Cough 101

Cough 101: What you need to know to decode your cough

Everyone knows the feeling: the sudden urge to clear your throat followed by the deep, familiar echoes of a cough. With so many potential causes, it's no wonder that a cough can raise eyebrows, especially when everyone's on high alert during cold and flu season. Is that cough as grim as it sounds? Does the cough mean you need to see a doctor? Find out what your cough might mean, common misconceptions, and when you should see an MDLIVE board-certified doctor.


What is a cough? Why do we cough?

A cough is our body's natural reflex to clear irritants, such as mucus, germs, and dust, from our throat or respiratory system. Think of it as our body's built-in alarm system to protect against intruders that could harm our respiratory health. Common causes include respiratory infections, allergies, acid reflux/GERD, and exposure to environmental irritants, such as smoke or pollution.

3 things you might have wrong about your cough.

1. The length of my cough isn't that important.

One of the most common misconceptions is that the sound of a cough is the only thing that matters. However, contrary to popular belief, the duration of a cough is often more important in determining the severity of the underlying condition. There are three different types of coughs based on duration:

Acute cough:
Typically lasts less than 3 weeks. These are often associated with short-lived illnesses.
Subacute cough:
Typically lasts 3-8 weeks. They sometimes hint at an unresolved infection or post-viral syndrome.
Chronic cough:
Lasts more than 8 weeks in adults or 4 weeks in children. Chronic coughs can indicate an underlying issue, like asthma or allergies.

2. A scary-sounding cough? Must be serious!

Sometimes, a cough can sound scary. But don't judge a book by its cover. A loud cough doesn't always mean something terrible or indicate a severe underlying condition. While a cough can be a vital symptom in determining the underlying issue, it should always be evaluated in conjunction with other symptoms.

3. I haven't coughed; I must be fine!

It's easy to think that if you're not coughing, you're not sick. But that's not always true. Some common adult and adolescent illnesses, like strep throat, mononucleosis, roseola, or hand, foot, and mouth disease, don't usually come with a cough. Remember, diseases can show up in different ways – and sometimes, coughs develop later.

Vontrelle Roundtree, MD

Ahem, ahem: a doctor’s cough advice.

We turned to Dr. Vontrelle Roundtree, MDLIVE Associate Chief Medical Officer, for tips on how to treat a cough, and what associated symptoms to look out for that may point to something more serious.

How to alleviate cough symptoms

"First, make sure you are providing your body with plenty of fluids, as staying hydrated can help loosen mucus and make it easier to expel. Hot teas can also help to soothe an irritated throat. Consider natural or locally grown honey as a bonus, as it acts as a natural cough suppressant, helping to reduce the frequency and severity of coughing."

Cough Drops
Try Cough Drops:
If you're dealing with a persistent cough, cough drops can be a handy quick fix. They make your mouth produce more saliva, which helps soothe your throat and ease that nagging, itching feeling.

Steamy Shower
Steamy Showers Help:
You might have noticed that steamy showers make you feel better when you're sick. Adding moisture to the air through a shower or a humidifier can help open up your airways and loosen a stuffy nose.

Over the counter medicine
Over-the-Counter Cough Medicine:
When nothing else seems to work, you can consider using over-the-counter cough medicine. For dry coughs, a cough suppressant that contains dextromethorphan can be effective in blocking the cough reflux. For a wet cough producing mucus or phlegm, an expectorant can help thin and loosen mucus, making it easier to cough up. However, it's important to consult a doctor before starting any medication. A doctor may recommend an alternative treatment if your cough is due to an underlying condition, like asthma or GERD.

Why is my cough worse at night?

Is your cough a night owl? Some coughs may be more pronounced at nighttime due to the build-up of mucus while lying down, leading to pesky postnasal drip. Did you know that some parts of our immune function, like fighting off bacteria, are more active overnight? That might explain why you’re experiencing heightened symptoms and increased nighttime coughing. Another cause might be silent reflux, a condition in which stomach acid flows back up the esophagus.


Can coughing be a sign of COVID-19?

While cough is a symptom of COVID-19 for some, the flu, RSV, and common colds all share similar symptoms, making it challenging to identify the underlying cause. The best way to find out is to get tested. MDLIVE doctors can also help you determine the root of your symptoms and create an effective treatment strategy. Dr. Roundtree strongly encourages adhering to the CDC's recommendations for COVID-19 vaccinations and boosters. These vaccines can significantly impact the severity of symptoms, potentially even preventing hospitalization.

When deemed medically appropriate, MDLIVE board certified doctors can assess your treatment options and prescribe the FDA-approved antiviral medication, Paxlovid.


When is a cough serious enough to warrant an emergency room visit?

While most coughs resolve on their own, certain symptoms should prompt an immediate visit to the emergency room. If you or your loved one experiences difficulty breathing, chest pain, confusion, or bluish lips or face, don't wait—seek emergency care.

Remember, a number of different conditions can cause a cough. Characteristics like duration, sound, and associated symptoms can help you understand what's going on.

5 types of coughs and when you should see a doctor.


Can be Caused by:

An allergy cough is typically dry and doesn’t bring up mucus. It is typically accompanied by itchy and watery eyes, a runny nose, sneezing, and/or an itchy throat. Allergies do not cause fever, nor do they typically cause chest congestion, upset stomach, or muscle aches.

Flu symptoms, like a dry cough, often come on quickly, setting it apart from other illnesses, like the common cold. Other telltale flu symptoms include body aches, chills, extreme fatigue, fever, headache, and sore throat.

A COVID-19 cough is typically dry and unproductive. While symptoms vary, recent strains of COVID-19 bring on fever, fatigue, body aches, sore throat, nausea/vomiting, and stuffy/runny nose.



Can be Caused by:

Common Cold (Ex. rhinovirus, adenovirus, etc.):
Usually produces mild symptoms, including runny or stuffy nose, mild cough, sneezing, and sore throat. Given the mucus and congestion often associated with the common cold, the resulting cough is wet and productive. The common cold does not typically cause fever in adults, although children may experience a low-grade fever.

Settles in your lungs, causing inflammation and difficulty breathing. The cough associated with pneumonia is wet and produces phlegm. Additional symptoms include fever, shortness of breath, fatigue, and chest pain. It’s important to seek medical treatment if you suspect pneumonia.

Respiratory Syncytial Virus (RSV):
A common virus that causes respiratory infection, most typically seen in children. While the cough can vary, it often starts as a wet, productive cough that may sound a bit like wheezing. Other symptoms include a fever, stuffy or runny nose, decreased appetite, and difficulty breathing. It’s important to monitor for severe symptoms. Seek medical treatment for severe symptoms.



Can be Caused by:

Pertussis (Whooping Cough):
A bacterial infection that affects the respiratory tract and is known for its characteristic severe and rapid coughing fits. While initially the cough may be mild, and you may have a low-grade fever and runny nose, the symptoms will progress, developing into a high-pitched “whoop” sound. The coughing fits are typically forceful, causing fatigue or even vomiting. Whooping cough can last for six weeks or longer. It’s critical to seek medical attention immediately if you suspect pertussis, especially in an infant.

Audio file courtesy of Doug Jenkinson, MD



Can be Caused by:

Croup is a common respiratory condition in young children characterized by upper airway inflammation and most often caused by a viral infection. The cough sounds much like the bark of a seal. Other symptoms include stridor (a high-pitched wheezing that sounds when breathing in), hoarseness, mild fever, and difficulty breathing. Mild cases of croup can often be managed at home; however, severe cases, especially if the child is showing signs of significant respiratory distress, require medical attention.

Audio file courtesy of Tali Ditye, Ph.D.



Can be Caused by:

Sometimes, a chronic, dry cough may be the only symptom in certain types of asthma. Other times, cough is accompanied by wheezing, shortness of breath, increased mucus production, and heightened symptoms after exposure to triggers like allergens or exercise.
A condition where acid from the stomach backs up into the esophagus, irritating the lining. It may trigger a chronic cough, often joining other symptoms, like heartburn, chest pain and sensation of a lump in the throat.
Chronic Obstructive Pulmonary Disease (COPD):
A chronic lung disease and the umbrella term used for chronic bronchitis and emphysema. It causes airflow limitations, leading to inflammation and a productive cough that lasts for months. Other symptoms can include shortness of breath, wheezing, and fatigue.

When should you see an MDLIVE doctor?

If you are concerned for any reason about your cough or simply need help finding relief, see a healthcare professional. You can see an MDLIVE board-certified doctor in 15 minutes or less from the comfort of your home and avoid exposure to sick people in crowded urgent care centers, walk-in clinics, or ER waiting rooms.

Note: Some chronic cough conditions may not be suitable for virtual evaluations and may require an in-person assessment.

Posted date: October 12, 2023

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