Most people diagnosed with multiple sclerosis (MS) are familiar with the condition’s typical symptoms — muscle spasms, nerve pain, emotional changes, and fatigue. But MS also has less well-known symptoms, including coughing and problems with phlegm.

If you feel like you’re coughing more since being diagnosed with MS or that you have a lot more phlegm, you aren’t alone. Here’s what you should know about how coughing and phlegm could be related to MS, as well as tips for managing these symptoms.

How Do Coughing and Phlegm Affect Life With MS?

Many MyMSTeam members experience persistent coughs even without signs of infection. “My wife has a nagging cough she can’t shake off,” wrote one member. “It’s been more than two weeks.” Another member explained, “I haven’t been able to get rid of this cough. I’m coughing to the point of vomiting.”

One member described experiencing particularly severe coughing: “I seem to have a cough straight from hell.” They went on to note, “I think this is an MS-related nuisance. … My diaphragm seems to have lost the ability to have a really productive cough.”

"I’m also having a lot of phlegm build up and get stuck in my throat. I feel like I’m choking all the time.”

— A MyMSTeam member

Other members experience phlegm without a cough. One asked, “Does anyone have problems with phlegm in their throat? It’s an everyday problem for me.” Another added, “I keep getting mucus in my throat! I’m constantly clearing my throat.”

Excess mucus production can make for a lot of discomfort, especially if you have MS and are choking at night. “I’m also having a lot of phlegm build up and get stuck in my throat, so it’s very hard to spit it out,” described one member. “I feel like I’m choking all the time.”

Some people try to cough up phlegm but don’t have much luck. “I’ve had what feels like coughing spasms, sort of like my throat is trying to push something up, even when I haven’t swallowed anything,” one member described. “Occasionally, a small amount of sputum comes up, but not much.” Another echoed this feeling: “I have phlegm sometimes, and I can’t really cough it up.”

For a few people, coughing and phlegm occur only with certain activities. One member explained, “I notice the cough and phlegm only happen when I eat.”

What Causes Coughing and Phlegm in MS?

There are many reasons people diagnosed with MS might experience coughing and phlegm. Keep reading to find out some of the most common causes of multiple sclerosis coughing fits and excess secretions.

Illness

People with MS may be more likely to develop respiratory infections, particularly chest infections like pneumonia due to both possible reduced function of some muscle groups and the effects of disease-modifying treatments. If you are living with MS and experiencing coughing and mucus, your doctor should check for infection. Also, if you have MS and a sore throat, don’t assume this symptom is from a cold or the flu. See your doctor for an accurate diagnosis.

People with MS may also get sicker than others when they become ill. This can mean that they produce more mucus, have more postnasal drip, and cough more than others with the same infection but not MS.

Lesions in the Nervous System

Sometimes, lesions caused by MS can occur in areas of the brain that coordinate respiratory muscle function, like in the chest and airways, and swallowing. These lesions might make coughing less effective, which can be risky and make it harder to clear your throat properly. You might feel like there’s too much mucus in your throat or have an urge to cough.

Brain lesions can also form in parts that control nerves in the mouth and throat. This change in nerve function can create a sensation of too much phlegm or a feeling that mucus is always in these areas. If you have multiple sclerosis throat tightness or the feeling of something stuck in your throat, seek medical advice from your health care provider.

Muscle Weakness

Living with MS can lead to a more sedentary lifestyle, which can have negative effects on posture and muscle strength. Although leg weakness may be a more noticeable symptom, muscle weakness can also affect the muscles in the throat, chest wall, and more, making it harder to cough effectively. Maintaining cough strength can help remove excess mucus. In fact, research has found that having low cough strength with MS is connected to more severe disability on certain rating systems.

Tips for Managing Coughing and Phlegm With MS

There are different ways to manage coughing and throat mucus if you have MS. Although home remedies can help with some problems, they might not work well for a weak cough. It’s important to talk to your neurologist or health care provider. They can provide personalized solutions and involve specialists like respiratory or neurorehabilitation doctors to make sure you get the right care.

Treat Infections

One key way to minimize phlegm is to treat respiratory illnesses effectively. Because people with MS may get more infections and become sicker from them, it’s especially important to contact your doctor if you’re ill. One member of MyMSTeam has a rule of thumb: “If it’s yellow or green, I call my doctor.”

“Hot tea helps break up the mucus.”

—A MyMSTeam member

Although yellow or green phlegm doesn’t always indicate an infection, any change in the color, consistency, or quantity of mucus can mean there’s a change in your health. Other clues such as fever, exposure to an allergen, or facial pain, can help your doctor determine the cause of the change and whether you need medication.

Avoid Infections

To help prevent infections, ask your doctor which vaccinations are safe and effective for you. Also, if you’re taking disease-modifying medications for your MS, ask your doctor if you should schedule vaccinations around your medications.

Consider avoiding large gatherings when the common cold, flu, and COVID-19 infections are spiking, as well as wearing a mask inside when there’s a viral infection going around.

Drink Tea

Hydration is important to help clear mucus. Some MyMSTeam members recommend drinking tea to help soothe a cough, reduce a tickle in the back of the throat, or loosen mucus. One member wrote, “Hot tea helps break up the mucus.” Another advised, “Drink some tea with honey and lemon.”

Honey is a popular additive to tea. It can help soothe sore throats and may help suppress coughing. One member recommended honey with tea, adding, “That will help with coughing and will thin mucus in the nose and throat.” If problems with swallowing make it challenging to drink, ask your doctor about other ways to stay hydrated.

Thin the Mucus

Over-the-counter (OTC) decongestants or expectorants (cough medicine) like guaifenesin (sold as Mucinex) can help thin mucus so that it’s easier to cough up. However, you should talk to your doctor before using these products. This solution won’t work if you can’t effectively cough up the mucus, and it may lead to aspiration, posing potential dangers. Consulting with a health care professional is essential to ensure these remedies are appropriate and safe for you.

“I started using Mucinex, and it works really well for me.”

— A MyMSTeam member

OTC decongestants or expectorants may come in the form of pills, liquids, or nasal sprays. Thin mucus is easier to cough up and clear out of your throat. Some members swear by the medication: “I started using Mucinex, and it works really well for me,” one member said.

Don’t start taking cough suppressants or other OTC medicines without first speaking to your health care provider, especially if you have a condition such as high blood pressure, diabetes, or hyperthyroidism. Like all medications, OTC drugs have side effects. Some decongestants and expectorants have side effects that can interact with prescription medications or make serious health conditions worse.

You can also consider home remedies, like gargling with salt water to clear out mucus and relieve a sore throat, but always check with your health care provider before trying something new, even if it seems harmless.

Get Immediate Care for Any Breathing Problems

If you have a severe or persistent cough, shortness of breath, or trouble breathing, contact your doctor or emergency health care services immediately. They will be able to identify and treat potential infections. They can also address the underlying cause of your cough and figure out whether your MS is contributing to breathing problems.

If your cough is weak, your doctor may advise rehabilitation. They may recommend a specific form of physiotherapy focused on strengthening the chest muscles or suggest using a machine to train your cough strength.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 217,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you experienced chronic coughing and excess phlegm with MS? What approaches have helped you manage these symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.