Cough Clue #4: What Does the Cough Sound Like?

When a Cough Isn't "Just a Cough": Page 4

By , senior editor
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Nurse comforting a worried senior man while at the hospital

It's loud and hacking.

Many smokers write off coughing as the price of their vice; unfortunately this thinking makes them less likely to view a bad cough as a red flag to have checked out. People who smoke should be especially wary of a chronic cough, whether it produces mucus or not, and especially if it's loud and long or raspy.

It's wheezy.

A sound that's a cross between a cough and a gasp for breath is often heard in an asthma cough. It's often worse at night or first thing in the morning, because lying flat helps mucus collect in the airways.

It makes a "whoop."

The sound of a cough comes from the sudden release of air from the lungs after the larynx, which had temporarily closed, reopens. In the disease pertussis, though, the sound comes from the first part of a cough, the inhalation. So desperate and sharp is the gasping for breath that it produces a distinctive whooping noise -- the "whoop" in whooping cough. In adults, the whoop may sound more like long spasms of coughs (a coughing fit). The Chinese call pertussis "the cough of 100 days."

"It's a very severe, persistent cough," says Dr. Edelman. "A child can break a rib from coughing so hard."

Once common, highly contagious, and deadly, pertussis grew rare after a vaccine was developed for it; by 1976, there were just 1,000 cases, the all-time low. (It's the "P" component in the DPT or DTaP inoculation.) But by 2005, some 25,000 cases were reported to the Centers for Disease Control, and estimates of true annual incidence are as high as 2 million -- 28 percent of them in adults. Why? Probably a combination of unfounded concern over vaccine safety and weakening immunity over time since the childhood vaccine. (A booster is recommended for all adolescents and adults up to age 65, especially for those in contact with babies and young children, who are most vulnerable to getting extremely sick from whooping cough.)