Types of Coughs and What They Mean How to Decode 10 Types of Coughs

We all cough occasionally, especially in winter when colds hunt us down. It’s often nothing to worry about and will disappear on its own. But when does it mean something serious? Here’s how to translate different types of coughs… Go to any movie theater and you’ll hear coughing, as common as the rustling of popcorn bags. Most of us think of coughs as harmless, usually just a symptom of a cold. But “a cough is never normal,” says critical care pulmonologist Nicola Hanania, M.D., director of the Asthma Clinical Research Center at Baylor College of Medicine in Houston, Texas. Coughs always signal that something’s wrong – that excess mucous, stomach acid, smoke or even a medication (most commonly blood pressure drugs) has irritated nerves in passages leading to the lungs. The resulting cough is working to clear them. Because types of coughs vary wildly, it’s often hard to diagnosis a bigger problem. A simple cold may bring dry barking or wet, productive hacking. But so can bronchitis or pneumonia, even GERD. But you don’t want to go running to your doctor every time you cough. So when should you seek medical help? Here’s the most important question to ask yourself: How long does it last? After eight weeks, a cough is considered chronic and is unlikely to disappear on its own. But it’s best to seek medical help long before – after just two weeks of an unexplained cough, many doctors say. And beware: If that cough, even one caused by a simple cold, comes with fever, blood, green or yellow phlegm, chest pain or shortness of breath, head to your doctor fast, says pulmonologist Peter Dicpinigaitis, M.D., director of the Montefiore Cough Center at Montefiore Medical Center in Bronx, New York. Here’s a guide explaining the conditions that cause coughs and how to soothe and get rid of them: 1. Colds and Flu “Almost all coughs due to the common cold come and go without trouble,” Dicpinigaitis says. Still, they can be a big hassle if they keep you up all night or doubled over during the day. What to do: The first and best line of defense? Drink at least a quart of water or other fluids daily, Hanania says. “Fluids keep the [respiratory] system hydrated and the cough moist." Moist trumps dry because they aren’t as painful and you can hack up whatever’s in the lungs more easily. But don’t take over-the-counter (OTC) cough suppressants unless coughing keeps you up at night, Hanania advises. That's because, true to name, they suppress the cough – keeping the mucous in. If you take anything, “a mucolytic [an expectorant such as MucinexDM or VicksDM] may soothe the cough” and make it more moist. Their active ingredient, dextromethorphan, is taken in doses of 30 milligrams or more to be effective, he says. “If the cough is mild, it’s best to wait it out and let the cold go away,” Dicpinigaitis says. But whether your cough is mild or severe, see your doctor if you have high fever or colored discharge. And if you have chest pain or difficulty breathing, go immediately to a physician or the emergency room. Doctor’s Rx: If the cough is severe, a physician may prescribe a combination cough suppressant/painkiller for a few days or dextromethorphan, an expectorant. Although colored discharge can signal an infection, many doctors won’t prescribe antibiotics for a cold because most are caused by viruses, not bacteria. 2. Post-nasal drip Most types of coughs are caused by post-nasal drip, triggered by allergies, fumes or an upper respiratory infection, says Margaret Lewin, M.D., assistant professor of Medicine at Weill Medical College of Cornell University in New York City and medical director of Cinergy Health in Miami, Fla. “The sinuses produce fluid that drips down the throat and that produces a cough, because your body won’t let you drown in your own secretions,” she says. The cough can be dry or wet, accompanied by a tickling or sore throat. Whatever the trigger, it’s working to clear mucous and secretions. What to do: If you suspect the drip is caused by allergies – something only an allergist can verify – try an antihistamine, Lewin says. If dry air could be the culprit, use a humidifier at night, when post-nasal drip tends to be worse. If the drip stems from a cold, try a decongestant like Sudafed and a nasal spray like Afrin. But don’t use such products more than three days, she says. After that, decongestant sprays cause nasal tissues to swell and you’re back to stuffy, even without a cold. You can also rinse your sinuses with saline solution using a neti pot, a teapot-like vessel available in drugstores. The rinse helps stop the drip and gets rid of the cough too. Learn how to use a neti pot. According to Lewin, see a doctor if: Your sinuses are painful, but you have no signs of a respiratory infection, like achiness The cough and drip lasts more than two weeks You have to travel on an airplane Doctor’s Rx: If OTC antihistamines fail, your doctor may prescribe inhaled steroids, which are anti-inflammatory and have little effect system-wide, unlike oral or injected steroids. “Inhaled decongestants, like Afrin, provide only symptom relief,” and don’t reduce inflammation, Hanania says. 3. Sinusitis/Rhinitis Sinusitis, an inflammation of the sinuses, causes that tickling, dripping sensation down the back of the throat that triggers various types of coughs. Rhinitis is inflammation of the nasal passages, which also leads to post-nasal drip. What to do: Rhinitis, sinusitis and post-nasal drip are classic allergy symptoms, Hanania says. Try an antihistamine, “especially at night to block the dripping that makes you cough in the morning,” he says. Antihistamines block histamines (the substances released by cells in response to allergens) and cause reactions like a drippy nose. You can also try nasal spray decongestants, but again, they help symptoms without addressing inflammation, Hanania says. Doctor’s Rx: If the sinusitis or rhinitis is bacterial, a doctor may prescribe antibiotics and probably an inhaled steroid to reduce nasal passage and sinus inflammation, Hanania says. 4. Allergies Do you wonder why you cough all spring? Coughs related to rhinitis, sinusitis and post-nasal drip all can be triggered by allergies. What to do: For starters, avoid whatever triggers symptoms: dust, perfumes or animals, Hanania advises. And try OTC antihistamines. Doctor’s Rx: You’ll probably be tested for allergies, exposing you to common allergens through skin tests and watching for a reaction. “The medications – usually inhaled steroids – are those that open the airways but are also anti-inflammatory,” Hanania says. 5. Asthma “The second most common cause of coughs is asthma,” Lewin says. “Some people, instead of loud wheezing, get only a cough.” Asthma, a chronic bronchial condition that causes air passages to tighten, can crop up suddenly after an upper respiratory infection or exposure to irritants like perfume, paints – even exposure to cold air. What to do: “Avoid whatever triggers the asthma, whether environmental allergens or exercise,” Hanania says. A workout can sometimes trigger asthma, probably because of a person’s sensitivity to changes in temperature, humidity and air pollution, he says. “If you have shortness of breath, wheezing or a cough that lasts more than two weeks, go directly to your doctor,” Lewin says. Doctor’s Rx: After testing for allergies, a physician will probably prescribe a bronchodilator, a medication that widens the air passages, making it easier to breathe, Dicpinigaitis says. For an exercise-triggered cough, a doctor may prescribe a short-acting bronchial inhaler, which contains a bronchodilator to open the airways. “Your doctor may also prescribe inhaled steroids, Dicpinigaitis says. “The bottom line is that the cough will go away with standard asthma treatment.” 6. Smoker’s cough “Many smokers think of it as a morning cough,” Hanania says. But a cough can be a sign of a more serious disease like COPD (chronic obstructive pulmonary disease) or lung cancer. COPD is an umbrella term for emphysema and chronic bronchitis. Chronic, or long-lasting bronchitis, is an inflammation of the airways that comes with a deep, phlegmy cough, primarily brought on by smoking, Dicpinigaitis says. About “50% of people with COPD – 12 million out of 24 million – haven’t been diagnosed,” Hanania says. Emphysema, also linked to smoking, occurs when the lungs’ air sacs are damaged, which leads to shortness of breath. Lung cancer doesn’t always produce a cough; that usually occurs if the cancer is irritating the airways. What to do: “Quit smoking. Now,” Hanania says. “If smoking is the cause of the coughing, the cough typically goes away four weeks after quitting,” Dicpinigaitis says. Doctor’s Rx: “Any smoker over 40 who has a cough or shortness of breath needs to have a lung function test,” Hanania says. It’s a simple breathing test: You blow into a small machine, which measures how much air you inhale and exhale. Once diagnosed, your doctor probably will prescribe long-acting bronchodilators, he says. “In severe [cases], we add inhaled steroids,” he says. If the doctor suspects lung cancer, you’ll have to undergo diagnostic tests, such as X-rays or a biopsy. But lung cancer rarely causes chronic coughs. Watch out for those that bring up bloody mucous; that’s a sign to see your doctor immediately. 7. Acute bronchitis/Pneumonia Acute – sudden, but short – bronchitis is essentially a cold or a viral infection, Dicpinigaitis says. It can also be bacterial. Pneumonia, an infection of the lungs, also can be viral or bacterial. What to do: For mild bronchitis, treat it as you would a cold. If you have chest pain, head to a doctor or emergency room immediately. Doctor’s Rx: If the cause is bacterial, your doctor will put you on antibiotics and may prescribe bronchodilators. If it's severe pneumonia, you may be hospitalized. 9. Reflux (GERD) Surprisingly, if you have acid or non-acid reflux – the back-up of stomach fluids into your esophagus – your only symptom may be a cough, not heartburn. “More than half of people with reflux disease have only a cough,” Dicpinigaitis says. What to do: You’ll have to play detective: Try an OTC anti-acid, such as Tums; if that clears up your cough, chances are GERD was the cause. “Sometimes that’s enough,” he says. Doctor’s Rx: The doctor first may go for a trial treatment, offering a medication to block stomach acid production to see if that relieves the cough. Next steps: An anti-acid and medication to tighten the esophageal sphincter, or valve between the stomach and esophagus. Clear up the GERD and say goodbye to the cough. 10. Whooping Cough (Pertussis) Caused by bacteria and initially wearing the trappings of a cold, highly-contagious whooping cough – a dry hacking – has been one of the types of coughs that has been recurring over the past decade, either because people weren’t vaccinated as children or their childhood vaccination, DtaP, has lost its kick, Dicpinigaitis says. “The cough is typically high-pitched and so persistent that people can become short of breath, Hanania says. “But it can be missed – just as in a cold.” “More than 20% of people who cough for more than two weeks have whooping cough,” Lewin says. What to do: Put a humidifier in your bedroom, which will loosen the phlegm and soothe irritated lungs. Doctor’s Rx: The doctor will likely swab your nose or throat to test for whooping cough bacteria, called bordello pertussis. Once a diagnosis is confirmed, you’ll be prescribed antibiotics. In the meantime you may just have to endure the cough for several weeks. Use a suppressant if the cough’s keeping you from sleeping. Health writer Dorothy Foltz-Gray is a frequent contributor to Lifescript.