M.D. Program - School of Medicine

What Your Persistent Cough Could Mean And How To Get Rid Of It

Most of us rarely get through the colder months without a bug of some kind hitting us hard. But when that pesky cough drags on for weeks, you start wondering if you'll ever be healthy again...Or if it's a sign of something more serious.

So what can you do to help yourself and get some much-needed sleep at night to try and heal?

Researchers from the American Chemical Society claim cough syrups work little better than a placebo, while other popular remedies such as echinacea, vitamin C and zinc are not likely to help either.

At best cough suppressants can leave you drowsy and give you a better night's sleep, claim the scientists.

There is little or no evidence that the heavily marketed active ingredients – including the DXM (dextromethorphan) often found in 'night time' formulations – do anything to ease the cough. So what can we do about it?

Why do we cough?

Prof Ron Eccles, director of the Common Cold Centre at Cardiff University says: "Coughing does actually have an important purpose. It's a safety reflex, your body's way of keeping unwanted stuff from getting into your lungs.

However, post-virus inflammation of the airways means this debilitating symptom can linger long after the initial infection has gone."

But there are some simple tricks experts say will bring you some relief by soothing your irritated airways.

Water is your friend

Drink plenty of fluids: Keeping hydrated helps thin out the excess mucus and reduces your cough reflex. Drinking liquids also helps keep mucus membranes moist. This is particularly helpful in winter when houses tend to be hot and dry.

Add moisture to the air: Dry air can be irritating, so a humidifier will also help ease congestion.

The downside is that if you don't clean humidifiers thoroughly after every use they can become breeding grounds for fungus and mould which they then pump into the air, exacerbating coughs further.

Bowls of water or damp towels placed on a radiator make for a safe, cheap alternative to plug-in humidifiers.

Have a steamy shower: The heat can loosen secretions in your nose which can ease a cough.

Try putting a few drops of eucalyptus or menthol oil on the shower wall (but never directly onto your skin) to boost the effect. Sucking cough sweets can help, says the American Chemical Society. They stimulate the production of saliva which soothes your irritated throat. Boiled sweets also help.

Any drinks will have the same effect

Sipping hot drinks: A warm cuppa combines the steam effect for thinning mucus with throat-soothing effects. Many people particularly swear by honey and fresh lemon in hot water.

Keep a glass of water handy, day and night: Sipping water can help thwart a coughing fit, and the sooner you can stop one the better. Continually coughing irritates your airways further, making your cough last longer.

Cough-proof your home

Sleep with extra pillows: When it comes to a night-time cough, gravity is the enemy. All the mucus you would normally swallow during the day flows back and irritates your throat as you lie down.

Keep the air inside your home irritant-free: Air fresheners and scented candles may seem harmless, but for some people they can cause sinus irritation which produces extra mucus that leads to even more coughing.

The worst irritant in the air is smoke, so avoid cigarettes and any areas where there are smokers.

Stay inside in the warm as much as possible: Cold air can exacerbate a cough. So if you have a cold or other respiratory infection avoid being outside for too long.

What's causing my cough

Although most coughs at this time of year are virus-related, there are several other types of cough it pays to be aware of.

They can be a warning sign that you have an underlying condition such as asthma, heartburn or even cancer.

Here's how to work out which you have and when to see your GP…

Post-viral cough

Symptom: An irritating cough that follows a nasty cold or flu bout.

Cause: A fly virus typically causes inflammation which leads to mucus draining down the back of the throat triggering a cough.

Coughs linger because the inflammation often stays long after the initial illness.

Treat it: Take a paracetamol for any pain or fever and sip a hot drink, which promotes secretions in the airways, soothing irritation. See above for more tips.

Chest infection/bronchitis

Symptom: A hacking cough, often bringing up green-looking phlegm.

Cause: A lung infection usually following a cold or flu virus.

Treat it: Lots of fluids to prevent dehydration and to thin the mucus. Antibiotics will only help if the cause is a bacterial infection.

Asthma

Symptom: A chronic dry cough that's worse at night, sometimes disturbing sleep.

Cause: An irritating night cough is often the first sign of asthma, especially in children, but you can develop it at any age.

Treat it: Talk to your GP – typically the first thing they will recommend is a blue 'reliever' inhaler, which releases medication to open the airways.

Heartburn

Symptom: A 'throaty' cough following a meal, and sometimes waking you at night, often leaving a nasty acid taste in your mouth.

Cause: Acid reflux (heartburn) occurs when stomach acid flows back up the oesophagus, irritating the throat and triggering a cough. Large or rich meals late at night are triggers.

Treat it: If it's occasional, a simple over-the-counter indigestion treatment will reduce the production of stomach acid. If it's frequent, see your GP.

Whooping cough

Symptom: Uncontrollable coughing fits, which may produce a 'whoop' sound.

Cause: This highly contagious disease has been on the rise again in recent years. A vaccine is given to babies and pregnant women.

Treat it: Babies and young children are at the highest risk of severe complications and if they do succumb need close monitoring and often antibiotics.

Medication cough

Symptom: A dry, niggling cough, often worse at night

Cause: ACE inhibitors, a common drug used to control high blood pressure, can cause a chronic cough in up to 20 percent of patients.

Treat it: If you think your cough coincided with starting medication, talk to your GP about alternatives.

Worrying new cough

Symptom: A new cough lasting longer than three weeks – especially in smokers.

Also look out for – coughing up blood, breathlessness, weight loss, tiredness or chest pain.

Cause: Anyone experiencing any of the above symptoms needs to get to talk to their GP immediately as they could indicate lung cancer – the third most common cancer in the UK.

Smoking accounts for 90 percent of cases.

Treat it: Once picked up by X-ray, treatment can involve a combination of surgery, chemotherapy and radiotherapy.

How Can I Stop A Coughing Attack?

A coughing attack can happen for various reasons, and there are several things a person can do to help stop uncontrollable coughing. These include taking antihistamines, using cough medication, avoiding smoking, treating an underlying condition, and more.

Coughing is a symptom of many different health conditions. Some of these conditions are relatively harmless, while others are much more severe.

This article outlines the different types of coughs and lists the most common causes of acute and chronic coughs. It also provides information on how to stop a coughing attack, diagnose a cough, and when to see a doctor.

There are several methods a person can try to stop a coughing attack when one begins. These include:

drinking plenty of water

sipping hot water with honey

taking over-the-counter (OTC) cough medicines

taking a steamy shower

using a humidifier in the home

Many coughs occur due to dryness or irritation in the throat. The methods listed above can all help relieve dryness and irritation if present.

A cough can also be a symptom of an underlying health condition. In these instances, treating the underlying condition should stop the cough.

How to stop infants from coughing

Children and infants who have a cough should drink plenty of water. This will help soothe the throat and minimize coughing.

Placing a cool mist vaporizer or humidifier next to a child's bed can help alleviate nighttime coughing.

The Food and Drug Administration (FDA) does not recommend giving OTC cough medicines to children under 2 years of age.

Additionally, people should not give honey to infants under 1 year of age, as it can lead to an illness called infant botulism.

Many different health conditions can cause a cough. It can be helpful to understand the different types of coughs to identify the condition.

According to the American Lung Association (ALA), healthcare practitioners classify coughs as follows:

Acute cough: This is a cough that comes on suddenly and lasts up to 3 weeks.

Subacute cough: This is a cough that comes on suddenly and lasts around 3–8 weeks.

Chronic cough: This is a cough that lasts longer than 8 weeks.

Productive cough: This is a cough that produces phlegm.

Dry cough: This cough does not produce phlegm.

Nocturnal cough: This is a cough that only occurs at night.

Hemoptysis: This is when a person is coughing up blood or blood-stained mucus from their lungs.

The following are some common causes of acute coughs.

COVID-19

During the current pandemic, a dry cough, which is a symptom of COVID-19, may be a concern for some people. This is the disease caused by the novel coronavirus SARS-CoV-2.

The main symptoms of COVID-19 are:

Most people who contract SARS-CoV-2 will develop mild symptoms. However, some may develop severe and even life threatening symptoms. The Centers for Disease Control and Prevention (CDC) advises people to seek emergency medical treatment if they develop any of the following symptoms:

Upper respiratory tract infections

An upper respiratory tract infection (URTI) is a viral or bacterial infection of one or more of the following:

the nose

the sinuses

the pharynx, which is the part of the throat that sits behind the mouth and nasal cavity

the larynx, or voicebox

Some examples of URTIs include:

A cough is a common symptom of URTIs. Other common symptoms include:

Lower respiratory tract infections

Lower respiratory tract infections (LRTIs) affect the lungs' large airways. Some examples include bronchitis and pneumonia.

Bronchitis is an infection of the bronchi, the lungs' main airways. The primary symptom of bronchitis is a dry or productive cough. A productive cough may produce green, yellow, or blood-tinged mucus.

Other symptoms include:

Pneumonia is an infection in one or both of the lungs. It typically causes a dry or productive cough.

Some other common symptoms of pneumonia include:

Allergic rhinitis

Allergic rhinitis, or hay fever, occurs when a person's immune system overreacts to something in the environment.

Common environmental allergy triggers, or allergens, include:

People with allergic rhinitis may experience a dry cough due to breathing in an allergen. Some other potential symptoms of allergic rhinitis include:

nasal congestion

sneezing

itchy eyes, nose, mouth, or throat

swollen eyelids

Inhaling irritants

A person may develop an acute cough after breathing in certain environmental irritants. Examples include:

Inhaling irritants can cause symptoms similar to those of allergic rhinitis.

The sections below outline some of the more common causes of a chronic cough.

Asthma

Asthma is a chronic lung condition that causes inflammation and narrowing of the airways. This narrowing makes it difficult for air to move in and out of the lungs, resulting in breathing difficulties.

There is no cure for asthma, but treatments are usually effective in managing the condition. If a person does not control the condition well, however, they may experience the following symptoms:

coughing fits

wheezing

a tight feeling in the chest

shortness of breath

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) refers to a group of chronic lung conditions that obstruct airflow in and out of the lungs.

COPD can inflame and thicken the airways within the lungs, and it can damage the lung tissue responsible for exchanging gases.

Chronic coughing and shortness of breath are common symptoms of COPD. Other possible signs and symptoms of COPD include:

wheezing

excessive mucus production

frequent respiratory infections

cyanosis of the lips or fingernail beds

fatigue

Lung cancer

Lung cancer is the third most common cancer type in the United States. It occurs when cells divide uncontrollably in the lungs, causing tumors to grow. Tumors can cause breathing difficulties, and spread to other parts of a person's body.

People with lung cancer may not have symptoms until the disease is at an advanced stage.

According to the CDC, a lingering cough that may gradually worsen is a possible symptom. Other potential symptoms include:

Medications

A cough can sometimes be a side effect of certain medications.

A cough is one of the most common adverse side effects of angiotensin converting enzyme inhibitors (ACEIs). Doctors sometimes prescribe these to treat high blood pressure.

According to a 2012 case report, the antiepileptic drug, topiramate may also cause a dry cough, but this is rare.

To prevent a coughing fit, a person will need to identify and treat the underlying cause of the cough.

People with chronic respiratory conditions will require medical treatments to reduce the frequency and severity of coughing fits.

Those who develop coughing fits in response to certain allergens or irritants should try limiting their exposure to those substances.

Another option for people with allergies is to take antihistamines. These drugs help suppress the immune system's response to environmental allergens, thereby preventing coughing fits.

Quitting smoking will also help prevent coughing episodes.

Coughing is a common symptom of a variety of health conditions.

According to the ALA, a person should take note of the duration, type, and features of their cough when speaking with a healthcare professional to assist with diagnosis.

A healthcare professional may ask about a person's medical history, the nature of the cough, whether the cough gets worse or better in certain settings, and if they have any additional symptoms.

Examples of questions a doctor may ask a person include:

When did your cough start?

Does the cough produce mucus?

What is the color and consistency of the mucus?

Is there blood in the mucus?

Do you have allergies or cough triggers?

Have you been in contact with people with respiratory infections, such as the common cold, tuberculosis, pneumonia, or whooping cough?

Do you have any known medical illnesses?

Do you smoke tobacco or cannabis, vape, or use drugs?

If a person is experiencing other symptoms, such as chest pains, difficulty breathing, headaches, drowsiness, confusion, fever, and they are coughing up blood then a doctor may prescribe further tests.

Tests can include:

A person should see a doctor if their cough is severe, persistent, or worsens over time. These characteristics can indicate that a person requires medical treatment.

Parents and caregivers should also speak to a doctor if their child displays any of the following symptoms:

a fever of any kind in an infant under 3 months of age

a fever of 102°F (38.9ºC) or higher in a child of any age

cyanosis of the lips

wheezing

difficult or labored breathing

a loss of appetite or thirst

excessive sleepiness

excessive irritability

a cough that lasts longer than 3 weeks

Also, anyone who develops bothersome symptoms of COVID-19 should contact their doctor. If the symptoms are severe, they need immediate medical attention.

There are several steps a person can take to stop or manage a cough. These include drinking plenty of water, taking over-the-counter cough medicines, and using an indoor humidifier.

There are several health conditions that can cause a cough. Some are relatively harmless and tend to go away on their own. Others are much more severe and may require medical treatment.

A person should talk with a doctor if they develop a severe, persistent, or worsening cough. A person should also contact a doctor if they or their child develop any other concerning symptoms.

A doctor will work to identify the cause of the symptoms and prescribe appropriate treatments.

Severe Long COVID Linked To Lasting Cough, Sputum Production

People who experienced severe long COVID had two stand-out symptoms: Persistent cough and a lot of sputum within the year after being hospitalized for their initial infection, according to a new study.

The report details a team from Keio University in Tokyo that examined data on hospitalized adults who were diagnosed with COVID-19 between January 2020 and February 2021. The participants came from 26 different hospitals. Researchers compiled data and patient-reported outcomes from surveys and mobile apps during the year after the people were released. About 1,200 people were involved, but the numbers decreased as the study duration went on. In total, 690 people were evaluated throughout the entire course of the initiative.

The research was published on Nov. 14 in Respiratory Research.

Symptoms reported after people had COVID-19 included fever, cough, sputum, breathlessness, sore throat, taste impairment, smell impairment, abdominal pain, and diarrhea.

The rates of wet and dry cough were similar at 3, 6, and 12 months after infection. The proportion of people producing sputum without coughing increased over time compared with those with both sputum production and coughing, the authors reported.

At 12 months post-infection, severe COVID-19 was linked with cough and sputum production based on imaging findings, kidney and liver abnormalities and pulmonary blood clots. The team also noted higher levels of lactate dehydrogenase (which shows organ or tissue damage), Krebs von den Lungen-6 (which indicates lung inflammation or damage) and hemoglobin A1c (or elevated blood glucose).

At all follow-up visits, researchers analyzed the risk factors for the persistent symptoms. They say that use of intermittent mandatory ventilation (IMV), smoking and older age are all culprits.

"These findings emphasize that a preventive approach including appropriate vaccination and contact precaution and further development of therapeutic drugs for COVID-19 are [sic] highly recommended for patients with risk factors for severe infection to avoid persistent respiratory symptoms," the authors wrote.

---