Decode These 7 Coughs

Want relief from your rattle, rumble, hack or whoop? Determining its cause may help.

A cough may not draw a “bless you!” the same way sneezes do, but it’s something we all experience. It’s the body’s way of protecting itself when an irritant threatens the throat or airways.

“Fortunately, most coughs are benign and self-limiting—they run their course and go away on their own,” says Mitchell Engler, M.D., a pulmonologist at Bergen Medical Alliance in Englewood.

What medicine terms an acute cough—one that’s been going on for three weeks or less—doesn’t mean you have to book it to the doctor unless it’s very thickly productive or accompanied by other worrisome symptoms such as fever and sore throat, adds pulmonologist Harris Tesher, M.D., of Holy Name Medical Center in Teaneck.

Coughing can be caused by several conditions, some of which—colds and viral flu, for example—don’t have quick cures and must be waited out. That doesn’t mean you can’t find some relief from your cough. Dr. Engler recommends drinking plenty of fluids to keep hydrated and using an over-the-counter expectorant such as guaifenesin (marketed as Mucinex, Flexall, Siltussin or Air-Power). “It thins out mucus and makes it easier to cough up,” he explains.

If your cough lasts more than three weeks, it’s time to see your physician. A diagnosis can be tricky, because coughs don’t always match up neatly between characteristics and causes. Still, it’s good to know what you’re up against, so bone up on these seven likely suspects.

Postnasal Drip

Also known as “upper-airway cough syndrome,” this most common cough usually produces phlegm. But contrary to folk wisdom, that phlegm’s color isn’t a reliable indicator of illness. “People will say that if it’s discolored it must be a bacterial infection,” says Dr. Engler. “That’s simply not the case.”

What to do:

If over-the-counter meds don’t bring relief, your physician may prescribe a nasal steroid along with decongestant and antihistamine medications.

Asthma

“This cough, the second most prevalent, tends to be dry, and it’s often accompanied by wheezing and chest tightness,” says Dr. Tesher.

What to do: An asthma rescue inhaler may help calm the cough, and your physician may suggest anti-allergy therapy.

Post-respiratory Infection

This cough can show up when you’re recovering from an upper respiratory infection. It develops when the nerves in the airway become hyper-responsive.

What to do: There’s no specific treatment regimen here. Take it easy and try home and over-the-counter remedies—and get lots of rest.

Pneumonia

“This is the cough we worry about when someone comes in acutely ill with a brand-new cough,” says Dr. Tesher. “It usually comes with a fever and is very productive, with a thick pus.”

What to do: If you suspect pneumonia, see your physician right away. The diagnosis is confirmed when, along with a heavy cough and fever, an “infiltrate finding”—an abnormal substance—shows up on a chest X-ray. Antibiotics can knock out bacterial pneumonia, while viral pneumonia can be treated with medications to combat symptoms and keep the infection from spreading in the body. But antiviral medications don’t always provide relief. “Antiviral agents like TamiFlu are effective for some viruses,” explains Hormoz Ashtyani, M.D., a pulmonologist at Hackensack University Medical Center in Hackensack. “The main goal of treatment in viral pneumonia is to provide support and give the body a chance to defeat it.”

Acid Reflux

Roughly one-fourth of chronic coughs are linked to gastroesophageal reflux disease (GERD), which develops when acid backs up into the esophagus. The acid can irritate nerve endings, triggering a nagging cough. This cough could be the culprit if you find you’re coughing more after meals or if your voice is sometimes hoarse. “If your cough gets worse when you lie down,” explains Dr. Tesher, “that’s a sign that it’s either postnasal drip or acid reflux.”

What to do: Your physician may prescribe a proton pump inhibitor or an H2 blocker, a medication that reduces the amount of acid produced by the stomach’s lining. Raising the head of your bed at night may help too.

Whooping Cough (Pertussis)

This highly contagious disease has made a comeback, and it affects adults as well as kids. It gets its name from the sound of its cough—a very specific, loud barking cough that comes in fits. Says Dr. Tesher, “Often there’s post-cough vomiting.”

What to do: Pertussis is a bacterial infection that responds to treatment with antibiotics. But since its distinctive “whoop” doesn’t always show up clearly at the start, it can be challenging for doctors to spot. See a physician promptly if you even suspect you or your child is developing whooping cough.

Chronic Obstructive Pulmonary Disorder (COPD)

This progressive condition, which literally takes your breath away, produces long bouts of mucus-heavy coughing that often seem self-perpetuating. Its usual cause is cigarette smoking, although long-term exposure to dust, air pollution or chemical fumes may also play a role.

What to do: Heed your doctor. What triggers concern in a constant cougher is a change in the nature—the quality, frequency or depth—of the coughing. Also, advises Dr. Engler, “if you notice that sputum is streaked, specked or tinged with blood, see your physician promptly.” Treatments include bronchodilators and inhaled steroids, and extreme cases of COPD may require oxygen therapy. If you’re a smoker, this is the time to quit. Seek support from your physician or smoker helplines and websites.

Did you know?

Need to tame a pesky cough? Try a teaspoon and a half of honey. Recent studies suggest honey is at least as effective as dextromethorphan, the most common cough-suppressant medication in relieving coughs that keep both adults and children awake. It’s easier to spell too. (But don’t give honey to a baby under 1 year old because of a small risk of infant botulism.)

Fun Fact

Human coughs can expel air at speeds of up to 500 miles per hour. —Mayo Clinic