Cough

Coughing is usually a symptom of a respiratory illness. But the cough itself can be a medical problem if it continues for a long time and no physical cause is identified. This is known as “unexplained (or refractory) chronic cough”.

Health professionals classify coughs according to how long they last:

• Acute cough: up to three weeks
• Subacute cough: three to eight weeks
• Chronic cough: more than eight weeks

Other criteria include:

• Type: A cough that brings up mucus is called a productive cough. One that doesn’t is called a nonproductive or dry cough.
• Sound: Coughs can be quiet and hoarse or make a barking, croaking, whistling or even metallic sound. Some painful coughs make a hacking sound.

If your cough is accompanied by a constant high fever, difficulty breathing, chest pain, a rapid heartbeat or blood in what you cough up, you should see a doctor.

Coughs are mostly caused by acute respiratory infections like:

• Common colds
• Acute bronchitis
• Sinusitis
• Influenza (“the flu”)
• Covid-19
• Pneumonia

Other possible causes are:

• Chronic lung conditions, like asthma or chronic obstructive pulmonary disease (COPD)
• Heartburn and GERD
• Heart failure
• Pulmonary embolism
• Bronchial or lung tumors
• Inhaled objects, cold air, toxic gases or smoke
• Allergies
• Certain medications like ACE inhibitors (to reduce blood pressure)
• Mental health issues such as stress

Coughs are very common, especially in winter. They are the number one reason why people go to their doctor. Children also get coughs a lot.

Prevalence differs depending on

• Cause: Coughing due to an acute infection (a common cold or acute bronchitis, for example) is much more common than coughing caused by a chronic respiratory disease like asthma or a chronic obstructive respiratory disease ( COPD).
• Environmental factors and lifestyle: Smoking and other factors that can irritate the lungs, like dust, are considered to increase the risk of coughing. Smokers also have a higher risk of colds lasting longer.
• Sex: The cough reflex is triggered more quickly in girls and women than in boys and men.

Coughs caused by acute respiratory infections can last several weeks. They usually disappear again by themselves.

Coughs caused by chronic illnesses often last longer. But the symptoms can develop very differently. For people with asthma, for example, the symptoms may be better or worse depending on the time of year.

Coughs can cause the following physical problems and complications:

• Vomiting
• Headaches
• Hoarseness
• Insomnia
• Involuntary loss of urine and urinary incontinence
• Irregular heartbeat

In rare cases, coughing fits can cause temporary unconsciousness (cough syncope). This happens when the blood flow and oxygen supply to the brain briefly stops.

A persistent cough can get you down and prevent you from going about your daily life. It can take a while to get used to having a chronic cough. But most people gradually find ways to cope better with their symptoms.

It is important to distinguish between acute respiratory infections and other illnesses with coughing as a symptom when making a diagnosis. Coughing caused by a common cold tends to disappear on its own after a while. But a chronic cough can be a sign of a more serious illness.

If you’ve had an acute or subacute cough for eight weeks or less, your doctor will just need to check your medical history and give you a physical examination to diagnose you. They will begin by asking about

• your symptoms,
• previous illnesses,
• any medication you’re taking and
• whether you smoke.

Sometimes they’ll also ask whether you’re exposed to a lot of smoke or dust – at work, for instance.

This is followed by a physical examination, in which the doctor checks your throat and listens to your lungs and heart. Sometimes they’ll do a throat swab too.

If you have a chronic cough (one that lasts for more than eight weeks), it makes sense to have more tests. The doctor will also need to do them if they suspect the cough is due to another illness or a sign of a medical emergency like an illness that needs urgent treatment or an object lodged in your lungs. Typical warning signs of a medical emergency are:

• Wheezing
• Difficulty breathing or breathing too fast
• Skin turning blue
• Heart beating too fast (tachycardia)
• Pain in the chest
• Coughing up blood or mucus containing blood
• Coughing up foamy mucus

Acute respiratory illnesses can be prevented by taking standard precautions, including:

• Hand hygiene: Washing your hands regularly, sneezing/coughing into your elbow or a tissue can stop germs spreading.
• Keeping your distance from other people.
• Face coverings can be particularly useful when new diseases, like COVID-19, are spreading.
• Quitting smoking: This is a good idea because smoking makes you cough and can prolong colds – and because quitting has lots of other health benefits too.

So far there is no proof as to whether vitamins, minerals or herbs can help. Nor is it clear whether sport or getting enough sleep can prevent respiratory illnesses.

Vaccines are available for certain illnesses that mainly cause coughing – like influenza, COVID-19 and whooping cough.

Acute or subacute coughs, like you get when you have a common cold, acute bronchitis, sinusitis or the flu, usually don’t need to be treated with medication. The cough tends to disappear by itself after a few weeks.

To stop the urge to cough, you can do things to keep your airways moist and avoid triggers like dry air or smoke. Some people like to inhale steam, drink lots or suck sweets when they have a cough. And essential oils can have a soothing effect for some people.

Herbal products containing ivy, thyme or primrose extract might bring some relief. They are available from pharmacies without a prescription.

Other medications for acute/subacute coughs have not been proven to be effective. But codeine-based cough remedies might help with sleeping problems caused by a dry (nonproductive) cough. You can only take them for a limited amount of time because they can have side effects and cause dependency. They are also not suitable for productive coughs because they stop you coughing up mucus.

You might be prescribed other medications or treatments, depending on what’s causing your cough. Pneumonia is usually treated with antibiotics. If you have a chronic illness like asthma or chronic obstructive pulmonary disease ( COPD), it’s often advisable to use a combination of medications, other treatments and lifestyle changes. That can mean things like getting more exercise or using certain breathing techniques.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.