These days a cough cannot be taken lightly! But how do you know if your cough is actually serious enough to take action?

What is a cough?

A cough is a reflex action to clear the airways of mucous, fluids, microbes, or foreign bodies, and it can get worse when exposed to irritants like smoke or dust. A cough can also signal that there might be an underlying medical issue.

A cough that lasts for less than three weeks is an acute cough. Most coughing episodes will clear up or at least significantly improve within two weeks. If your cough lasts between three and eight weeks, improving by the end of that period, it’s considered a subacute cough. A persistent cough that lasts more than eight weeks is a chronic cough.

Short-Term coughs

In rare cases, a short-term cough may be the first sign of a health condition that causes a persistent cough.

  • Upper respiratory tract infection (cold, flu, sinusitis, whooping)
  • Allergy of allergic rhinitis or hay fever
  • Flare-up of conditions like asthma, chronic obstructive pulmonary disease (COPD), or chronic bronchitis
  • Inhaled dust or smoke
  • Lower respiratory tract infection (bronchitis, pneumonia)

Persistent coughs

A persistent cough may be caused by:

  • A long-term respiratory tract infection, such as chronic bronchitis
  • Asthma – this also usually causes other symptoms, such as wheezing, chest tightness, and shortness of breath
  • An allergy
  • Smoking – a smoker’s cough can also be a symptom of COPD
  • Bronchitis – inflammation of the lining of your bronchial tubes, which carry air to and from your lungs
  • Postnasal drip – mucus dripping down the throat from the back of the nose, caused by a condition such as rhinitis or sinusitis
  • Gastroesophageal reflux disease or GERD here the throat becomes irritated by leaking stomach acid
  • A prescribed medicine, such as an angiotensin-converting enzyme inhibitor (ACE inhibitor), which is used to treat high blood pressure and cardiovascular disease

When to see a doctor

  • Swelling or lumps around the neck
  • Unexplained weight loss
  • Severe coughing
  • Difficulty swallowing
  • Permanent changes in the sound of the voice
  • Coughing up blood
  • Difficulty breathing
  • Chest pain or shortness of breath
  • Fevers that are not improving

“Even these symptoms don’t necessarily mean the cough is serious. I’m seeing plenty of people this year with fevers and coughs lasting two and even three weeks or more who still turn out to have simple viral infections. But these are symptoms that are worth a call or even a trip to your doctor’s office,” says Suzanne Kovin, M.D., a primary care physician and writer in residence at Massachusetts General Hospital in Boston.

COVID-19 cough

Coughing is a reasonably common symptom of COVID-19, affecting more than four in ten (46%) adults who are ill with the disease. Over half of adults with COVID-19 will not have a cough. Coughing usually occurs along with other symptoms, and only around one in ten people with COVID-19 have a nagging cough as their only symptom.

Fifty to 70 percent of people with symptomatic COVID-19 will develop a dry cough, according to William Checkley, MD, Ph.D., an associate professor in the division of pulmonary and critical care medicine at Johns Hopkins Medicine in Baltimore. The cough tends to come on quickly, says Dr. Checkley, beginning about a day or so after the onset of illness, but it doesn’t typically subside quickly, especially in people who aren’t vaccinated. 

An April 2021 study in The Lancet Respiratory Medicine found that cough lasts an average of 19 days for most people with COVID-19 and up to four weeks in about 5 percent of patients. Some people with long COVID might find themselves coughing for months.

Treatments for a cough

Coughs can be pretty annoying, but there are a number of things you can do to feel better and breathe easier. Treatment will depend on the likely cause of your cough.

For acute coughs due to viral infections, simple remedies may be all that is needed. This might include inhaling steam or ingesting honey and lemon to soothe your throat. If you feel sick with a temperature or aches and pains, acetaminophen or ibuprofen may help. Over-the-counter cough suppressants — antitussives (Vicks Formula 44, Buckley’s Mixture, Robitussin, Delsym) taken before bed can be very helpful. So can cough suppressants with codeine. They make you sleepy, so are good to use at night,

Sana Zuberi, MD, a primary care physician with Henry Ford Health System, recommends not taking anything for a cough. “It’s best, when you can, not to mask your symptoms too much, so you know how serious your condition is,” she says. Being conservative with medication will also help you know when you are getting better.

You will be strongly encouraged to stop smoking if you are a smoker. You will be given an inhaler if you suffer from asthma. If the cough is due to high blood pressure meds, you can switch to another type. If bacterial infection is likely, you may be prescribed antibiotics. A steroid nasal spray may help postnasal drip. Losing weight, cutting out acidic foods and alcohol, and taking medicine to stop acid in the stomach may all help acid reflux coughs.

You may be referred to a lung (respiratory) specialist for further testing. Most cases will be managed by your physician, but you may be referred for further investigation and treatment at a hospital.