Skip to main content
SpringerLink
Log in

The Role of Mucus in Cough Research

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Cough is a defense mechanism for promoting airway hygiene when mucociliary clearance is ineffective due to increased mucus secretion, inflammation, infection, or ciliary dysfunction. Secretions can contribute to airflow limitation and chronic hypersecretion can worsen airway inflammation with retained inflammatory cells and mediators. The focus of the Second Annual Cough Conference has been on cough as a troublesome symptom; but to understand the importance and effectiveness of cough clearance, it is critical to understand airway secretions. The biophysical properties of mucus and phlegm determine how readily these secretions can be cleared by coughing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ASL:

Airway surface liquid

CF:

Cystic fibrosis

CFTR:

Cystic fibrosis transmembrane ion transport regulator

NAC:

N-Acetyl l-cysteine

References

  1. King M, Zahm JM, Pierrot D, Vaquez-Girod S, Puchelle E (1989) The role of mucus gel viscosity, spinnability, and adhesive properties in clearance by simulated cough. Biorheology 26:737–745

    CAS  PubMed  Google Scholar 

  2. Rubin BK (1998) Surface properties of respiratory secretions: relationship to mucus transport. In: Baum G, Priel Z, Roth Y, Liron N, Ostfield E (eds) Cilia, mucus, and mucociliary interactions. Marcel Dekker, New York, pp 317–323

    Google Scholar 

  3. Rubin BK (2009) Mucus, phlegm, and sputum in cystic fibrosis. Respir Care 54:726–732

    PubMed  Google Scholar 

  4. Voynow JA, Rubin BK (2009) Mucus, mucins, and sputum. Chest 135:505–512

    Article  CAS  PubMed  Google Scholar 

  5. Henke MO, Renner A, Huber RM, Seeds MC, Rubin BK (2004) MUC5AC and MUC5B mucins are decreased in cystic fibrosis airway secretions. Am J Respir Cell Mol Biol 31:86–91

    Article  CAS  PubMed  Google Scholar 

  6. King M, Rubin BK (1994) Mucus rheology, relationship with transport. In: Takaishima T (ed) Airway secretion: physiological bases for the control of mucus hypersecretion, chap 7. Marcel Dekker, New York, pp 283–314

    Google Scholar 

  7. Hassan AA, Evrensel CA, Krumpe PE (2006) Clearance of viscoelastic mucus simulant with airflow in a rectangular channel, an experimental study. Technol Health Care 14:1–11

    PubMed  Google Scholar 

  8. Kater A, Henke MO, Rubin BK (2007) The role of DNA and actin polymers on the polymer structure and rheology of cystic fibrosis sputum and depolymerization by gelsolin or thymosin Beta 4. Ann N Y Acad Sci 1112:140–153

    Article  CAS  PubMed  Google Scholar 

  9. Agarwal M, King M, Rubin BK, Shukla JB (1989) Mucus transport in a miniaturized simulated cough machine: effect of constriction and serous layer simulant. Biorheology 26:977–988

    CAS  PubMed  Google Scholar 

  10. Ragavan AJ, Evrensel CA, Krumpe P (2009) Interactions of airflow oscillation, tracheal inclination and elasticity significantly improve mucus clearance during simulated cough. Chest (in press)

  11. Tomkiewicz RP, Kishioka C, Freemann J, Rubin BK (1998) DNA and actin filaments ultrastructure in cystic fibrosis sputum. In: Baum GL, Priel Z, Roth Y, Liron N, Ostfield E (eds) Cilia, mucus, and mucociliary interactions. Marcel Dekker, New York, pp 333–341

    Google Scholar 

  12. Kim JS, Okamoto K, Rubin BK (2006) Pulmonary function is negatively correlated with sputum inflammatory markers and cough clearability in subjects with cystic fibrosis but not those with chronic bronchitis. Chest 129:1148–1154

    Article  CAS  PubMed  Google Scholar 

  13. Lopez-Vidriero MT, Reid L (1978) Chemical markers of mucous and serum glycoproteins and their relation to viscosity in mucoid and purulent sputum from various hypersecretory diseases. Am Rev Respir Dis 117:465–477

    CAS  PubMed  Google Scholar 

  14. Tomkiewicz RP, Albers GM, Ramirez OE, Green F, King M, Rubin BK (1995) Rheologic properties of airway secretions in cystic fibrosis, chronic bronchitis, and fatal asthma. Biorheology 32:364–365

    Article  Google Scholar 

  15. Albers GM, Tomkiewicz RP, May MK, Ramirez OE, Rubin BK (1996) Ring distraction technique for measuring surface tension of sputum: relationship to sputum clearability. J Appl Physiol 81(6):2690–2695

    CAS  PubMed  Google Scholar 

  16. Rubin BK (2004) Taxonomy of mucoactive medications. In: Rubin BK, van der Schans CP (eds) Therapy for mucus clearance disorders. Marcel Dekker, New York, pp 129–146

    Google Scholar 

  17. Rubin BK (2007) Mucolytics, expectorants, and mucokinetic medications. Respir Care 52:859–865

    PubMed  Google Scholar 

  18. Ratjen F (2008) Recent advances in cystic fibrosis. Paediatr Respir Rev 9:144–148

    Article  CAS  PubMed  Google Scholar 

  19. Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC (2006) Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N Engl J Med 354:241–250

    Article  CAS  PubMed  Google Scholar 

  20. Pavia D, Thomson ML, Clarke SW (1978) Enhanced clearance of secretions from the human lung after the administration of hypertonic saline aerosol. Am Rev Respir Dis 117:199–203

    CAS  PubMed  Google Scholar 

  21. Kishioka C, Okamoto K, Kim JS, Rubin BK (2003) Hyperosmolar solutions stimulate mucus secretion in the ferret trachea. Chest 124:306–313

    Article  CAS  PubMed  Google Scholar 

  22. Rubin BK, Ramirez O, Ohar JA (1996) Iodinated glycerol has no effect on pulmonary function, symptom score, or sputum properties in patients with stable chronic bronchitis. Chest 109:348–352

    Article  CAS  PubMed  Google Scholar 

  23. Shim C, King M, Williams MH Jr (1987) Lack of effect of hydration on sputum production in chronic bronchitis. Chest 92:679–682

    Article  CAS  PubMed  Google Scholar 

  24. Marchette LC, Marchette BE, Abraham WM, Wanner A (1985) The effect of systemic hydration on normal and impaired mucociliary function. Pediatr Pulmonol 1:107–111

    Article  CAS  PubMed  Google Scholar 

  25. Deterding R, Retsch-Bogart G, Milgram L, Gibson R, Daines C, Zeitlin PL, Milla C, Marshall B, Lavange L, Engels J, Mathews D, Gorden J, Schaberg A, Williams J, Ramsey B, Cystic Fibrosis Foundation Therapeutics Development Network (2005) Safety and tolerability of denufosol tetrasodium inhalation solution, a novel P2Y2 receptor agonist: results of a phase 1/phase 2 multicenter study in mild to moderate cystic fibrosis. Pediatr Pulmonol 39:339–348

    Article  PubMed  Google Scholar 

  26. Fuchs HJ, Borowitz DS, Christiansen DH, Morris EM, Nash ML, Ramsey BW, Rosenstein BJ, Smith AL, Wohl ME (1994) Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The Pulmozyme Study Group. N Engl J Med 331:637–642

    Article  CAS  PubMed  Google Scholar 

  27. Rubin BK (2007) Mucus structure and properties in cystic fibrosis. Paediatr Respir Rev 8:4–7

    Article  PubMed  Google Scholar 

  28. Rubin BK (1999) Who will benefit from DNase? Pediatr Pulmonol 27:3–4

    Article  CAS  PubMed  Google Scholar 

  29. Rubin BK, Kater AP, Goldstein AL (2006) Thymosin β4 sequesters actin in cystic fibrosis sputum and decreases sputum cohesivity in vitro. Chest 130:1433–1440

    Article  PubMed  Google Scholar 

  30. Decramer M, Rutten-van Molken M, Dekhuijzen PN, Troosters T, van Herwaarden C, Pellegrino R, van Schayck CP, Olivieri D, Del Donno M, De Backer W, Lankhorst I, Ardia A (2005) Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet 365:1552–1560

    Article  CAS  PubMed  Google Scholar 

  31. Zayas G, Valle JC, Alonso M, Alfaro H, Vega D, Bonilla G, Reyes M, King M (2007) A new paradigm in respiratory hygiene: modulating respiratory secretions to contain cough bioaerosol without affecting mucus clearance. BMC Pulm Med 7:11

    Article  PubMed  Google Scholar 

  32. Morgenroth K, Bolz J (1985) Morphological features of the interaction between mucus and surfactant on the bronchial mucosa. Respiration 47:225–231

    Article  CAS  PubMed  Google Scholar 

  33. Im Hof V, Gehr P, Gerber V, Lee MM, Schürch S (1997) In vivo determination of surface tension in the horse trachea and in vitro model studies. Respir Physiol 109:81–93

    Article  CAS  PubMed  Google Scholar 

  34. Anzueto A, Jubran A, Ohar JA, Piquette CA, Rennard SI, Colice G, Pattishall EN, Barrett J, Engle M, Perret KA, Rubin BK (1997) Effects of aerosolized surfactant in patients with stable chronic bronchitis. A prospective randomized controlled trial. JAMA 278:1426–1431

    Article  CAS  PubMed  Google Scholar 

  35. Ericsson CH, Juhasz J, Mossberg B, Philipson K, Svartengren M, Camner P (1987) Influence of ambroxol on tracheobronchial clearance in simple chronic bronchitis. Eur J Respir Dis 70(3):163–170

    CAS  PubMed  Google Scholar 

  36. Rubin BK (2003) Mucoactive agents for the treatment of cough. In: Chung F, Widdicombe J, Boushey H (eds) Cough: causes, mechanisms, and therapy. Blackwell Publishing, Oxford, pp 269–281

    Chapter  Google Scholar 

  37. Rubin BK (2007) Designing clinical trials to evaluate mucus clearance therapy. Respir Care 52:1348–1361

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Virginia Commonwealth University School of Medicine, 1001 East Marshall Street, P.O. Box 980646, Richmond, VA, 23298, USA

    Bruce K. Rubin

Authors
  1. Bruce K. Rubin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce K. Rubin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rubin, B.K. The Role of Mucus in Cough Research. Lung 188 (Suppl 1), 69–72 (2010). https://doi.org/10.1007/s00408-009-9198-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-009-9198-7

Keywords

Search

Navigation