Clues About a Cough

When a Cough Isn’t “Just a Cough”
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From a discreet tickle in the throat to a relentless "smoker's cough," coughing is a reflex we can't resist. Though these odd noises that come up the respiratory tract and out the mouth are wordless, they have plenty to tell.

In fact, coughing is the top complaint people bring to doctors' offices. "Coughing is a very general symptom that can reflect minor irritation or serious problems in the airways or the lungs themselves," says internist and pulmonologist Norman Edelman, medical director of the American Lung Association.

So what's your cough saying? Here are five questions that lead to important clues.

How Long Has the Cough Been Going On?

Not long; minutes or hours.

We cough because something irritates the nerves of the respiratory tract. The pest can be fleeting -- a cloud of perfume or bug spray, an inhaled hot chili pepper, water swallowed the wrong way so that it clogs the windpipe. Or it can be something that hangs around longer, like dust, mucus, or stomach acid.

With any cough, first we take a short breath and then the voice box (larynx) closes. The abdominal and chest muscles contract, and pressure builds to release air from the lungs when the larynx reopens -- whereupon whoosh, the fast burst of air whisks through the airways, clearing them. That's important, because invasive bodies in the lower respiratory system can harbor bacteria that cause an infection in the airways or even pneumonia (infection of the lung itself).

For many sudden coughs, the drama ends when the airway is cleared and/or the offending substance goes away.

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It's been less than a month.

The common cold is the number-one reason for "acute" coughs (those lasting less than three weeks). Colds tend to run their course in seven to ten days. But the rule of thumb on the cough that usually accompanies a cold is that it can take as long as two to four weeks to end, says Edelman. That's because airways may continue to be inflamed and sensitive even after the infection has cleared.

Most coughs that come with colds clear on their own without any treatment, research shows.

Argh, it's been more than two months now.

Between one and two months, coughs are considered "subacute" -- they might clear up or they might flag an underlying disease. After eight weeks, a cough is considered "chronic." Among the most common causes of a chronic cough:

  • Upper-airway cough syndrome (UACS), the newish term for postnasal drip syndrome. It's the most common cause of acute and common coughs.
  • Asthma, a constriction of the airways. A top cough-causer for kids, adults get it, too.
  • Chronic obstructive pulmonary disease (COPD). This can take the form of chronic bronchitis (damage to the bronchi or large air tubes) or emphysema (damage to the tiny air sacs deep in the lungs), or both. People who smoke are at highest risk.
  • Gastroesophageal reflux disease (GERD). (The old term "acid reflux" is fading because there's also nonacid reflux.) GERD happens when the stomach content backs up into the esophagus.

In many cases, when the problem is treated, a long-term cough disappears.


When Does the Cough Happen?

I cough at certain times of the year.

Does the cough seem to follow a calendar? Seasonal allergies can affect the airways to produce a cough right along with the most common hay fever symptoms of sinus blockage and eye irritation. Cold weather, especially exercising in it, can trigger a kind of asthma called "hyperactive airways."

I've coughed since starting new blood pressure medication.

A chronic dry cough afflicts 10 to 20 percent of people who take angiotensin-converting enzyme inhibitors (ACE inhibitors) for high blood pressure and heart failure. The cough may appear right away or months after beginning treatment. The throat also feels raw. This cough clears within a week to a few months of changing meds.

I cough before I speak.

Even though coughing is automatic, you can also cough voluntarily (as with blinking and swallowing). Some people develop the nervous habit of throat clearing before they talk -- ahem! -- or during public speaking. The phenomenon is so common that lung experts have given it a name: a "habit cough."

I cough whenever my body wants to; I can't control it.

This is the most common situation. A persistent, uncontrollable cough is usually linked to an underlying disease. More rarely, coughing and throat clearing can be a tic -- a semivoluntary movement that could be suppressed but that people feel a compelling urge to do anyway, partly because doing so brings a brief relaxing sensation.

What Type Is Your Cough? -- Do You Cough up Anything Yucky?

Nope, it's a dry cough.

A dry cough (in which nothing comes up from the lungs but air) is the usual aftermath of catching a cold. Depending on the severity of the infection, it can be muffled or loud, a series of short little coughs or great noisy hacks. Other coughs that are sometimes dry: a smoker's cough in early stages of lung dysfunction or some types of asthma-related coughs.

Yes, I cough up a light (clear to pale yellow) mucus.

Mucus is the stuff that moisturizes your nose and keeps the passages clean. (You might know it as phlegm or sputum -- same stuff.) Colds and the flu tend to produce colorless or pale mucus. Sometimes there's a lot of it, which must be blown out through the nose, coughed up, or swallowed. It's a myth, by the way, that it's bad for you to swallow the gunk.

A cough with excessive mucus (of any color) most days of the month is a key feature of chronic bronchitis.

Yes, I cough up greenish or tan phlegm.

"Green stuff," contrary to commonly held belief, does not particularly indicate a treatable bacterial infection, unless it's accompanied by other symptoms such as moderate-to-high fever or shortness of breath. Coughs producing green phlegm are common after viral infections, which are the most common cause of acute bronchitis. (Studies have found that people with garden-variety bronchitis don't benefit from antibiotics.) If you're worried that green phlegm might be pneumonia, talk to a doctor. If you have other worrisome symptoms, you may need a chest X-ray to check for pneumonia. (People who are over age 65 or who have a chronic lung or heart illness should consider the pneumonia vaccine, which can lessen symptoms if pneumonia develops.)

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The mucus coughed up with chronic bronchitis or emphysema tends to be in the green-brown-tan family. During a COPD exacerbation -- a sudden worsening of symptoms -- the secreted mucus may get thicker, darker, and harder to cough up. That's because the airways are narrowing further.

Yes, I cough up a little red stuff.

Seeing blood (any reddish shade from pink to rust) in mucus warrants consulting a doctor. Sometimes blood-streaked mucus shows up in the smoker's cough associated with COPD. Pneumonia, tuberculosis, and lung cancer are other serious concerns producing bloodied sputum. Frothy pinkish mucus may indicate pulmonary edema, an accumulation of fluid in the lungs' air sacs, which can be caused by a bad lung infection or a problem such as heart failure. Shortness of breath with frothy pink mucus is usually considered an emergency-room situation.

What Does the Cough Sound Like?

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."

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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.)

Do You Experience Other Symptoms Along With Cough?

Not really.

Sometimes a chronic cough is the only sign of asthma a person experiences. (Others also experience wheezing, tightness in the chest, and feeling out of breath.) Another possibility for a lone cough is gastroesophageal disease. As many as half of people with GERD who cough don't experience its other classic symptoms, heartburn or a bad taste in the mouth.

Cough plus shortness of breath.

Shortness of breath is the major symptom of COPD. Some people experience it only when they exercise or exert themselves (as when walking up a flight of stairs); for others, it's continuous. So if you've got cough you can't shake and it seems harder to catch your breath, get checked. "People often lose 40 percent of their lung function before they notice," says Edelman. "It sneaks up on you over time." In the United States, most people who get COPD are smokers. Worldwide, chronic bronchitis and emphysema can also be caused by air pollution and by breathing fumes from cooking over an open stove. Asthma also causes shortness of breath in some people.

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Cough plus fever.

Fever, with or without chills and night sweats, indicates an infection. This can be a mild viral infection such as a cold or a sign of something more serious, like pneumonia or tuberculosis (TB, a serious bacterial infection of the lungs). Weight loss is another feature of TB.

Cough plus "snorting" and "trickling."

Some people describe postnasal drip -- now known as upper airway cough syndrome -- as "like having a runny nose in the back of your throat." To cope with excessive mucus produced by the sinuses, a person may snort (clear the nose by pulling air and mucus up through it) or feel like they are gagging on a constant trickling sensation at the back of the throat that causes them to try to cough it up. The person might also have bad breath, a constant sore throat, nausea, or vomiting as side effects. The causes of chronic postnasal drip include allergies and sinusitis -- even the changing hormonal levels of pregnancy can be to blame. Depending on the findings of a complete physical exam, the treatments range from nasal irrigation, allergy medications, and antibiotics to surgery.

Cough plus chest pain or heartburn.

In people who have reflux disease, a chronic cough and sore throat may be accompanied by GERD's classic symptoms: a heaviness in the chest or a sensation of something stuck there, or heartburn after eating a heavy meal, lying down, or bending over. Symptoms usually worsen at night, and coughing can disturb sleep.

The Bottom Line: Now What?

A physical exam and diagnostic testing can reveal more clues. A doctor will look at the lungs, for example, for signs of asthma or structural problems such as emphysema or lung cancer. A look at the stomach can confirm GERD, while the sinuses reveal signs of postnasal drip. Other tests that help decide how to treat a cough include pulmonary function testing (to measure how well lungs work), a chest X-ray, a CT scan, and an endoscopy (to examine nasal passages, bronchial tubes, or the esophagus). Often, more than one condition is causing a cough.

The good news: Doctors can pinpoint the problem(s) in the vast majority of cases.

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

over 1 year, said...

Most symptoms of bronchitis and pneumonia can develop from other cold illness like flu and a common cold. A change in lifestyle together with natural remedies can help manage cold. Reference:

over 1 year, said...

Thank You Paula Spencer Scott for sharing such an informative article. After reading this article i came to the connection between Bronchitis and Simple Cough. Do you know Is Bronchitis Contagious And How Does It Spread? . Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored, white, yellow-grey or green. There are two types of bronchitis.Chronic Bronchitis which means your airways are irritated over and over. This type lasts for a few months or longer, and usually comes back year after year. Things that irritate your lungs, like dust, chemicals, or smoke from a fire or cigarettes, usually cause it. Chronic bronchitis isn’t contagious, but it’s a serious health problem that requires a doctor’s care. Acute Bronchitis which can last for 1 to 3 weeks. It’s usually caused by cold or flu viruses. Since these viruses are contagious, acute bronchitis usually is, too. Often developing from a cold or other respiratory infection, acute bronchitis is very common. Chronic bronchitis, a more serious condition, is a constant irritation or inflammation of the lining of the bronchial tubes, often the smoker’s cough. Acute bronchitis usually is self-correcting condition which improves within a few days without lasting effects, although you may continue to cough for weeks. However, if you have repeated episodes of bronchitis for most of the days in three months per year: you may have chronic bronchitis, which requires medical attention. Chronic bronchitis is one of the conditions included in chronic obstructive pulmonary disease (COPD).

almost 2 years, said...

Im desperate my 7 year old son have this cough fir like 5 months already sometimes is there he just ge t it sometimes one day no but he getscthis like 3 c to 4 days a week it takes like an hour to go away sometimes i give him the alergy meficine zitricen and goes away but wont go away for ever does anyone in the same situation as me

about 3 years, said...

Cough so bad can't catch my breath when coughing mucus n throat scare I might cough ta hard trying ta catch my breath I thought I was dying voice going out what do that mean sometimes cough to hard I end up p/n on my self

about 3 years, said...

This is very useful information, I had double pneumonia 013 and 014 almost exactly a year apart July 1-5 013 And July 1-4 014. This year I'm having nodules showing up in my right lung. Left lung cleared out. Having needle biopsy Thursday June 18th Hopefully find out what this is, stop this aggravating cough. It's terrible, I quite coughing up anything, but the cough goes on, irritating and wheezy Thank you

over 3 years, said...

My sister's cough was esophageal cancer.

over 3 years, said...

Very informative with my love of fragrances and air fresheners. They may like me as much as I like them. My husband has a lung problem and the winter and fall are horrible for him, the coughing and the wheezing! Keeping moisture from a kettle or a vaporizer in the room that he is in helps also a touch of Vicks vapor rub under his nostrils when he is headed out. It helps him breathe a lot better, thanks for listening.....

over 3 years, said...

My brother, a non smoker, health fantatic, ignored an ongoing mild cough. His stupid doctor did not insist on a chest X-ray because he did not smoke. Three yrs later my brother was dead of lung cancer.

over 3 years, said...

my persistent tickle or cough was ovarian cancer

over 3 years, said...

I always have a itchy tickle in ms throat, Dr always says it ia my sinus but this not comforting or helping me. When I get sick I usually get antibotics for Ainus infection now I have Pneumonia he gives me Codeine Meds for cough which helps, I have ashtma too and use 3 inhalers 4 nasal sprays and Neti bottle, suck on lemon candies and drink lemon tea gargle with salt water, it will subside for awhile but even after I am better it comes back itching and starting coughing again, I have been to a Allergist, tested, Dr next ENT any other suggestions?

over 3 years, said...

Well, the cough is getting better. The inhaler they gave me is doing some good. I was finally able to sleep through the night. The cough still occurs, but further spaced out. Think I'll be able to go back to work soon.

over 3 years, said...

How dangerous is a cough due to an allergic reaction to that high blood pressure med know as lisinopril? I'll tell you. I know someone who coughed so hard he passed out, fell an his face and ended up with mulitiple fractures. Also know (knew) someone who coughed so hard he passed out, fell on his face, bruised his forhead badly. A week later he didn't wake up. Left behind a wife and 4 kids. I also had the coughing. Accidently found out that it was from Lisinopril and stopped taking it immediately. Why is this still on the market?

over 3 years, said...

The comment on upper airway cough syndrome was valuable; that obviously is what my husband has. He will have spells of coughing that last a few days and then go away for weeks. His epidodes are accompanied by a runny nose.

over 3 years, said...

Fortunately there is no hypertension or heart disease involved in my cough, but you're correct that this must be checked in a chronic cough.

over 3 years, said...

If some kind of relief for caughing comes up,, please let me know.. Al

over 3 years, said...

Wish I could find that prevent cough so much.

over 3 years, said...

Please, please, please include PH and PAH (pulmonary arterial hypertension) as a possible cause of a persistent cough and shortness of breath. It is often misdiagnosed a COPD. The correct treatment is not given and the person may die from heart failure.

over 3 years, said...

I have had a chronic cough for three months now. The primary doctor says I'm perfectly healthy except for that cough. My allergist had my lungs x-rayed to rule out both pneumonia and something they didn't discuss in the article, CANCER. My aunt's lung cancer was diagnosed as acid reflux by the doctor who failed to x-ray her lungs. By the time we convinced her to see a different doctor and get her lungs x-rayed, the cancer had spread to cover 1 & 3/4 of her lungs. She died just 6 months later. Meanwhile, my allergist is covering all bases and trying to stomp out the cough which is producing gelatin consistancy clear mucus. If anyone has any other suggestions as to what it can be, let me know and I'll bring it up with the doctor. He's ruled out COPD, pneumonia, lung cancer, bronchitis, asthma, infection, acid reflux, and a pile of other things. Sigh... Suggestions anyone?

almost 4 years, said...

My Mom has Alzheimer's and for the last 2-3myths has developed a cough.Nonproductive and just spits up saliva. She still eats well and doesn't seem to have any problem swallowing. She says she has no problem and this just doesn't happen when she eats also when she lying down and during nite.Any clue what's going on or is this just a stage of the disease?

about 4 years, said...

Thank you for this very thorough coverage on the subject.

about 4 years, said...

I have had a persistent cough, for approximately 2 1/2 years. I have had lung infections in the past, prior to the start of my frequent cough. I sometimes have "coughing fits." I had chest x-rays, and testing of my lungs with a spirometer, and about a year ago another chest x-ray. Since we have moved during this time, in the last year I have seen a new physician, who order that last x-ray. She also recommended a CAT scan. With our current provider, that would cost $300. copay, so I have been reluctant to have one, but am beginning to wonder, if I should do so.