


Avoid breathing in quickly and deeply through your mouth after coughing. Quick breaths can interfere with the movement of mucus up and out of the lungs and can cause uncontrolled coughing.

Drink 6-8 glasses of fluid per day unless your doctor has told you to limit your fluid intake. When mucus is thin, coughing is easier.

Use the controlled coughing technique after you use your bronchodilator medication or anytime you feel mucus (congestion).

Mucus clearing devices

If you have trouble coughing up secretions, your physician may prescribe a mucus clearing device, such as the Flutter device or the Positive Expiratory Pressure (PEP) valve. There are other mucus clearing devices on the market that may be prescribed by your doctor.

A mucus clearing device (such as the Flutter) helps loosen mucus in the airways so you can cough it up more easily. The Flutter consists of:

  • A mouthpiece
  • Protective cover
  • High-density stainless steel ball
  • A circular cone

When you exhale, your breath moves the steel ball inside, causing vibrations in your lungs. These vibrations loosen the mucus so it can move up and out of the airways.

The PEP valve generates variable resistance to the air you breathe out (called positive expiratory pressure). The PEP setting best for you is determined by your physician or therapist.

To use the PEP valve, place the mouthpiece in your mouth, seal your lips around it, take a deep breath using your diaphragm and breathe out slowly with a moderate force through the one-way valve for as long as you can. The increased pressure in the airways will give you the feeling to cough. When you feel the urge to cough, take a deep breath in, hold for 1-3 seconds and cough to loosen the mucus.

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