If you have been walking around and pushing through a miserable cough and respiratory illness (like myself), you are not alone.
Actually, the word and feeling miserable is an understatement. How do you know this? What you thought, was an endless supply of “HALLS”, “Ricola”, throat lozenges or whatever soothing drops you prefer along with the boxes of Kleenex (because you have had to move on, to carting around a roll of toilet paper), needs to be restocked, yet again. Let’s also mention, trying to function at work (because you are void of sick days) and social activities, in an era when the most minor “throat clearing ah-hem” causes a not very subtle side eye from a friend, colleague or complete stranger.
According to the CDC the 2023-2024 respiratory virus season is likely past peak but far from over. A few respiratory viruses are still hanging on to cause some inconvenience this spring. It is not time to let your guard down.
Here are a few basic facts provided by the Cleveland Clinic, along with recent study data presented by Georgetown University Medical Center which may help provide a bit of relief and maybe a better grasp on your health!
What is a cough?
A cough is a natural reflex that is your body’s way of removing irritants from your upper (throat) and lower (lungs) airways. A cough helps your body heal and protect itself.
What are the types of cough?
There are many types of cough. Some of the names for coughs describe how long they last, while other types describe how they feel or sound, and other types are actual conditions.
Types of coughs may be related to how they last
- Acute cough begins suddenly and lasts for two to three weeks.
- Subacute cough is one that stays around after you’ve had an infection and lasts three to eight weeks.
- Chronic cough lasts longer than eight weeks. Long-lasting coughs may also be called persistent coughs.
- Refractory cough is a chronic cough that hasn’t responded to treatment.
Types of coughs may be related to mucus
- A productive cough, or a wet cough, is a cough that brings up mucus or phlegm.
- A non-productive cough, or a dry cough, doesn’t bring up mucus or phlegm.
Types of coughs that have distinct sounds and are related to specific conditions
- Whooping. Pertussis, or whooping cough, is an infection that causes a cough that sounds like a “whoop.”
- Barking. A cough that sounds like barking can be a sign of croup.
- Wheezing. This type of cough often happens when you have blocked airways. It can be associated with an infection, like a cold, or chronic conditions, like asthma.
Types of coughs related to when you cough
- Daytime cough.
- Nighttime (nocturnal) cough.
- Cough with vomiting. This often happens with children. They cough so hard that they gag and sometimes vomit.
Who is more likely to experience a cough?
Anyone can get a cough. A cough is the most common symptom reported in healthcare providers’ offices.
However, some people are more likely to get coughs than others. These include those who:
- Smoke substances (like tobacco or marijuana).
- Vape.
- Have chronic illnesses, especially those involving the lungs or nervous system.
- Have allergies.
- Are children. Kids get sick often, especially if they’re in daycare or school.
Possible Causes
What are the most common causes of a cough?
There are many things that can make you cough. Some of them include:
Irritants or allergens
- Smoke.
- Strong smells (like cleaners and perfumes).
- Mold.
- Dust.
- Pollen.
- Pet dander.
- Mucus.
- Certain medications, like the blood pressure medications known as ACE inhibitors.
Medical conditions that can cause acute and subacute cough
- Cold.
- Flu.
- Acute bronchitis or bronchiolitis.
- Sinusitis.
- Pneumonia.
- Whooping cough (also called pertussis).
- Asthma.
- Allergies.
- Acute second- or third-hand smoke exposure.
Medical conditions that can cause chronic cough
- Chronic bronchitis.
- Asthma.
- Allergies.
- Chronic obstructive pulmonary disease (COPD) and other lung conditions.
- Gastroesophageal reflux disease (GERD).
- Throat disorders, including vocal cord disorders.
- Postnasal drip.
- Heart failure and other cardiac conditions.
Care and Treatment
What can be done to control or relieve a cough?
Treating a cough will depend on what is causing the cough. If you have an infection, your healthcare provider might prescribe some type of antibiotic or antiviral medication, but most viral coughs do not require antiviral medications. For GERD, they might suggest diet changes or prescribe a proton pump inhibitor or an H2 blocker.
Water can be good for a cough. Drinking it can help ease a cough from throat irritation or dryness. Adding it to the air with a vaporizer or a steamy shower are other ways water relieves a cough.
Quitting smoking and avoiding other irritants are also ways to relieve a cough. Those irritants may include medicines, scents (like perfume or candles), smoke or allergens.
What over-the-counter treatments can I use for cough?
There are plenty of cough syrups and cough medications available over-the-counter for adults. In general, they have not been shown to work better than a spoon full of honey. Cough drops and butterscotch hard candies can help soothe your sore throat. You may also get relief from hot beverages like tea, especially if you put honey in them.
You shouldn’t give cough medicines to your child if they’re under 6 years of age without the approval of their healthcare provider.
When To Call the Doctor
When should I call my healthcare provider about a cough?
If you or your child have a chronic disease you should call your healthcare provider for specific advice.
In general, call your healthcare provider if you have a cough that will not go away and these symptoms:
- Wheezing (noise when you breathe out).
- Fever over 101.5 Fahrenheit or fever that lasts more than a day or two.
- Chills.
- Phlegm (thick mucus, also called sputum), especially phlegm that is yellow, green, or bloody.
Go to an emergency room or call 911 if you have a cough and you:
- Feel like you’re choking.
- Can’t breathe well.
- See a lot of blood when you cough.
- Have severe chest pain.
If you feel you have taken the appropriate measures, but are still frustrated with your care , prescription or outcome, the following information may help fill in the blanks.
According to specialists, use of antibiotics provided no measurable impact on the severity or duration of coughs even if a bacterial infection was present, finds a large, prospective study of people who sought treatment in U.S. primary or urgent care settings for lower-respiratory tract infections.
The study by researchers at Georgetown University Medical Center and colleagues appeared April 15, 2024, in the Journal of General Internal Medicine.
“Upper respiratory tract infections usually include the common cold, sore throat, sinus infections and ear infections and have well established ways to determine if antibiotics should be given,” says the study’s lead author, Dan Merenstein, MD, professor of family medicine at Georgetown University School of Medicine. “Lower respiratory tract infections tend to have the potential to be more dangerous, since about 3% to 5% of these patients have pneumonia. But not everyone has easy access at an initial visit to an X-ray, which may be the reason clinicians still give antibiotics without any other evidence of a bacterial infection. Plus, patients have come to expect antibiotics for a cough, even if it doesn’t help. Basic symptom-relieving medications plus time brings a resolution to most people’s infections.”
The antibiotics prescribed in this study for lower tract infections were all appropriate, commonly used antibiotics to treat bacterial infections. But the researchers’ analysis showed that of the 29% of people given an antibiotic during their initial medical visit, there was no effect on the duration or overall severity of cough compared to those who didn’t receive an antibiotic.
“Physicians know, but probably overestimate, the percentage of lower tract infections that are bacterial; they also likely overestimate their ability to distinguish viral from bacterial infections,” says Mark H. Ebell, MD, MS, a study author and professor in the College of Public Health at the University of Georgia. “In our analysis, 29% of people were prescribed an antibiotic while only 7% were given an antiviral. But most patients do not need antivirals as there exist only two respiratory viruses where we have medications to treat them: influenza and SARS-COV-2. There are none for all of the other viruses.”
To determine if there was an actual bacterial or viral infection present, beyond the self-reported symptoms of a cough, the investigators confirmed the presence of pathogens with advanced lab tests to look for microbiologic results classified as only bacteria, only viruses, both virus and bacteria, or no organism detected. Very importantly, for those with a confirmed bacterial infection, the length of time until illness resolution was the same for those receiving an antibiotic versus those not receiving one – about 17 days.
Overuse of antibiotics can result in dizziness, nausea, diarrhea, and rash along with about a 4% chance of serious adverse effects including anaphylaxis, which is a severe, life-threatening allergic reaction; Stevens-Johnson syndrome, a rare, serious disorder of the skin and mucous membranes; and Clostridioides difficile-associated diarrhea. Another significant concern of the overuse of antibiotics is resistance. The World Health Organization released a statement on April 4, 2024, stating: “Uncontrolled antimicrobial resistance [due to the overuse of antibiotics] is expected to lower life expectancy and lead to unprecedented health expenditure and economic losses.”
“We know that cough can be an indicator of a serious problem. It is the most common illness-related reason for an ambulatory care visit, accounting for nearly 3 million outpatient visits and more than 4 million emergency department visits annually,” says Merenstein. “Serious cough symptoms and how to treat them properly needs to be studied more, perhaps in a randomized clinical trial as this study was observational and there haven’t been any randomized trials looking at this issue since about 2012.”
How can cough be prevented?
You can prevent some kinds of cough by avoiding irritants that you know cause you to cough.
You can help prevent coughs caused by infections by:
- Getting vaccinated for influenza, COVID-19 and pneumonia.
- Avoiding people who are ill.
- Avoid touching your eyes, nose and mouth.
- Wash your hands often with soap and water and/or using hand sanitizers.
Additional Common Questions
How do I know if my cough is serious?
To diagnose what’s behind your cough, your healthcare provider will take a medical history, give you a physical exam, and may order some tests. As part of the exam, your provider will check your vital signs, like temperature and the number of breaths you take. They might check your oxygen levels, do a spirometry test in the office, or order a chest X-ray or lung function tests if your cough has lasted a long time.
Your provider may ask:
- If you use or did use tobacco, marijuana, or if you do or have vaped.
- What kind of work you do.
- How long you have been coughing.
- How well you breathe when you are resting and when you are working hard.
- If the cough keeps you from sleeping well.
- If anything comes up when you cough (like phlegm or blood).
- What medicines you take.
- If you have a bad taste in your mouth.
- If you have bad breath that will not go away.
- If you have pain, especially in your face.
- If you have lost weight without trying.
Can pregnancy make you cough?
Pregnancy doesn’t usually make you cough, but your immune system does change. This could mean that you get a cough or cold while you’re pregnant. Also, the cold or cough might last longer.
Contact your healthcare provider if your illness lasts longer than you expect or if you have trouble eating, sleeping or breathing.
What does it mean if I cough after eating?
If you cough after eating, you might have had something “go down the wrong way,” meaning it went toward your lungs instead of your stomach. Our upper airways are set up to stop food or drink from going all the way into our lungs most of the time. If food does go toward the “wrong pipe” it’ll make you cough, but it’s not usually serious. Sometimes what you’re eating or drinking can make it past that protection and actually go into your lungs. This is called aspiration, and it can happen if you’ve got problems with swallowing or other digestive or lung issues. If you frequently have issues with coughing and eating, let your healthcare provider know.
What should I know about COVID-19 and cough?
Cough is a symptom of COVID-19. It can also be part of a post-COVID syndrome (or long COVID).
As part of long COVID, a cough can continue for weeks or months after you’ve been infected. You’ll probably have other symptoms, too, like feeling very tired, having trouble concentrating or remembering things, and/or having trouble breathing.
Contact your healthcare provider about being tested for COVID-19 if you haven’t been diagnosed with it yet. If you have, follow the suggestions of your provider about how to deal with ongoing symptoms.
*The above information is not a substitute for your doctor’s advice:
A note from Cleveland Clinic:
Having a cough often means nothing serious. It’s normal (and helpful) to cough in certain situations. Coughing helps you get rid of things in your throat and airways that are irritating or making it harder to breathe. If you also have other symptoms like trouble breathing, fever, trouble eating or sleeping, or you’re coughing up bloody or colored sputum, call your healthcare provider for advice. Because young kids can’t tell us what they’re feeling, it’s a good idea to call your child’s provider if they have a cough and fever or a cough that sounds uncomfortable or concerning to you.
About Georgetown University Medical Center:
As a top academic health and science center, Georgetown University Medical Center provides, in a synergistic fashion, excellence in education — training physicians, nurses, health administrators and other health professionals, as well as biomedical scientists — and cutting-edge interdisciplinary research collaboration, enhancing our basic science and translational biomedical research capacity in order to improve human health. Patient care, clinical research and education is conducted with our academic health system partner, MedStar Health. GUMC’s mission is carried out with a strong emphasis on social justice and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” GUMC comprises the School of Medicine, the School of Nursing, School of Health, Biomedical Graduate Education, and Georgetown Lombardi Comprehensive Cancer Center. Designated by the Carnegie Foundation as a doctoral university with “very high research activity,” Georgetown is home to a Clinical and Translational Science Award from the National Institutes of Health, and a Comprehensive Cancer Center designation from the National Cancer Institute. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate) and on Twitter (@gumedcenter).
In addition to Merenstein and Ebell, the other co-author is Bruce Barrett MD, PhD at the University of Wisconsin, Madison,
This work was supported by an AHRQ grant R01HS025584.
The researchers report having no personal financial interests related to the study.
