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Q: Over the years I have been bothered by coughing up phlegm from the back of my throat many times a day. One doctor told me it is not infected because the phlegm is white, but didn't really help me get rid of it.

My problem may not seem like much, but after years of having this sometimes embarrassing and inconvenient problem is getting to me. What should I do?

-- H.J., Buffalo
A: The obvious answer is to find out what is causing the phlegm. But often that is not easy. Let me explain.

Mucous is made in the lining of the respiratory tract, from the nose to the depths of the lungs, and includes the sinuses. Any irritation causes increased secretion of mucous (phlegm). Sputum is a mixture of phlegm, foreign particles, and cells.

Under normal conditions the production of mucous is in balance with minimal coughing and swallowing. But if you're inhaling excessive amounts of irritants, especially things you are allergic to, or have certain diseases of the lungs, the amount of mucous becomes bothersome. It can become so thick that it seems to block off your breathing tube (trachea).

Reflux esophagitis, or GERD, can cause coughing similar to that caused by the buildup of too much mucous. However, stomach contents rarely get far enough up into the throat to be coughed up.

Particularly because of your problem clearing the phlegm, the best course is to stop forming excess amounts in the first place. So the first step is to identify the source of the problem. Since secretion of phlegm is commonly caused by irritation to lung tissue as a result of infection or allergens, this is a good place to start.

Examination of the sputum produced can be helpful. A yellowish, green or brown appearance suggests bacterial infection. Clear, white or watery sputum suggests a viral infection, allergy or irritant as the cause. A microscopic examination of the sputum may show evidence of bacteria and white blood cells.

To test whether an underlying bacterial infection is the cause of increased production of phlegm, sometimes a doctor will prescribe an antibiotic. If the antibiotic helps dramatically, a bacterial infection was the cause, or at least a complication. Standard antibiotics are not effective against viral infections, however.

Antibiotics are prescription medications, so you'll have to see a health care provider. While you're there, ask if a laboratory examination of your phlegm is appropriate for your particular situation.

Allergies are common causes of excessive, chronic (long-term) production of phlegm. You can test the possibility of an allergy by taking some antihistamines (there are many good ones sold over the counter) and see if your condition improves.

It sounds like seeing a doctor could be helpful, especially if you write down as much as you know about your problem, and if there is anything that makes it better or worse.

Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611; or contact him at This column is not intended to take the place of consultation with a health-care provider.

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