Cough: Causes, Types, Help

Brief overview

What is cough? Rapid, violent expulsion of air; can be acute or chronic, with or without expectoration.
Causes: e.g. cold, flu (influenza), bronchitis, allergy, asthma, covid-19, pulmonary embolism, tuberculosis, cardiac insufficiency
When to see a doctor? In case of chest pain, shortness of breath, high fever, coughing up large amounts of blood, etc.
Diagnostics: patient interview, physical examination, possibly throat swab, blood test, X-ray, lung function test, etc.
Treatment: treat underlying disease (e.g., pneumonia, asthma). General measures such as steam inhalations, home remedies such as tea, if necessary cough-solving or cough-soothing medications, refraining from smoking.

Cough: Description

Acute and chronic cough

According to the duration of the cough, physicians distinguish between acute, subacute and chronic cough:

Acute cough lasts up to three weeks. It is usually caused by respiratory infections (cold, bronchitis, etc.). In addition, acute cough can occur, for example, as a result of an allergy, pulmonary embolism, when a foreign body is swallowed or inhaled, or in cases of acute toxic poisoning (such as in a fire).
Chronic cough lasts longer than eight weeks. Possible causes include asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and lung cancer.

Cough that lasts three to eight weeks is called subacute by medical professionals.

Dry cough (irritating cough)

Dry cough is also called an unproductive cough or cough without sputum – and that’s exactly what it is: a cough without secretion. It is triggered by irritation of the respiratory tract. Hence the term irritable cough.

Chronic dry cough can be caused, for example, by chronic rhinitis or chronic sinusitis, reflux disease and asthma. In addition, chronic dry cough can also be a side effect of ACE inhibitors (cardiovascular drugs).

The duration of the cough is more relevant to treatment than whether it is productive or dry.

Productive cough (cough with sputum).

Here the cough is accompanied by a lot of mucus production, hence the name cough with sputum. The mucus is usually clear as glass. Yellowish sputum from the lower airways is due to inflammatory cells. Greenish bronchial secretions indicate bacterial infection.

Acute productive cough may occur in the setting of pneumonia, for example, as well as in the later stages of acute bronchitis.
Chronic productive cough may indicate chronic bronchitis or COPD, among other conditions.

Coughing up blood (hemoptysis)

Cough: causes and possible diseases

Overall, the main causes of cough are:

Common cold: A common cold is an infection of the upper respiratory tract with viruses. It is typically accompanied by cough, runny nose, nasal congestion and a general feeling of illness.
Flu (Influenza): True flu is also a viral infection of the respiratory tract. However, while a cold can be caused by a variety of pathogens, the viruses involved here are known as influenza viruses. A real flu is more severe than a simple cold. It starts very suddenly with high fever, headache, muscle and limb pain, sore throat and difficulty swallowing, and a dry cough (often changing to one with viscous mucus). Sometimes patients also suffer from nausea.
Bronchitis: Bronchitis refers to an inflammation of the respiratory tract that is often accompanied by an agonizing cough. In acute bronchitis, a dry cough occurs first, and later a productive cough. In addition, the affected person has a cold and sore throat. Doctors speak of chronic bronchitis when someone has had a daily cough and sputum (productive cough) for at least three consecutive months in at least two consecutive years. Very often smoking is the cause of chronic bronchitis.
Pneumonia: A cough may also indicate pneumonia. At first, it is usually dry; later, the patient coughs up mucus. Other symptoms of pneumonia include shortness of breath, high fever, sudden chills, and severe feeling of illness.
Ingestion or inhalation of irritant gases, dust, etc.: When food or liquid accidentally ends up in the trachea instead of the esophagus, a dry, irritating cough results – the body tries to move the foreign bodies back up toward the oral cavity by coughing. The same happens when irritant gases, dust or other foreign bodies are inhaled (inhalation) or swallowed (aspiration).
Allergy: Allergic cough can occur, for example, in the case of mold allergy, food allergy and dust mite allergy. People with a pollen allergy (hay fever) often also develop asthma later on, for which coughing and shortness of breath are the first signs.
Bronchial asthma: Asthma is a widespread, chronic disease with inflammation and narrowing of the airways. Patients suffer from a predominantly dry cough (also at night) and attacks of shortness of breath. A whistling breath noise (wheezing) is also typical.
Lung collapse (pneumothorax): In this case, there is a pathological accumulation of air between the inner and outer lung pleura, where there is normally no air. The reason for this is, for example, the bursting of alveoli or an injury to the lung. The affected lung collapses, recognizable by sudden onset of chest pain that may radiate to the back. In addition, dry cough, respiratory pain, and increasing shortness of breath with shallow breathing often develop.
Pulmonary embolism: Coughing can also be a sign of pulmonary embolism, which is a blockage of a blood vessel in the lungs by a blood clot. Smaller pulmonary emboli sometimes cause no symptoms or only a brief cough. Larger blood clots, on the other hand, cause sudden symptoms such as coughing (possibly bloody), shortness of breath, chest pain, palpitations, dizziness, loss of consciousness and bluish discoloration of the skin and mucous membranes.
Interstitial lung diseases: This term covers more than 200 different lung diseases caused by damage to the alveoli (air sacs). As a result, there is inflammation and a pathological proliferation of connective tissue (fibrosis) in the area of the lung interstitium, i.e. the thin tissue wall between the alveoli. Interstitial lung diseases are accompanied by shortness of breath under exertion (exertional dyspnea) and an attack-like, dry cough.
Whooping cough (pertussis): Pertussis is a severe respiratory infection caused by bacteria and is highly contagious. Patients suffer from spasmodic attacks of coughing followed by gasping for air (hence the name whooping cough).
Pseudo-croup: A dry, barking cough is typical of this virus-related inflammation of the upper respiratory tract. Other symptoms include hoarseness, whistling or squeaking breathing sounds when inhaling, and no or only a slight increase in temperature. Shortness of breath may also occur. Pseudocroup is most common in young children.
Tuberculosis (consumption): Tuberculosis (TB) is a chronic bacterial infectious disease that usually affects the lungs, and less commonly other body organs. The characteristic symptoms of pulmonary tuberculosis include persistent cough, either with (productive cough) or without sputum (dry cough). In the advanced stage of the disease, bloody sputum is coughed up (hemoptysis).
Cystic fibrosis: In this congenital metabolic disease, the secretion of various bodily secretions such as mucus and sweat is disturbed. For example, more viscous mucus forms in the respiratory tract, causing increasing shortness of breath. Often, a chronic cough also develops (usually with mucus production, sometimes mixed with blood).
Cardiac insufficiency: In cardiac insufficiency (heart failure), the heart can no longer supply the body with sufficient blood and oxygen. The organ weakness can affect the left side of the heart (left-sided heart failure), the right side of the heart (right-sided heart failure), or both halves (global heart failure). Both left-sided and bilateral (global) heart failure may cause chronic dry cough, especially at night (the cough increases when lying down).
Side effect of medications: Some medications can cause a chronic dry cough as a side effect, often occurring in attacks. These medications include, for example, ACE inhibitors and beta blockers. Both serve as cardiovascular drugs, for example, in heart failure and high blood pressure. In addition, use of the anti-inflammatory cortisone (in spray form) can also cause coughing.

Cough: Chronic diseases

Asthma, chronic bronchitis, cystic fibrosis – as can be seen from the above list, cough can also be a symptom of various chronic diseases.

Chronic cough in children

In children, chronic cough often results from:

hypersensitivity of the respiratory tract after a viral infection
bronchial asthma
reflux of acidic stomach contents into the esophagus (gastroesophageal reflux) or inhalation of stomach contents (pulmonary aspiration)

Rare causes of chronic cough in children include inhalation of foreign bodies, cystic fibrosis, and inflammation of the smallest airways in the lungs (bronchiolitis) following a viral infection.

Chronic cough in adults

Common causes of chronic cough in adults include:

chronic bronchitis (as a result of smoking)
bronchial asthma
Reflux of acidic stomach contents into the esophagus (gastroesophageal reflux)
Overproduction of mucus in the nose and sinuses with mucus drainage into the throat (“post-nasal drip”)
Left-sided cardiac insufficiency (left heart failure)

In rare cases in adults, for example, pneumonia, tuberculosis, lung cancer, or taking ACE inhibitors (cardiovascular drugs) are responsible for the chronic cough, or the chronic cough is psychological.

Cough: Treatment

In the case of uncomplicated acute cough due to a cold, general measures are usually sufficient to alleviate the symptoms. For example, sufferers should drink enough (e.g.: herbal tea, water), do steam inhalations (20 minutes at 43°C water temperature) and refrain from (active and passive) smoking.

Medication for cough

Medications are given for cough only if it is absolutely necessary or if the symptoms severely affect the patient (such as agonizing cough). Depending on the need, a cough expectorant or cough blocker may be used.

Sometimes such cough medications are also used in severe advanced diseases such as lung cancer, when a cure is no longer possible.

Cough expectorant

However, it is currently not sufficiently proven that cough expectorants actually help with an acute cough in the context of an acute respiratory infection. In the case of chronic bronchitis or COPD, the drugs may be able to prevent symptoms from getting worse (exacerbation).

Cough blockers

Cough blockers (cough suppressants, antitussives) such as codeine, dihydrocodeine, and dextromethorphan are often used to treat an agonizing, dry, irritating cough – that is, a nonproductive cough without sputum. They are intended to dampen the urge to cough and thus allow the irritated mucous membrane in the airways to recover. Cough blockers are often also given in the evening – with the aim of allowing the patient an undisturbed night’s rest.

Caution is also advised with antitussives because of the possible side effects. In the case of some preparations (such as codeine, a substance related to opium), there is also a risk of misuse and dependence; in addition, cough blockers can cause constipation and poor concentration as side effects.

For these reasons, antitussives are often viewed critically and prescribed only with caution. Patients should seek advice from a physician or pharmacist regarding the possible side effects.

Cough blockers must never be used in cases of productive cough! By suppressing the coughing stimulus, the mucus in the airways is otherwise no longer coughed up, which can impede breathing and promotes the colonization of bacteria in the stuck mucus. For the same reason, an expectorant (cough suppressant) and a cough blocker should not be used at the same time for a cough.

Antibiotics

By the way, antibiotics do not help against viral infections of the respiratory tract (e.g. cold, flu).

Homeopathy against cough

If you want to try homeopathy for dry cough, you should reach for Bryonia (for dry irritating cough, headache and aching limbs) or Drosera (dry, barking cough and shivering fever). You can find out which potency of the homeopathic remedy is most suitable in each individual case and how to use the preparation correctly from an experienced doctor, pharmacist or alternative practitioner.

The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.

Home remedies for cough

Additional home remedies for coughs include warm compresses or compresses for the chest and back, such as a mustard flour compress for a chesty cough and a ginger compress for a productive cough. Inhalation is another good tip, especially in the latter case: deep inhalation of warm vapors facilitates the loosening of stuck mucus in the airways.

Another tried-and-tested home remedy for a troublesome cough is cough syrup. You can prepare it yourself with onions or radishes, for example. How to do this and more about effective home remedies for dry and productive cough you will learn in the article Home remedies for cough.

Home remedies have their limits. If the symptoms persist for a long time, do not get better or even get worse, you should always consult a doctor.

Cough: When should you see a doctor?

You should seek immediate medical attention in the following cases of cough:

Cough with chest pain
Cough with shortness of breath (and possibly bluish discoloration of the skin, such as on the lips)
Coughing with high fever
Coughing up large amounts of blood (hemoptysis)
Coughing during/after a stay in countries where tuberculosis is widespread
Coughing after contact with tuberculosis patients
Cough in case of known cancer in the history
Cough in patients with immune deficiency, HIV infection or under immunosuppressive therapy (treatment that suppresses the immune system)
Cough in extremely heavy smokers

You should seek immediate medical attention in the following cases of cough:

Cough with shortness of breath (and possibly bluish discoloration of the skin, such as on the lips)
Coughing with high fever
Coughing up large amounts of blood (hemoptysis)
Coughing during/after a stay in countries where tuberculosis is widespread
Coughing after contact with tuberculosis patients
Cough in case of known cancer in the history

Cough in patients with immune deficiency, HIV infection or under immunosuppressive therapy (treatment that suppresses the immune system)

Cough in extremely heavy smokers

Throat swab: If diphtheria could cause the cough, the doctor takes a throat swab. This is examined in the laboratory for diphtheria bacteria and their toxin. The doctor may also take a throat swab (or nasal swab) to detect possible infection with the novel coronavirus.
Examination of sputum (sputum examination): Examination of sputum during a productive cough can identify tuberculosis or pleurisy, for example, as triggers of cough.
Blood tests: For example, the doctor looks particularly at the white blood cell (leukocyte) count when clarifying pneumonia, for example. An analysis of the blood gases (oxygen, carbon dioxide) can show whether the gas exchange in the lungs is disturbed, as is the case in asthma and COPD.
Pulmonary function test: Here, the physician examines whether the cough is due to narrowing of the airways, as in asthma, COPD or bronchiectasis. Various examination methods are available, including spirometry and bodyplethysmography.
Bronchoscopy: In this procedure, the physician inserts a tiny camera attached to a thin tube or a type of metal pipe through the trachea to look inside the lungs. This examination is indicated when a swallowed foreign body or lung cancer could trigger the cough. The bronchoscope can also be used to obtain specific samples of secretions or tissue for further examination.
Prick test: This skin test is used to clarify allergies. By applying various test substances, it is possible to determine whether, for example, dust mites, molds or certain foods cause an allergic cough and other allergy symptoms.
Sweat test: It is useful if cystic fibrosis is suspected as a trigger for coughing. This is because the disease not only changes the composition of the mucus in the respiratory tract, but also that of the sweat, among other things.
Gastroscopy: If the cough could be due to reflux of stomach contents into the esophagus (reflux disease), this can be determined by gastroscopy.
Computer tomography (CT): CT can be used to determine whether the cough is caused by chronic sinusitis, lung cancer or pulmonary embolism, for example.
Heart ultrasound (echocardiography): A heart ultrasound will show if heart failure is behind the cough.