April 15, 2020/Primary Care

What Does Your Cough Say About Your Illness?

Dry or wet, acute or chronic — it may point to a cause

woman suffering from a persistent cough

A persistent cough can disrupt your daily activities and drive you to distraction. But, whether it stays around for a few days or turns into a nagging annoyance that lingers for weeks, the type of cough you have can often give you a clue about what’s ailing you.

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Pulmonologist Rachel Taliercio, DO, says upper respiratory infections cause a significant percentage of acute cough. Knowing more about your cough (whether dry or wet, acute or chronic) can help determine the best treatment options, especially if the cough does not resolve.

Acute coughs from temporary illness

An acute cough most likely appears when you have a cold, flu or other temporary infection. It may last up to eight weeks, and medication usually helps quiet this type of cough.

If you’re not getting relief from over-the-counter medication or the condition persists beyond a week or two, consult your doctor. They will determine whether a treatable infection is causing your cough.

Whooping cough or pneumonia also may prompt an acute cough, Dr. Taliercio says. She describes how these coughs may sound and how to treat them.

Whooping cough (pertussis). A vaccine can prevent this virus, which once was on the decline. If you get pertussis, the cough can become so intense, you may vomit.

  • How does it sound? Severe, hacking cough, including a “whooping” sound with inhalation
  • How to treat it: Antibiotics

Pneumonia. This condition inflames the lungs and can make them fill with fluid. Vaccines can prevent some pneumonia infections.

  • How does it sound? Initially a dry cough that later turns wet with yellow, green or red-tinged mucus
  • How to treat it: Antibiotics for bacterial infections; rest and cough medication for viral infections

Chronic coughs from underlying conditions

Chronic cough is defined as a cough that lasts eight weeks or more, and it can have several different causes. Treatment options for chronic cough caused by underlying conditions varies, depending on the illness.

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Chronic obstructive pulmonary disease (COPD). This condition causes lung inflammation that constricts your airways, making breathing difficult. It’s usually caused by long-term exposure to lung irritants, such as cigarette smoke.

  • How does it sound? A chronic, hacking cough that creates a significant amount of mucus, particularly in the morning
  • How to treat it: Bronchodilators (drugs that help open airways), inhaled steroids, oxygen therapy, quitting smoking

Gastroesophageal reflux disease (GERD). GERD occurs when stomach acid irritates your esophagus. It’s the second most common cause of chronic cough, accounting for 40% of cases.

  • How does it sound? Dry, spasmodic cough; occurs most often when you lie down
  • How to treat it: Over-the-counter medications to reduce acid production

Post-nasal drip. Mucus dripping down the back of your throat causes this type of cough, which may occur with allergies, colds or sinus infections.

  • How does it sound? Dry or wet; worsens at night
  • How to treat it: Antihistamines dry up post-nasal drip from allergies. Saline washes and steam relieve congestion from lingering colds. See a doctor if symptoms last more than a week to check for a potential sinus infection.

Asthma. Asthma causes airway inflammation, swelling and increased mucus production that makes breathing more difficult.

  • How does it sound? Dry or wet cough that ends with a rattle or wheeze; often worsens at night, in cold air or with exercise
  • How to treat it: Inhaled bronchodilators (such as albuterol) or corticosteroids (such as fluticasone) for quick relief

Medication-related cough. This type of cough may appear a few weeks after you start taking a new medication. For example, 20% of patients taking ACE inhibitors for high blood pressure experience a cough.

  • How does it sound? Dry cough
  • How to treat it: Consult your doctor about switching medications.

Dealing with a cough reflex you can’t control

A refractory chronic cough, or a cough you can’t control, lasts for more than eight weeks and doesn’t respond to treatment. It occurs less than 20% of the time, Dr. Taliercio says.

It happens when inflammation irritates the nerves in the larynx, causing an involuntary cough reflex. Patients also often feel as if there’s something stuck in their throat.

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“People are most bothered by and distraught over the unpredictable coughing episodes,” she says. “Sometimes, they can cough so hard they pass out.”

  • How does it sound? Dry coughs that occur in spasms and are difficult to control
  • How to treat it: Off-label use of existing medications for other conditions, including neuromodulators (such as neurontin) and low doses of tricyclic antidepressants (such as amitriptyline)

Behavioral speech therapy can also help patients manage this type of cough, Dr. Taliercio says. In two or three sessions, patients will learn about cough suppression techniques, cough causes, breathing exercises, vocal hygiene and personal cough triggers.

“This type of therapy gives people control over their cough,” she says.

If you’re struggling with a lingering cough, try listening to what it’s telling you. And if it persists, your doctor can likely help pinpoint a cause and prescribe an appropriate treatment.

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