17755 Cough

Overview

A cough is a sudden, forceful push of air out of your lungs. It is a reflex — something your body does automatically — to clear your airways of mucus (phlegm), dust, smoke, or germs. Because it is a reflex, you often cannot stop a cough once it starts. A cough is not a disease in itself. It is a symptom, meaning a sign that something is irritating or affecting your airways. Most coughs are short-lived and settle on their own, but some last for weeks and need a doctor's check.

Very common. Almost everyone has several coughs each year, and it is one of the top reasons people see a family doctor or pharmacist. In most people it settles within one to three weeks.

Anyone can get a cough. Young children get coughs often because their airways are small and they catch lots of viral infections. Older adults and people with long-term lung or heart conditions are more likely to develop a cough that needs medical attention, and more likely to have complications. Smokers, people with asthma or allergies, and people exposed to dust or fumes at work also cough more often.

Symptoms

Common symptoms

• A dry, tickly cough or a chesty cough that brings up mucus (phlegm)
• A tickle or scratchy feeling in the throat
• Sore throat, runny or blocked nose, or a hoarse voice
• Coughing more at night or first thing in the morning
• A mild fever or feeling generally run down
• Chest discomfort or aching muscles from the effort of coughing
• Feeling short of breath after a coughing fit

Symptoms in children

• Coughing that is worse at night or when lying down
• A 'barking' or 'whooping' sound, or a cough followed by a gasp for breath
• Vomiting after a coughing fit, which is common and usually not dangerous
• Refusing feeds or drinks, or fewer wet nappies than usual
• Being more clingy, sleepy, or irritable than usual

Symptoms in older adults

• A cough that is quieter or less forceful than expected, even when there is a chest infection
• Confusion or new drowsiness, which can be a sign of infection in older adults
• Loss of appetite, tiredness, or a fall that seems unexplained
• Leaking urine when coughing, which is common and treatable
• A cough that lingers longer than usual because the cough reflex is weaker with age

Causes

Main causes

• Viral infections such as the common cold, flu-like illness, or a chest infection — the most common cause of a short-term cough
• Mucus running down the back of the throat (post-nasal drip) from a cold, allergy, or sinus problem
• Asthma, where the airways narrow and become sensitive, causing cough, wheeze, and breathlessness
• Smoking or breathing in smoke, dust, or chemical fumes
• Acid reflux, where stomach acid travels up the food pipe and irritates the throat
• Some blood pressure medicines can cause a persistent dry cough — never stop a medicine on your own; ask your doctor
• Longer-term conditions of the lungs, such as long-term obstructive lung disease or scarring of the lungs
• Whooping cough (pertussis), a bacterial infection that causes long coughing fits
• Less commonly, heart problems, a clot in the lung, or other serious conditions

Risk factors

• Smoking, or living with someone who smokes
• Having asthma, allergies, or a long-term lung condition
• Working with dust, flour, chemicals, or fumes
• Being a young child, especially one who goes to nursery or has older siblings
• Being an older adult or having a weakened immune system
• Recent travel to places where infections spread easily, or close contact with someone who is unwell

When to see a doctor

See a doctor urgently if:

• You are struggling to breathe or breathing much faster than usual
• You are coughing up blood
• You have chest pain, or feel faint, dizzy, or confused
• You have a high fever that will not settle, or you feel very unwell very quickly
• A baby under three months old has a cough or fever
• A child seems floppy, unusually sleepy, or is not drinking
• You have a long-term lung or heart condition and the cough is new or worse

Book a routine appointment if:

• Your cough has lasted more than three weeks
• The cough keeps coming back, or you have had several courses of antibiotics for it
• You have lost weight without trying, or you sweat heavily at night
• You feel short of breath doing things that used to be easy
• The cough is affecting your sleep, work, or daily life
• You are a smoker or ex-smoker with a cough that has changed or will not go away
• You leak urine when you cough (this is common and treatable)
• You are being treated for a cough and are not getting better

Diagnosis

A doctor or nurse will usually start by asking about your cough: how long you have had it, whether it is dry or brings up mucus, what makes it better or worse, and whether you have other symptoms such as fever, breathlessness, or heartburn. They will ask about your medical history, medicines, smoking, and your home and work environment. Then they will examine you — listening to your chest with a stethoscope, checking your breathing rate and oxygen level, and looking at your throat and nose. Often this is all that is needed to work out the likely cause. If the cough is persistent or there are warning signs, they may arrange tests.

Tests that may be done

• A blood pressure and oxygen reading (a small clip on your finger)
• A chest X-ray if the cough is persistent or there are concerning features
• A sample of mucus (spit) to check for infection
• Lung function tests, where you blow into a machine to measure how well your lungs work
• Allergy testing if an allergy is suspected
• Blood tests to look for infection, inflammation, or other conditions
• A test for whooping cough if it is going around or your symptoms fit
• In some cases, a scan of the chest or a referral to a lung specialist

What to expect at your appointment

Most visits are quick and reassuring. You will usually be told what the likely cause is and given advice on how to manage at home. If you are sent for tests, results can take a few days to a couple of weeks. Ask your doctor or nurse what to do while you wait, and when to come back if things do not improve. It helps to write down your questions beforehand and bring a list of any medicines you take.

Treatment

Treatment depends on the cause. For the most common cause — a viral infection — there is no cure, and the aim is to ease your symptoms while your body recovers. Because viruses do not respond to antibiotics, antibiotics are only used when a bacterial infection is likely. For a cough linked to asthma, reflux, allergies, or a medicine, treating that underlying problem is what usually settles the cough.

Self-care at home

• Rest and drink plenty of fluids to keep your throat moist and loosen mucus
• A warm drink with honey and lemon can soothe a tickly throat — honey is not suitable for babies under one year old
• Try sitting upright and using extra pillows at night if coughing is worse lying down
• Keep rooms well ventilated and avoid smoky, dusty, or very dry air
• Steam from a warm shower can help loosen a chesty cough; take care with hot water, especially around children
• Avoid smoking and vaping, and keep your home smoke-free
• Ask your pharmacist before giving any cough medicine to a child under six years old
• If coughing makes you leak urine, pelvic floor exercises can help — ask your doctor or a physiotherapist

Medical treatments

Your doctor or pharmacist may suggest medicines to ease the cough or the symptoms around it — for example something to calm a dry cough, something to loosen mucus, or simple pain and fever relief. They may also treat an underlying cause, such as an inhaler for asthma, treatment for acid reflux, or a change to a medicine that is causing the cough. Antibiotics are only helpful if a bacterial infection is likely. Always check with a pharmacist or doctor before using cough medicines, especially if you are pregnant, breastfeeding, taking other medicines, or giving them to a child, and never stop a prescribed medicine without advice.

When is surgery considered?

Surgery is almost never needed for a cough itself. Very rarely, a specialist may consider a procedure for a specific underlying problem found during tests. Your doctor would explain this fully if it ever applied to you.

Living with this condition

A lingering cough can be tiring and frustrating, especially when it disturbs your sleep or makes it hard to concentrate at work or school. Try to pace yourself, keep hydrated, and rest when you can. Gentle activity is fine if you feel up to it. Tell friends, family, or colleagues that the cough may last a few weeks so they understand — and ask for help with chores or childcare if you need it.

Lifestyle tips

• Stop smoking if you smoke — this is the single biggest thing that helps a persistent cough; ask for support to quit
• Avoid second-hand smoke, scented candles, air fresheners, and strong cleaning fumes if they trigger your cough
• Keep your home at a comfortable temperature and humidity; very dry air can irritate the throat
• Wash bedding regularly and reduce dust if allergies seem to play a part
• Use a scarf over your nose and mouth in cold, windy weather if cold air sets off coughing
• Keep up to date with recommended vaccinations

Diet and exercise

There is no special diet that cures a cough, but eating well and drinking enough fluids supports your recovery. Warm drinks can soothe the throat, and honey may help calm a night-time cough in adults and children over one year old. Gentle exercise such as walking is fine and helps your lungs and mood; build up slowly if you have been unwell. Avoid very strenuous activity while you are breathless or feverish, and see your doctor if exercise makes you cough or wheeze.

Mental health and emotional wellbeing

A cough that will not go away can affect your mood, sleep, and confidence. It can be embarrassing in public, disruptive at work, and worrying when you do not know the cause. Long-standing cough is linked with anxiety and low mood in some people. These feelings are understandable and worth mentioning to your doctor — support is available. If you ever feel overwhelmed or unsafe, contact your local crisis support service or your local emergency number straight away.

Prevention

Not all coughs can be prevented, but you can lower your chances of catching and spreading infections and reduce cough triggers. Wash your hands regularly, cover coughs and sneezes with a tissue or your elbow, and stay home when you are unwell. Avoid smoking and smoky places, keep rooms ventilated, and reduce exposure to dust and fumes at home and work.

Vaccines

Vaccines help prevent some causes of cough. Depending on your age, health, and where you live, your doctor may recommend vaccination against flu, COVID-19, whooping cough, pneumococcal infection, or other illnesses. Whooping cough vaccination is offered in pregnancy and in childhood in many countries. Ask your doctor or pharmacist which vaccines are right for you.

Screening programmes

There is no routine screening test for cough itself. However, if you are a smoker or ex-smoker and have a cough that has changed or lasted more than three weeks, your doctor may arrange tests such as a chest X-ray. Some countries offer lung health checks to people at higher risk — ask your doctor whether you are eligible.

Complications

If left untreated

• A cough that lasts a long time can disturb sleep and leave you exhausted
• Chest muscles can ache, and ribs can occasionally be strained from forceful coughing
• Leaking urine when coughing is common, especially after pregnancy, and is treatable
• Vomiting after coughing fits, particularly in children
• An untreated bacterial chest infection can become more serious, especially in older adults or people with weak immune systems
• An underlying condition such as asthma or reflux may go unrecognised, so symptoms continue
• Coughing spreads infections to others if you do not cover your mouth and wash your hands

Long-term outlook

The great majority of coughs get better on their own or with simple treatment, and people return to normal life within a few weeks. Even a cough that lingers after a viral infection usually settles with time. If a cough turns out to be caused by something longer-term, such as asthma or reflux, treatment is usually very effective at controlling it. Seeing your doctor when a cough persists is a sensible step — not a reason to worry, but a way to get the right help early.

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