Why You Cough

We all cough. You can have a mild cough that can be annoying or a severe cough that can be so harsh it can break a rib.

Experts say coughing is the top reason people see a doctor — more than 30 million visits a year. You can have an acute cough, one that comes on suddenly, like during a cold, or a chronic cough, which lasts more than eight weeks in adults and four weeks in children.

Your first step toward relief is to identify the type of cough you have and what's causing it. Then, consider your symptoms. With that info, you can choose the best treatment.

A cough is supposed to protect you. It gets out stuff that doesn't belong in your lungs and windpipe, such as inhaled dirt or food. But it can also be caused by other things. How long a cough lasts depends on what's causing it.

There are several classifications for coughs. They include:

• Productive cough. Also called a wet cough, this cough brings up mucus or phlegm.
• Nonproductive cough. This is a dry cough that doesn’t bring up mucus or phlegm.
• Acute cough. It comes on suddenly and lasts two to three weeks.
• Subacute cough. This type lingers after you’ve had an infection and can last three weeks.
• Chronic cough. This is a cough that lasts eight weeks for adults and four weeks for children and may require medical attention.
• Refractory cough. This is a chronic cough that hasn’t responded to treatment.

Coughing is your body’s natural reflex, a response to something that affects your throat or airway. It’s mostly a healthy response because your body is trying to protect you. Food caught in your throat, mucus in your airway, or even certain types of medications can send a message to your brain, telling your chest and stomach muscles to tighten up and push air out of your lungs, making you cough. It might be just one or two coughs or many more. It all depends on what caused the coughing in the first place.

There are many common triggers for both “productive” (or wet) coughs and “nonproductive” (or dry) coughs. Productive coughs help get mucus out of your lungs. Dry coughs don’t produce anything.

Wet coughs can be caused by:

Viruses. Colds and the flu are the most common causes of a productive cough although you might have a dry cough long after you’ve had a cold. It can last weeks. This could be because coughing irritates your lungs, which leads to more coughing, which irritates your lungs, and so on.

Postnasal drip. When you're congested, mucus can drip down from your nose into the back of your throat, making you cough. You can get postnasal drip from colds, flu, sinus infections, allergies, and other problems.

Chronic obstructive pulmonary disease (COPD). It includes emphysema and chronic bronchitis, although some doctors include asthma. These illnesses can weaken the tubes in your airway (bronchial tubes) and the tiny sacs (alveoli) that pass oxygen into your blood and remove carbon dioxide. Cigarette smoking is the most common cause of COPD.

Heart conditions. Heart failure can cause a chronic cough. If your heart isn’t working properly, fluid can build up in your lungs. Your body causes the cough, hoping you’ll get rid of the fluid.

Dry cough causes

Dry coughs are usually caused by something that irritates your airways or throat. 

Irritants. Even if you don’t have allergies, things such as cigarette smoke or strong perfumes can set off a hacking spell.

Allergies and asthma. If you have allergies or asthma, you may have triggers such as mold or dust. Inhaling these can cause your airways to overreact and try to protect you. They're trying to force out what’s bothering them. 

Acid reflux. When you have heartburn, stomach acids back up into your throat, especially when you’re lying down. This reflux can irritate your windpipe, vocal cords, and throat and make you cough.

Other causes. Many other problems, such as lung inflammation, sleep apnea, drug side effects, and breathing in cold, dry air, can be triggers.

Why do you cough more at night?

Nighttime can be hard if you have a bad cough. There are several reasons why you might cough more just when you’re trying to get to sleep.

Your body position at night has a lot to do with it. If you have postnasal drip, your mucus might drain on its own during the day as you’re up and about. You might find yourself clearing your throat, but you might not need to cough. When you’re lying down, this mucus gathers at the back of your throat, either irritating your vocal cords or causing you to inhale it. Both will make you cough.

Something similar happens with acid reflux and heart failure. If you have acid reflux, while you’re sitting or standing, the acid stays inside your stomach, below the muscle that keeps the acid from moving back up into your throat. But when you’re lying down, it is easier for the acid to move sideways into the throat. With heart failure, being upright helps keep fluid lower in your body. When you’re lying down, the fluid can build up in your lungs.

Finally, things that cause you to clear your throat during the day, such as irritants or drug side effects, can make you cough at night because you won’t clear your throat while you’re sleeping.

Treating a cough depends on the cause. Options include:

Medicines

Over-the-counter cough remedies can help in many ways. Suppressants are supposed to lessen your urge to cough. Expectorants thin mucus and make it easier to hack up. If you have a wet cough though, you need to bring that mucus up from your lungs. So, it’s not recommended to use a suppressant unless you’re desperate to get some rest. Instead, it’s best to use an expectorant.

Be careful when choosing over-the-counter cough medicines because some people shouldn’t take them. They can interact with some prescription medications and may also cause problems if you are older than 60, or have asthma, high blood pressure, glaucoma, or an enlarged prostate. Speak with your pharmacist before buying one.

Avoid triggers

If you have allergies or asthma, try to remove allergens from your home, such as keeping pets out of your bedroom and using air conditioners or air filters during the pollen season. You won’t see the effects right away, but if you stay away from what bothers you, you should start to feel better. If you smoke, talk to your doctor about different ways to try to stop smoking.

Treatment for another problem

If your cough is caused by a medical problem, such as asthma, acid reflux, COPD, or heart failure, you may need to change your treatment plan for the illness before your cough will improve. For example, some people with acid reflux stop coughing once they start taking medications that stop the reflux. Talk to your doctor about how you might manage your cough.

There are many things you can try at home to ease your cough, such as:

• Drink warm fluids to soothe your throat.
• Stay hydrated.
• Gargle with salt water if your throat is sore.
• Sleep with your head and chest elevated.
• Try cough drops if your throat is irritated.
• Moisturize the air you breathe, either with a vaporizer or humidifier. You could also run a hot shower in a closed bathroom and breathe in the air.

Some people find honey soothing for a cough but don’t give it to a child under 1 year old. Honey can have a bacteria called clostridium that can cause serious illness in infants.

Sometimes, you may have a cough that seems to be triggered by a tickling feeling in your throat. It can be very annoying and the cough can trigger irritation, which leads to more coughing. Here is a technique that might help you get rid of that tickly cough.

• Place your hand over your mouth as soon as you feel that tickle or you think you’ll cough.
• Swallow one time.
• Keep your hand over your mouth and hold your breath for a few seconds. 
• Take slow, smooth breaths for the next 30 seconds.
• Tell yourself that you’re not going to cough.
• Breathe in normally through your nose.
• Take your hand away from your mouth.
• Repeat it if needed.

Sometimes, a cough is more serious than “just a cough.” If you experience any of these issues, it could be a sign of a medical emergency. Call 911 right away if:

• You feel like you’re choking.
• You have difficulty breathing.
• There is blood when you cough.
• You have severe chest pain as well as a cough.

Although these next signs might not be a medical emergency, they could be a sign of a serious illness. If you have any of these, contact your doctor as soon as possible to see what you should do:

• Your cough isn’t going away.
• You start wheezing. This is a whistling sound that appears when you breathe out.
• You have a fever above 101 F or you have a fever for more than one or two days.
• You’re coughing up yellow, green, or bloody phlegm or mucus.

Everyone has a cough now and then, but if your cough is producing phlegm or mucus, don’t try to stop it with a suppressant – that stuff needs to come out of your lungs. If you have a dry cough caused by an irritation or an allergy, you may need to do some detective work to see what’s causing it so you can avoid it. A cough can also be a sign of something serious, so if your cough continues or gets worse, contact your health care provider.

What is the best medicine for a cough?

There is no one best medicine for a cough. You may want to take a suppressant to stop the cough if you have a dry cough or you really need some sleep. Or you might need an expectorant to thin out the mucus so you can cough it up more easily.

How can I stop coughing so much?

There are some home remedies you could try, such as drinking warm fluids, breathing in warm, moist air, and sleeping with your head elevated. 

How do I know if my cough is serious?

Some signs that your cough could be serious include:

• Wheezing
• Difficulty breathing
• Chest pain while coughing
• Fever
• Coughing up blood
• Coughing up phlegm that is brown, green, or bloody

What does a bronchitis cough sound like?

A bronchitis cough is often a wet cough because you need to bring up mucus from your airway. But it can also be a dry cough that causes whistling or wheezing.