Health Library CoughsFrom Healthwise

Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of your cough can be determined only when other symptoms are evaluated.

Productive coughs

A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses (postnasal drainage) or may have come up from the lungs. A productive cough generally should not be suppressed; it clears mucus from the lungs. There are many causes of a productive cough, such as:

• Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat.
• Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis, sinusitis, or tuberculosis.
• Chronic lung disease. A productive cough could be a sign that a disease such as chronic obstructive pulmonary disease (COPD) is getting worse or that you have an infection.
• Stomach acid backing up into the esophagus. This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken you from sleep.
• Nasal discharge draining down the back of the throat (postnasal drip syndrome). This can cause a productive cough or the feeling that you constantly need to clear your throat. Experts disagree about whether a postnasal drip or the viral illness that caused it is responsible for the cough.
• Smoking or other tobacco use. Productive coughs in a person who smokes or uses other forms of tobacco is often a sign of lung damage or irritation of the throat or esophagus.

Nonproductive coughs

A nonproductive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a nonproductive cough, such as:

• Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night.
• Bronchospasm. A nonproductive cough, particularly at night, may indicate spasms in the bronchial tubes (bronchospasm) caused by irritation.
• Allergies. Frequent sneezing is also a common symptom of allergic rhinitis.
• Medicines called ACE inhibitors that are used to control high blood pressure. Examples of ACE inhibitors include captopril (Capoten), enalapril maleate (Vasotec), and lisinopril (Prinivil, Zestril, or Zestoretic).
• Exposure to dust, fumes, and chemicals in the work environment.
• Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Teens and Adults.
• Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed Objects.

Coughs in children

Children may develop coughs from diseases or causes that usually do not affect adults, such as:

• Croup.
• Bronchiolitis.
• Infection of the lower respiratory system (such as caused by respiratory syncytial virus, or RSV).
• Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy. For more information, see the topic Swallowed Objects.
• Exposure to secondhand smoke from parents or caregivers who smoke.
• Emotional or psychological problems. A dry, nonproductive "psychogenic cough" is seen more frequently in children than in adults.

Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

A careful evaluation of your health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of your cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If you have other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Information section.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Chest discomfort or pain that is crushing or squeezing or feels like a heavy weight on the chest
• Chest discomfort or pain that occurs with:
  • Sweating
  • Shortness of breath
  • Nausea or vomiting
  • Pain that spreads from the chest to the back, neck, jaw, upper abdomen, or one or both shoulders or arms. See an illustration of chest pain.
  • Dizziness or lightheadedness
  • A fast, slow, or irregular heartbeat
• Moderate to severe difficulty breathing:
  • In a child
  • In an adult and older child
• Choking. If choking is present, go to the topic Choking Rescue Procedure. Do not perform the Heimlich maneuver if the person is still coughing or able to speak.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have the following symptom, evaluate that symptom first:

• A fever: Go to the topic:
  • Fever, Age 4 and Older.
  • Fever, Age 3 and Younger.

	Yes	Does your child have a cough?
When to See a Doctor See significance of a cough in a child if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do coughing spasms cause your child to turn blue or purple, but his or her color returns to normal when coughing stops? Yes Does your baby younger than age 3 months have spasms that cause vomiting after coughing spells? Yes Does your baby younger than age 3 months seem more sleepy than usual? Yes Is your child coughing up bloody sputum (mucus from the lungs with more than just an occasional streak of blood)? Yes Does your child make a harsh, high-pitched sound when he or she breathes in (stridor)? Call your health professional today if you answer "Yes" to any of the following questions. Yes Does your baby younger than age 3 months have a cough and a change in eating habits? Yes Has your child older than age 3 months had several spasms that caused vomiting after coughing spells? Yes Does your child have a barking cough with signs of mild difficulty breathing? Yes Does your child have an occasional streak of blood in his or her sputum (bloody mucus from the lungs, not bleeding from the nose or the back of the throat)? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has your baby younger than age 3 months had a cough with no other symptoms for longer than 24 hours? Yes Has your child had a barking cough for 24 hours or longer but does not have other signs of difficulty breathing? Yes Has your child had a productive cough for longer than 24 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Has your child older than age 3 months had a cough for longer than 3 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you wheezing?
When to See a Doctor See significance of wheezing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a medical condition that causes wheezing, and your moderate wheezing is not responding to prescribed medicine or treatment? Yes Did wheezing begin after taking a medicine? Yes Do you have new or increasing wheezing that is limiting your activity? Yes Do you feel short of breath, even at rest, but you can still speak in short sentences? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have new or increasing wheezing but you are still able to complete your normal activities? Yes Do you have mild wheezing, even at rest, but you do not feel short of breath and can still speak in complete sentences? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had new shortness of breath after any amount of exertion during the past 24 hours, but you are able to breathe normally when you are resting? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have mild difficulty breathing?
When to See a Doctor See significance of mild difficulty breathing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Did mild difficulty breathing begin after taking a medicine? Call your health professional today if you answer "Yes" to the following question. Yes Do you have new or increasing mild difficulty breathing, even at rest, but you can still speak in complete sentences? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had new shortness of breath after any amount of exertion during the past 24 hours but you are able to breathe normally when you are resting? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have chronic mild breathing problems that have been stable and now are slowly getting worse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have pain in the muscles or ribs of the chest (chest wall pain)?
When to See a Doctor See significance of chest wall pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe chest wall pain? Yes Do you have chest wall pain that is causing mild true shortness of breath? Yes Are you coughing up blood? Yes Do you have pain deep in the leg or calf? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have moderate chest wall pain? Yes Do you have mild difficulty breathing? Yes Do you have a fever of 100 °F (38 °C) or higher with no other cause? Yes Do you think that you have a fever, but you are unable to measure your temperature? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Is chest wall pain that has continued for more than 24 hours interfering with rest or sleep? Yes Have you had sudden, sharp chest wall pain that lasts for only a few seconds but comes and goes for 24 hours or longer? Yes Have you had mild chest wall pain when you cough or take a deep breath for longer than 3 days? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you coughing up bloody sputum that is bright red or rust-colored mucus (hemoptysis)?
When to See a Doctor See significance of bloody sputum if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a large amount [2 tsp (10 mL)] of bright red blood in your sputum? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have small streaks of bright red blood in your sputum? Yes Do you produce small streaks of blood or rust-colored mucus during all or most of your coughing episodes? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you frequently coughed up rust-colored sputum or a small amount of blood-streaked sputum in the last 24 hours? Yes Have you had occasional small streaks of bright red blood in your sputum and other respiratory symptoms for longer than 48 hours? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you coughed up rust-colored sputum or a small amount of blood-streaked sputum after other cold symptoms have gone away? Yes Have you coughed up rust-colored sputum or a small amount of blood-streaked sputum but you do not have a cold or other respiratory symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a productive cough?
When to See a Doctor See significance of a productive cough if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think that you have a high fever, but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have fever of 101 °F (38 °C) to 104 °F (40 °C)? Yes Do you think you have a moderate fever, but you are unable to measure your temperature? Yes Do you have mild shortness of breath? Yes Are you older than 60, and you have had an ongoing fever after 24 hours of home treatment? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever less than 101 °F (38 °C) and coughed up sputum more than 12 times in 24 hours? Yes Have you coughed up sputum more than 12 times a day for longer than 48 hours, but you do not have a fever? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had a productive cough for longer than 2 weeks without other respiratory symptoms? Yes Do you have a chronic cough that has been evaluated by a doctor and is not following the expected course? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a dry (nonproductive) cough?
When to See a Doctor See significance of a dry (nonproductive) cough if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think that you have a high fever, but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 101 °F (38 °C) to 104 °F (40 °C)? Yes Do you think you have a moderate fever, but you are unable to measure your temperature? Yes Has a cough come on gradually over hours or days after a choking episode? Yes Are you older than 60, and you have had an ongoing fever after 24 hours of home treatment? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had a fever less than 101 °F (38 °C) despite 48 hours of home treatment? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had a dry cough for longer than 2 weeks? Yes Do you have a chronic cough that has been evaluated by a doctor but is not following the expected course? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Heartburn: Go to the topic Heartburn.
• Other respiratory or cold symptoms: Go to the topic:
  • Respiratory Problems, Age 11 and Younger.
  • Respiratory Problems, Age 12 and Older.
• Sore throat: Go to the topic Sore Throat.
• Ear problems: Go to the topic:
  • Ear Problems and Injuries, Age 11 and Younger.
  • Ear Problems and Injuries, Age 12 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Coughing is your body's way of removing foreign substances and mucus from your lungs and upper airway passages. Productive coughs are often useful, and you should not try to eliminate them. Sometimes, though, coughs are severe enough to impair breathing or prevent rest. Home treatment can help you feel more comfortable when you have a cough.

Home treatment for adults

• Prevent dehydration. Fluids may help thin secretions and soothe an irritated throat. Dry, hacking coughs respond to honey in hot water, tea, or lemon juice. Do not give honey to children younger than 1 year of age.
• Elevate your head with extra pillows at night to ease a dry cough.
• Try a cough drop to soothe an irritated throat. Expensive medicine-flavored cough drops are no better than inexpensive candy-flavored drops or hard candy. Most cough drops have no effect on the cough-producing mechanism.
• Quit smoking and do not use other forms of tobacco, especially while you have a cough. For more information on quitting smoking, see the topic Quitting Tobacco Use.
• Avoid exposure to inhaled irritants, such as smoke, dust, or other pollutants, or wear a face mask that is appropriate for the exposure. Many kinds of face masks are available. Check with your doctor or pharmacist to determine which type of face mask will provide you with the most benefit.
• If you suspect problems with stomach acid may be contributing to your cough, see the topic Heartburn.

Cough preparations may help your cough. Avoid cold remedies that combine medicines to treat many symptoms. It is generally better to treat each symptom separately. There are two kinds of cough medicines: expectorants and suppressants.

• Expectorants help thin the mucus and make it easier to cough mucus up when you have a productive cough.
  • Use an expectorant if you have a cough that produces thick mucus and you are having difficulty coughing the mucus up. Don't depend entirely on an expectorant to thin the mucus; drink plenty of water also.
  • Look for expectorants containing guaifenesin, such as Robitussin, Mucinex, and Vicks 44E.
• Suppressants control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake.
  • Use cough suppressants wisely. Don't suppress a productive cough too much, unless it is keeping you from getting enough rest. Coughing is useful because it brings up mucus from the lungs and helps prevent bacterial infections. People with asthma and other lung diseases need to cough.
  • If you have a dry, hacking cough, ask your doctor about an effective cough suppressant medicine.
  • Look for suppressant medicines containing dextromethorphan, such as Robitussin-DM or Vicks Dry Hacking Cough. Studies show that over-the-counter cough medicines do not work very well. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.

Cough preparation precautions

• Cough preparations can cause problems for people with other health problems, such as asthma, heart failure, high blood pressure, glaucoma, or an enlarged prostate. Cough preparations may also interact with other medicines, such as sedatives and certain antidepressants. Read the package carefully or ask your pharmacist or doctor to help you choose one.
• Use cough preparations with caution if you are older than 60 or if you have chronic respiratory problems.
• Read the label so you know what you are taking. Some cough preparations contain a large percentage of alcohol; others contain codeine. There are many choices. Ask your pharmacist to advise you.
• Do not take someone else's prescription cough medicine.

For more information on home treatment of respiratory problems, see the Home Treatment section of the topic Respiratory Problems, Age 12 and Older.

Home treatment for children

It is important to follow the directions on cough medicines for children how much medicine to take and how often to take it may be very different than for adults. For more information on treating respiratory problems, including coughs, see the Home Treatment section of the topic Respiratory Problems, Age 11 and Younger.

If your child has a barking cough during the night, you can help him or her breathe better by following the home treatment for a barking cough.

• Hold your child in a calming manner.
• Keep your child quiet, if possible. Crying can make breathing more difficult. Try rocking or distracting your child with a book or game.
• Use a humidifier to add moisture to the air. Do not use a hot vaporizer. Use only water in the humidifier. Hold your child in your lap, and let the cool vapor blow directly into your child's face.
• If there is no improvement after several minutes, take the child into the bathroom and turn on the shower to create steam. Close the door and stay in the room while your child breathes in the moist air for several minutes. Make sure your child is not burned by the hot water or steam. Do not leave your child alone in the bathroom.
• If there is still no improvement, bundle your child up and go outside in the cool night air.

Do not give cough and cold medicines to a child younger than 2 unless you've checked with the doctor first. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.

Do not give your child leftover antibiotics or antibiotics or other medicines prescribed for someone else.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Other symptoms develop, such as moderate to severe chest pain with coughing, difficulty breathing, a productive cough, or fever.
• You start coughing up blood.
• A cough lasts longer than 2 weeks without other respiratory symptoms.
• Symptoms become more severe or more frequent.

There is no sure way to prevent a cough. To help reduce your risk:

• Wash your hands frequently during the cold and flu season. This helps prevent the spread of a virus that may cause a cold or influenza.
• Avoid people who have a cold or influenza if possible.
• Don't smoke or use other forms of tobacco. A dry, hacking "smoker's cough" means your lungs are constantly irritated. For more information, see the topic Quitting Tobacco Use.
• Avoid exposure to secondhand smoke, both at home and in the workplace.
• Increase your fluid intake. This helps keep the mucus thin and helps you cough it up. It also helps prevent dehydration.
• Get a flu shot (influenza vaccine) each autumn if you are older than 50 or have a health risk that increases your risk for a serious problem. For more information, see the topic Influenza.
• Get a pneumonia shot (pneumococcal vaccine) if you are older than 65 or if you have chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD), or a health risk that increases the seriousness of your symptoms. For more information, see the topic Immunizations.
• Make sure your immunizations are current, such as pertussis to reduce your risk of getting whooping cough. For more information, see the topic Immunizations.
• If your child stays in a day care center, ask the day care providers to wash their hands often to prevent the spread of infection.

Prevention tips for children

• If your child goes to a day care center, ask the staff to wash their hands often to prevent the spread of infection.
• Make sure that your child gets all of his or her vaccinations, especially for diphtheria, tetanus, and pertussis (DTaP) and for Haemophilus influenzae type b (Hib). For more information, see the topic Immunizations.
• If one of your children is sick, separate him or her from other children in the home, if possible. Put the child in a room alone to sleep.
• For information on preventing allergies or asthma, see the topic Allergic Rhinitis or Asthma in Children.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• How long have you had the cough?
• How often do you cough?
• Does the cough have a pattern, such as worsening at night or becoming more frequent in the morning?
• What situations increase your coughing?
• Are you exposed to any irritants, such as smoke, dust, or chemicals, in your home or workplace?
• Is the cough productive (brings up sputum) or unproductive (dry and hacking)? Be prepared to describe the color (bloody, rusty, white, yellow, or green), amount, and consistency of any sputum.
• Do you have other symptoms that may be related to your cough, such as nasal drainage, fever, shortness of breath, wheezing, or other suspected cold symptoms?
• What home treatment have you tried? Did it help?
• What prescription and nonprescription medicines or other treatments have you tried? Did they help?
• What prescription and nonprescription medicines do you take regularly?
• Have you ever been diagnosed with allergies or asthma? Does anyone else in your family have allergies or asthma?
• Have you traveled recently?
• Do you have any health risks?

• Acute Bronchitis
• Allergic Reaction
• Allergic Rhinitis
• Asthma in Children
• Asthma in Teens and Adults
• Chest Pain
• Croup
• Ear Infections
• Facial Problems, Noninjury
• Fever, Age 3 and Younger
• Fever, Age 4 and Older
• Gastroesophageal Reflux Disease (GERD)
• Heartburn
• Hiatal Hernia
• Influenza
• Nonprescription Medicines and Products
• Pneumonia
• Quitting Tobacco Use
• Respiratory Problems, Age 11 and Younger
• Respiratory Problems, Age 12 and Older
• Sinusitis
• Sore Throat
• Swallowed Objects
• Swollen Glands and Other Lumps Under the Skin
• Tuberculosis (TB)
• Whooping Cough (Pertussis)

Author:	Jan Nissl, RN, BS	Last Updated: February 25, 2008
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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