How Do I Know If My Cough Is Serious?

Coughing is a symptom of many conditions, from autoimmune disease, to infection, to cancer and environmental factors. How serious the cough is depends on its severity, duration and the accompanying symptoms.

A cough can be voluntary or involuntary, and it is the body’s way to help clear the airways of irritants and to prevent infection. Cough is not a disease in itself, but a symptom of an underlying medical condition.

A cough is categorized as acute, subacute, or chronic depending on how long it lasts.

• Acute coughs last less than three weeks 
• Subacute coughs last three to eight weeks and remain after the initial cold or respiratory infection is over
• Chronic coughs last more than eight weeks 

A cough may be accompanied by other cold symptoms, including:

• Postnasal drip 
• Runny or stuffy nose
• Sore throat
• Hoarseness
• Heartburn 
• Unpleasant taste in the mouth

See a doctor immediately if you experience the following symptoms accompanying a cough because it may be serious:

• Difficulty breathing/shortness of breath
• Shallow, rapid breathing
• Wheezing
• Chest pain
• Fever
• Coughing up blood or yellow or green phlegm
• Coughing so hard you vomit
• Unexplained weight loss
• Cough lasts more than 8 weeks
• Fainting 
• Swelling of feet or ankles

Causes of cough include:

• Infections
  • Common cold (viral infection)
  • Coronavirus 2019 (COVID-19) 
  • Bacterial or fungal infections
  • Pneumonia
  • Whooping cough (pertussis)
• Smoking
  • Most common cause of chronic cough
• Postnasal drip 
  • Allergies (allergic rhinitis)
  • Sinus infection
• Lung conditions
  • Asthma 
  • Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema
  • Interstitial lung disease
  • Lung cancer
• Gastroesophageal reflux disease (GERD) 
• Certain medications such as ACE inhibitors
• Inhalation of foreign objects into the lungs (usually in children)
• Sarcoidosis
• Congestive heart failure

Cough is diagnosed with a history and physical exam. Tests may be used to help diagnose the cause of the cough. 

• Lung imaging
  • Chest X-ray 
  • Chest computerized tomography (CT) scan 
• Lung function tests 
• Acid reflux testing
  • pH probe
  • Upper endoscopy 
• Swab of inside the nose to test for COVID-19
• Allergy skin tests 
• Lab tests of phlegm that is coughed up

Treatment of cough depends on the cause and whether the cough is acute or chronic. Treatment may include: 

• Over-the-counter (OTC) cough medicines containing guaifenesin and/or dextromethorphan (these can be found as cough syrups and in tablet form)
• Antibiotics for infection caused by bacteria such as bacterial pneumonia and bronchitis
  • Antibiotics will not treat cough caused by viruses such as the common cold, flu, or COVID-19
• Inhaled bronchodilators and inhaled steroids to treat asthma and COPD
• Decongestants such as pseudoephedrine (Sudafed), antihistamines such as diphenhydramine (Benadryl), or nasal inhalers like ipratropium bromide (Atrovent) for postnasal drip 
• Famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24-Hour), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium) to treat gastroesophageal reflux disease (GERD) 
• If cough is caused by an ACE inhibitor, your doctor may switch your medicine
  • Never stop taking a prescribed medication without first talking to your doctor
• Pain relievers (analgesics) to treat the pain caused by coughing

If the cough is not serious, home remedies may help relieve symptoms, such as:

• Staying hydrated
• Inhaling steam in a shower or using a humidifier 
• Gargling with warm saltwater 
• Cough lozenges (lozenges are not recommended for young children; they can be a choking hazard)  
• Don’t smoke
• Avoiding allergens such as pollen, dust, animals, or mold 
• Avoiding inhaled irritants such as smoke, dust, and other pollutants
• For GERD: Avoiding foods that increase reflux, avoiding meals before lying down, elevating the head while sleeping

To prevent cough:

• Don't smoke
• Manage chronic conditions that may cause cough such as asthma, postnasal drip, or GERD 
• Avoid people who are sick with the cold, flu, COVID, bronchitis, or pneumonia
• Get the whooping cough (pertussis) vaccine
• Eat fruit
  • Research suggests diets high in fruit fiber and flavonoids may prevent chronic productive cough