Chronic Secretions and Mucus Can Be Challenging

By Janice Koehn

2 min read

Since my initial myasthenia gravis (MG) diagnosis, I’ve noticed an increase in secretions/mucus. I have also been diagnosed with hypothyroidism, allergies, and asthma, so I just thought the increase was due to my allergies or asthma. As it turns out, maybe I wasn’t totally right or wrong in my assumptions!

What is causing it?

It’s difficult to tell which 1 of these ailments is causing the issue at any given time. Is it the allergies, asthma, or is it myasthenia gravis?

Once I use my inhaler or nebulizer, depending on how bad my symptoms are, I usually relax a little in knowing it must be asthma, since it gradually improves over about 15 to 30 minutes.

My symptoms are runny nose, postnasal drip, cough, clearing my throat frequently, and shortness of breath. Yes, shortness of breath usually accompanies the mucus issues in my throat. It, too, usually improves after using my inhaler or nebulizer.

The challenges

When I have a postnasal drip or stuffy nose, it usually causes me to breathe through my mouth. My mouth becomes dry and it causes the saliva to thicken.

When that happens, it’s near impossible to clear my throat, which leads me to constantly try and try and try, until my throat hurts.

Sometimes I awaken during the night or in the morning with dried saliva on my face. When we go to sleep, our muscles relax, including our facial muscles. Because of this, saliva can accumulate and escape through the sides of the mouth. So, how do we resolve this?

Relieving dry mouth

Some successful ways I’ve relieved my dry mouth are:¹

Using saline nasal spray for nasal congestion and runny nose
Taking prescription or recommended medications to help relieve my asthma and allergies
Brushing my teeth at bedtime, including gums, roof of my mouth, and tongue
Taking a glass of water to bed and sipping water during the night when I have a dry mouth
Avoiding caffeine since that can also cause dry mouth
Avoiding alcohol, except on rare occasions in small amounts, and I do not smoke

My inhaler helps

Sometimes, I’m constantly clearing my throat because I feel like I have a cup of mucus blocking my airway. It gets to the point where my throat gets sore and more sensitive ... and my chest gets tight.

When it becomes sensitive, I have trouble swallowing or I’ll get a "tickle" or "itch" on 1 side of my throat. If I don’t resolve it right away, I go into a coughing frenzy! Most generally, my inhaler helps relieve the sensation.

Careful about what I eat

Some foods will aggravate the sensation or will cause severe coughing. Black pepper can cause it or even a speck of saliva hitting that certain sensitive spot in the back of my throat.

The sensitivity in my throat has gotten much worse in recent years, so now I have to be so careful what I do and what I eat.

I was able to tolerate very spicy foods at one time, but now, I have to dial back to mild. I guess that’s better for me anyway.

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RNEducator Member
I also have asthma & allergies. Years ago I started taking a daily antihistamine to reduce my allergy symptoms and post-nasal drip as these two conditions tended to trigger my asthma. When my asthma was triggered, it usually turned into a lower respiratory infection. I had many of these before I was dianosed with MG. When my bulbar symptoms made it impossible for me to use a metered dose inhaler (MDI), I had my pulmonologist switch me to nebulized medications. Although the meds treat my asthma, the fine mist rehydrate my airways. I also use normal saline with the nebulizer to deliver moisture. I take guaifenesin when I have difficulty coughing up secretions. This is a mucolytic that breaks up thick secretions, making them easier to clear. This is important for us, since the work of coughing can tire the muscles we use for breathing. (I've also broken a rib from coughing, not something I recommend.) One lesson I learned the hard way involved Mestinon. I had a difficult time titrating the dose and timing of doses for years. It seems increased mucus production is a sign of under AND overdosage of the medication. I realized if I noticed more mucous production within an hour of taking the medication, it was due to an overdose, near the end of the drug's duration of action, it was an underdose. Increasing the dose always increased my mucus production, so I changed the dosing interval after speaking with my neurologist. Other tricks for managing secretions/mucus include: staying hydrated, avoiding caffeine & alcohol, avoiding overly dry or air conditioned environments. Deep breathing and coughing is a good way to clear deep secretions. Take 3 deep breaths, in and out. When exhaling on the third breath, cough to clear any mucus. This may sound weird, but singing helps greatly. It's similar to coughing and deep breathing in that it forces us to inflate our lungs more than when we breathe. The force of air leaving our lungs as we sing can move mucus from the airways by triggering a cough. When none of the above decrease my secretions, I rely on a suction device to clear my oral cavity and upper pharynx. Managing our oral and respiratory secretions is important for Myasthenics. As the article mentioned, we are at risk of aspirating liquids/our oral secretions contributing to an aspiration pneumonia. When mucus pools in our lungs and dries out, it can become a buffet for bacteria and lead to a pneumonia. We don't want either type of pneumonia.
Juliana Texley Moderator & Contributor
As I read your post, I am sitting here listening to Hubby hack. Some of it, of course, is Mestinon. It does increase secretions, but that's not really bad. In hubby's case, he also had radiation therapy (14 years ago) for throat cancer so there's that. But watch carefully for aspiration. A swallow study can be really valuable.