We all cough. It’s as common as breathing, and for most of us, it comes and goes without much fuss. But what if that tickle in your throat doesn’t go away? What if the cough starts affecting your sleep, work, or even makes you worry something serious is going on?
Let’s unpack the mystery of coughs—from the harmless ones to those that might signal something deeper.
What is a Cough?
A cough is more than just a sound—it’s your body’s way of clearing the airways. It’s a protective reflex that helps keep your lungs and throat free from irritants like mucus, dust, smoke, or germs.
Think of it as your body’s personal broom—sweeping out anything that doesn’t belong in your air passages.
Some quick facts:
- Cough is one of the most common reasons people visit their GP.
- Most coughs are short-term and resolve on their own within 3 weeks.
- Coughs that last longer than 8 weeks in adults are considered chronic.
There are two main types:
- Dry cough: No mucus, often feels like a tickle or irritation.
- Wet/productive cough: Brings up phlegm or mucus.
Understanding the type and duration of a cough can give us big clues about what’s causing it.
How Does Cough Actually Happen?
Imagine this: you’re walking into a dusty room. Suddenly, you feel the urge to cough. That urge? It’s not random.
Here’s a simplified step-by-step of what’s happening:
- An irritant (like dust, smoke, or mucus) hits the sensitive lining of your throat or lungs.
- Your nerve endings detect it and send a message to the cough centre in your brainstem.
- Your brain triggers a response: your diaphragm and chest muscles contract, your vocal cords shut tight, and pressure builds up.
- When the cords suddenly open—woosh!—a cough explodes out, trying to eject the intruder.
It’s basically your body’s emergency eject button.
What Causes a Cough?
Let’s start with this: Not all coughs are created equal. Some are caused by infections. Others by allergies. Some by lifestyle habits, and a few by conditions deep within your chest or stomach.
🌿 Common Causes of Acute Cough (less than 3 weeks):
- Viral infections (common cold or flu) – The most common cause. Often comes with sore throat, runny nose, and body aches.
- Post-nasal drip – When mucus from the nose drips down your throat, triggering a cough.
- Environmental irritants – Smoke, dust, perfumes, or cold air.
- Allergies – Can mimic a cold and come with sneezing and itchy eyes.
🔄 Causes of Chronic Cough (more than 8 weeks):
- Asthma – Especially if the cough worsens at night or after exercise.
- Gastroesophageal Reflux Disease (GERD) – Stomach acid travels back up, irritating the throat.
- Chronic bronchitis – Common in smokers; cough with phlegm, especially in the morning.
- Medications – Especially ACE inhibitors (used for high blood pressure), which can cause a dry cough in up to 10% of users.
- Whooping cough – A bacterial infection that causes severe coughing fits.
🚨 Serious But Less Common Causes:
- Pneumonia – Often presents with fever, shortness of breath, and a productive cough.
- Tuberculosis (TB) – Chronic cough, weight loss, night sweats, and coughing up blood.
- Lung cancer – May cause a new persistent cough, especially in smokers. Sometimes with blood-streaked sputum.
- Heart failure – Can cause fluid buildup in the lungs, leading to a wet cough, especially when lying down.
Risk Factors: Who’s More Likely to Have a Problematic Cough?
Anyone can get a cough, but it’s more likely to become prolonged or troublesome if you:
- Smoke or vape regularly
- Have underlying lung conditions (asthma, COPD)
- Are exposed to polluted environments or occupational chemicals
- Take medications like ACE inhibitors
- Have chronic acid reflux
- Have a weakened immune system (e.g., older adults, people with chronic illnesses)
Children, elderly adults, and those with multiple health conditions may be more vulnerable to complications from coughing, such as breathing difficulties or chest infections.
Other Symptoms That Might Come with a Cough
A cough often brings company. Depending on the cause, you might notice:
- Sore throat or hoarseness
- Runny or stuffy nose
- Wheezing or tight chest
- Fever or chills
- Fatigue or body aches
- Coughing up phlegm (green/yellow) – points toward infection
- Coughing up blood – a red flag that needs urgent attention
- Weight loss and night sweats – concerning signs that could point to TB or cancer
Tests to Identify the Cause
Doctors usually start with a good history and physical exam. In many simple cases, that’s enough.
But when the cough lingers or seems unusual, a few tests can help:
🧪 Common Investigations:
- Chest X-ray – To rule out pneumonia, TB, cancer, or heart failure.
- Sputum test – Checks for infections like tuberculosis or bacterial bronchitis.
- Lung function tests (spirometry) – Especially useful in asthma or COPD.
- Allergy testing – If an allergic cough is suspected.
- pH monitoring or upper endoscopy – If reflux is the suspected cause.
Important clinical note:
If a cough is clearly linked to an upper respiratory infection and enlarged lymph nodes are reactive, especially in the neck, no further investigation may be needed unless symptoms persist beyond a few weeks.
Treatment for Cough
💊 First, treat the cause—not just the cough.
There’s no one-size-fits-all remedy. Treatment depends on what’s triggering the cough.
🥇 Gold-Standard Approaches:
- Viral infection: Rest, fluids, and patience. Most go away on their own.
- Asthma: Inhalers (like salbutamol) to relax airway muscles.
- GERD: Acid-suppressing meds (like omeprazole), dietary changes (no late meals, spicy food), and elevating the head at bedtime.
- Allergies: Antihistamines, nasal sprays, and allergen avoidance.
- Post-nasal drip: Saline nasal rinse, antihistamines, or decongestants.
- Bacterial infection: Sometimes requires antibiotics—but only if truly needed.
🔄 Other Helpful Options:
- Cough syrups or lozenges – Provide symptom relief, but won’t cure the cause.
- Steam inhalation – Helps loosen mucus and soothe irritated airways.
- Hydration – Keeps mucus thin and easier to cough up.
- Quit smoking – Essential for chronic cough and overall lung health.
- Avoid triggers – Use air purifiers, wear masks in dusty areas, and limit exposure to irritants.
When Should You See a Doctor?
See your doctor if your cough:
- Lasts more than 3 weeks
- Gets worse over time
- Is accompanied by shortness of breath, weight loss, fever, or blood
- Affects your sleep or daily life
- Comes with wheezing or is triggered by exercise or allergens
Final Takeaway
Coughing is a symptom, not a disease. Most of the time, it’s your body doing its job—clearing the way and keeping you safe. But when it lingers or comes with worrying signs, don’t brush it off. Listen to your body’s signal. It may be telling you it needs help.
References
- “Evaluation of Chronic Cough in Adults” – American Family Physician, 2021. https://www.aafp.org/pubs/afp/issues/2021/0600/p725.html
- “Cough” – NHS Inform, Updated 2023. https://www.nhsinform.scot/illnesses-and-conditions/lungs-and-airways/cough
- “Chronic Cough” – Cleveland Clinic, Reviewed 2024. https://my.clevelandclinic.org/health/diseases/17855-chronic-cough