About That Cough

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A cough is the forceful release of air from the lungs against closed vocal cords, which results in its characteristic sound. When something irritates the throat or airways, nerves in the area stimulate the brain to have the chest muscles forcefully contract to push out the irritant. Occasional coughing is normal and healthy, however a cough can be quite forceful and vigorous and prolonged coughing can be exhausting and can cause sleeplessness, dizziness, fainting, headaches, urinary incontinence, vomiting, and even broken ribs. A cough can also spread viral or bacterial infections to other people.

An acute cough is defined as lasting less than three weeks and is one of the most frequent symptoms encountered in primary care medicine. The most common cause of an acute cough is the common cold. Other causes include viral illnesses like influenza and the coronavirus, pneumonia, inhaling an irritant like dust, chemicals, or a foreign body, pertussis (whooping cough), and respiratory syncytial virus (RSV) in kids. An acute cough may also be caused by the worsening of an underlying illness such as asthma, chronic obstructive pulmonary disease (COPD), or heart failure. A subacute cough, defined as lasting three to eight weeks, is usually the result of a recent respiratory infection. If a cough does not improve in four to six weeks, then additional medical evaluation is warranted.

A chronic cough is defined as lasting more than 8 weeks and requires a thorough medical evaluation including imaging studies (X Rays at least). The clinician may advise a patient taking an ACE inhibitor (i.e., lisinopril) to switch to a different blood pressure medication as a dry, chronic cough is a common side effect of ACE inhibitors. Smokers may be advised to quit. The most common causes of chronic cough in nonsmokers who are not taking an ACE inhibitor are asthma, acid reflux, and a postnasal drip. Allergies can be another cause of a chronic cough. Medical evaluation of an acute cough is recommended when the cough is accompanied by thick, green-yellow, phlegm, wheezing, fever, shortness of breath, fainting, ankle swelling, or unexplained weight loss.

Over the counter (OTC) cough remedies are recommended for acute coughs only. It is important to follow the dosing recommendations found on the package. Remember that they are intended to treat the symptoms of coughs and colds, not the underlying disease. Most studies show that OTC cough and cold remedies do no better than placebos anyway. An acute cough may be helped by home remedies that include sucking on hard candies (not for children under 6 because of the risk of choking), honey, moisturizing the air, drinking extra fluids, and avoiding smoking or inhaling secondhand smoke. Patients with an unexplained chronic cough that fails to improve even after completing medical examination and treatment should be referred to a cough specialist, usually a pulmonologist.

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By Peter Galvin, MD

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