Coughs are irritating, uncomfortable and, since COVID-19 arrived, make us feel a bit socially unacceptable.
A cough is the body’s powerful reflex to respond to a threat and irritation in your respiratory tract. When specialised sensors in your airways detect an irritant such as smoke, dust, allergens, irritants or infection, it triggers a cough reflex that causes the muscles in your airways to contract and push a burst of air out through your airways in an attempt to remove the cause of the irritation. In the case of infection, it may also make sputum (mucus) to help capture viruses and bacteria and expel them in the cough, defending and protecting your body from harm.
There are many ways to describe how your cough feels, and this can help us determine likely causes and target treatments. Catching a virus or bacteria is the most common cause of a cough, and this can bring other symptoms like sneezing, a runny or blocked nose, fever and feeling run down.
Long-standing medical conditions and medications can cause a cough, so it’s worth consideration and a visit to your doctor if a cough is persistent and not fitting with a common cold or minor chest infection.
We’ve become attuned to coughs as a sign of COVID-19 infection. This was certainly true at the start of the pandemic, but vaccination has made this a less common symptom than some others, like a sore throat and nasal congestion.
We’ll take you through how to assess your cough in terms of causes and reasons to visit the doctor. It’s also good to know when to keep away from loved ones and colleagues, as a cough can be contagious if it's caused by an infection.
Viruses: this is the most common cause of respiratory tract infection, most usually at the upper end, causing a common cold and mild dry cough, but they can push further down in the case of flu, caused by the influenza virus. You may have a forceful dry cough, fever, a poor appetite and immense fatigue with this, and the cough can last up to 3 weeks.
COVID-19: this coronavirus has evolved so that it’s very difficult to tell it apart from a common cold or flu, especially in those who have been fully vaccinated. You may be aware you have been in contact with someone confirmed to have COVID-19, but the only definitive way to diagnose COVID-19 is to take a swab from the nose and throat using self-bought lateral flow tests.
Antibiotics will have no effect on these viruses, they need time, rest and recuperation for your body to clear them. They may be a serious prospect for those with lung, heart, kidney or other serious long-term health conditions, and are highly contagious to those around you, so take some time out from work and close contact with family and friends.
This usually refers to a bacterial lung infection, and you are likely to feel unwell and fever, and coughing up thick sputum of a yellow/green or brown colour. This is known as a productive or chesty cough. There may be streaks of blood, you may feel chest pain from forceful coughing, and you may need antibiotics prescribed to help clear this. The elderly are more vulnerable to pneumonia and severe illness, compared to those who are younger and fitter.
Tuberculosis (TB) can cause an ongoing cough and breathlessness, and is more likely if you or a family member has spent a prolonged time in certain parts of Africa or the Indian subcontinent. It is contagious, but needs close contact for days to weeks to transmit.
Asthma – undiagnosed or poorly controlled – typically causes a dry cough, especially after exercise or first thing in the morning. You may hear a wheeze, a high-pitched squeezebox sound, and feel your chest is tight or you are short of breath. It can run in families along with eczema and hay fever, or be caused by certain allergens like pet fur, pollen or house dust mite. If you notice it occurs on your workdays but gets better on rest days or holidays, you may have occupational asthma, especially if you work with industrial or cleaning chemicals or animals.
These are found in the environment, such as dust, smoking, air pollution, industrial or cleaning chemicals, depending on your workplace, or air pollution. They can cause an irritating dry cough as your lungs dry to clear any debris. Even cold dry air can dry your throat and provoke the cough reflex.
If you notice a cough occurs on your workdays but gets better on rest days or holidays, you may have occupational asthma, where irritants at work are responsible.
The chemicals and tar contained within cigarettes cause a direct effect on the lungs, clogging up the air pockets designed to let oxygen in and unwanted carbon dioxide out, and this irritation causes coughing in the short and long term. A smoker’s cough is the result of a long-term habit, where your lung tissue is inflamed and damaged, and has a characteristic gravelly sound of loose mucus, where you may cough up sputum. A vaper’s cough is usually a dry cough, caused by a similar mechanism of irritation and inflammation of the lung tissue.
Long-term smoking is also responsible for permanent lung tissue damage called COPD (chronic obstructive pulmonary disease), which requires lifelong inhalers and occasionally steroid tablets and antibiotics for any flare-ups.
Any infection, inflammation or irritation can cause an overproduction of mucous and an ongoing drip from the nasal passages to the throat and lungs, causing you to cough. Additionally, a post-viral cough may persist as a tickly cough where you have no sputum to bring up, or it’s clear sputum, and this will get better once your lungs have fully recovered.
Overproduction of stomach acid or a surge that causes it to come up the oesophagus and cause heartburn can sometimes present with a cough. This happens because some acid may reach the throat and go down to the lungs, rather than back to the stomach.
An ongoing irritating and dry cough is one of the symptoms of long COVID, otherwise known as post-COVID syndrome. This can only be diagnosed if symptoms persist more than 3 months since the infection – you've cleared the virus from your body, but this signifies ongoing damage and inflammatory response. You may also feel breathless and unable to do the same exercise or activity as previously.
Any prescribed medication can come with side effects, and ACE-inhibitors, tablets to bring blood pressure down, are known to commonly cause a dry, irritating cough. You might know these as ramipril, enalapril or lisinopril. You should only stop these after a discussion with your doctor, and the cough will resolve once you’ve stopped them, but it can take up to 12 weeks.
As a general rule, a cough needs investigating if it has persisted for more than 3 weeks and has no obvious cause or has shown no improvement from an obvious infection. This is particularly true for long-term smokers or the elderly, as this may indicate lung cancer. If you are coughing up blood without signs of infection, you have unexplained weight loss or feel immense fatigue and breathlessness, it’s important to see your doctor.
Usually occurring in the elderly, a cough with frothy sputum may suggest the heart is not beating efficiently, and this can cause fluid to pool in the lungs and the legs, where you can get ankle swelling. You’ll likely feel quite short of breath, and may have other chronic health conditions like high blood pressure or kidney problems.
A cough is a natural defence against infection or irritation, so you don’t want to always supress it, but it can get exhausting, especially when it interrupts sleep or is embarrassing at certain work meetings of social events. So it’s good to have some natural or pharmacy remedies up your sleeve to counter it and make yourself feel better.
You can trust in the bees, or so research in the revered British Medical Journal has it, proclaiming honey reduced the frequency and severity of coughs over and above antibiotics and cough syrups. It’s believed to have antioxidant and anti-inflammatory properties, and it’s a natural cough suppressant as well as coating the throat to soothe it. You can take it in hot water or tea, adding lemon to help clear any congestion, or it can be drizzled on food. It’s best to avoid honey in babies under 1 years old.
Curcumin gives this luminescent root it’s yellow colour, and is thought to have anti-inflammatory and anti-microbial properties, to fight off inflammation and infection and soothe your cough. Some suggest taking it in tea, others say to add it to a glass of milk for a soothing effect. Or you can add it to your hot honey and lemon concoction. It usually needs a pinch of black pepper, or piperine, to boost absorption.
Make sure you’re getting the sleep you need, as this is when your immune system is working at its best. Early nights are generally more restful than lie-ins in the morning.
Fighting an infection requires more fluids than usual. It’s recommended to drink 8 glasses of water (or 1.5 litres) per day, but it’s a good idea to increase this with a cold. You will need to up this if you also have a fever, and it might be worth replacing any lost salts with rehydration salts.
Everyone seems to turn to vitamin C when they get a cough or cold, but there’s little evidence that this boosts your immune system in the short term – much better to keep a healthy varied diet going at times of wellness and feeling unwell. Similarly, there’s no evidence echinacea or zinc help prevent coughs or colds, or aid recovery.
This leafy plant belongs to the geranium family, and its roots have been used for medicinal properties by the Zulu people of South Africa for centuries. There’s evidence that pelargonium herbal preparations can help ease a cough and the congestion associated with upper respiratory infections. It’s recommended only for those aged over 12.
Pineapple juice contains a substance called bromelain, which helps to break up and thin out mucus, so it can be more easily dislodged and removed, helping you breathe more easily. It’s also an anti-inflammatory. You can take a fresh piece f the fruit or drink as fresh juice. It should be avoided if you are on blood thinners or taking certain antibiotics.
Thyme leaves are not only good in casseroles, they contain flavinoids that relax the throat muscles to relieve coughing and possibly short-term bronchitis. You can mix thyme leaves in your tea or take a supplement that also contains ivy.
Glycyrrhizin is a chemical found in the liquorice plant’s roots, and is thought to act as a cough suppressant.
The menthol in mint leaves helps soothe the throat and decongest mucus build-up in the chest, acting as a natural decongest to help us breathe more easily.
Asthma is often exacerbated by dry air, especially during the winter when the heating is on, so keeping an air humidifier on, especially in the bedroom, can moisten the air breathed in and help reduce coughing and other symptoms.
You can buy a unit to provide this, or pop a cup of water on the radiator or take a steamy shower before bed.
It’s a commonly held belief that warm steam will help clear congestion in the chest, but studies – most recently in the respected medical journal The Lancet – have quashed this myth. They determine that there is no additional symptomatic relief to treat the common cold, and it carries a risk of scalding to children, which can be serious and require hospital attention. That said, a bath or shower provides a warm, humid environment to comfort and can help ease muscle aches, which may aid a good night’s sleep and make you feel a bit better.
This is one of the best things you can do for your health, and your lungs will thank you for it. Smoking makes you more vulnerable to any chest infection, and for that to be more severe and take longer to recover from. Your lung tissue is in a constant state of damage so it can’t defend you from infections or repair the damage infections do to the same extent. Aside from infections causing a cough, you’re also at risk of a smoker’s cough, COPD and lung cancer in the long term.
Most dry coughs get better by themselves within two weeks with rest, plenty of fluids and throat-soothing treatments if needed. In some cases, symptoms can last for up to three weeks. You should book a routine appointment to discuss with your doctor if your cough is not improving after two weeks, you have asthma or you are concerned about your symptoms.
If your symptoms are severe and not responding to pharmacy medications, you are finding it hard to catch your breath, difficult to maintain fluids or to bring your fever down with medication, you are coughing up blood, have severe chest pain or you are a smoker and are suddenly losing weight, speak to your doctor urgently. If you have asthma that has worsened, or symptoms that fit with asthma, seek urgent attention if you think you are having a flare-up.
If you are immunocompromised because of medication or a condition, or you have long-term medical conditions such as diabetes, heart, lung, kidney, or neurological illnesses, speak to your doctor urgently rather than waiting for 2 weeks.
Your doctor will listen to your concerns and symptoms, and take note of other medical conditions, medications and any family history. They will take your vital signs, including breathing rate, heart rate, oxygen content in your tissues and blood pressure. They will listen to your heart and chest and may look at your throat. They may send you for further investigations, such as a chest X-ray, blood tests, take any mucus sample or throat swab, and they will refer you to a hospital team if necessary.
If they think you have developed a serious or long-term condition, they will refer you as urgently as needed to a specialist team.
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