I'm actually terrible at coughing up and spitting out all that stuff. My dr.s really don't say too much about it anymore, because they know I can't. They all said that it's not the greatest thing to do but your stomach acid will break down most of it, but if your stomach is sensitive, it can cause trouble. If you can spit it up do it, but don't freak if you can't , you won't be reinfecting yourself or anything.