The magic of 'the huff' when a cough just won't do the trick
by Tusanee Jierasak, physiotherapist
So it’s the middle of winter. And if you travel to work on public transport, like me, you might travel in fear, cowering and shrinking away from anyone who is coughing and sneezing everywhere. If you have unfortunately picked up a cold, and it has eased but now you are left with an enduring cough and everlasting phlegm in the chest, please read ahead.
Many don't realise that physios can specialise in respiratory work, dealing with all things to do with the heart and the lungs. I used to work in a hospital and one of the things respiratory physiotherapists do is to teach people how to breathe properly, and very importantly, how to cough efficiently to be able to remove phlegm (to prevent risks of developing respiratory complications). And I would like to share that with you.
Firstly, what is phlegm / mucus?
Phlegm is the term that refers to muscus produced in the lungs and lower respiratory tract. It is a gel-like protective layer that traps irritants, contains antibodies, and moisturises. As you stretch it, it becomes less thick and sticky and more like a liquid. Normal lung production is 10 to 100mls per day. However, during a cold or flu, there is increased phlegm production, a change in colour, and it is more viscous (thicker and stickier) which makes it harder remove. This can lead to the symptoms throughout the whole respiratory system, such blocked sinuses, difficulty breathing, and coughing fits to try and remove the phlegm from the lungs.
How do I cough correctly to clear phlegm?
You have probably heard those people on the bus or train taking multiple short shallow coughs. These are ineffective. The best way to do an effective cough is:
- Take a deep breath in
- Close the glottis (back of the throat) for a second or two
- Then open the glottis (back of the throat), engage your abdominal muscles, and perform an explosive breath out
This should help the phlegm come up from the lungs into the mouth. A few of these big coughs, will be a lot more effective than lots of short shallow ones.
Don't forget to cover your mouth!
What is a huff?
If you are too tired, or it is too painful to perform big coughs, you might like to try a huff. Huffing is a different way to move the phlegm through the airways, closer to the mouth.
- Take a deep breath in
- Keep the back of the throat open
- Engage your abdominal muscles, and breathe out short and forcibly through the mouth like trying to fog up a mirror
You can use huffing to bring the phlegm to a more central position in the lungs, and then take a big cough to remove it. Or you can try huffing with smaller or larger breaths in, to move the phlegm from different areas of the lungs, depending where it is stuck.
If you feel dizzy or lightheaded with these techniques, take a few gentle, relaxed breaths in between techniques.
Have a practice of these techniques right now as you are reading this, and then remember to give them a go next time you get stuck with a chesty cough.