ATS Patient Education | Information Series

Cough in Adults

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When air passes out through our voice box with force, a soundis made that we all recognize as a “cough”. The act of coughing
usually begins with a deep breath in, followed by air leaving
the mouth with force. A cough is your body’s way of preventing
material from entering your breathing tubes (airways) and clearing
mucus or foreign material from your airways. While coughing is a
one of the lung’s defenses, it is often a symptom of a problem thatneeds treatment.
Cough is one of the most common complaint for which people seek
medical care. This fact sheet reviews cough problems in adults.
A cough is not a disease, but can be a common symptom ofdifferent upper and lower respiratory tract diseases. Even if you
do not have a lung disease, you may cough. There are many things
that can lead to coughing.

14 days. People with a cold often have nasal stuffiness, runnynose, throat clearing, and a sore or scratchy throat. They also
may feel like they have mucus dripping down the back of theirthroat (post-nasal drip).

Not all coughs are from infection. For example, a cough can happen
when something irritates your nerve endings, called cough receptors.
Inhaling particles, vapors, smoke, fumes, dust, or cold air may irritate
these receptors and may make you cough.

Acute cough can also be due to inhaling irritants such aspollens or strong fumes. Cough may be the first symptom of
inadequate control of asthma. Less commonly, an acute coughcan be due to more serious conditions such as pneumonia orheart failure.

If you have a cough, keep track of how long you have beencoughing. Your healthcare provider may also ask questions about
whether or not it is wet or dry, or whether it wakes you from sleep,or any trigger for cough besides an active sickness.

Can a cough spread infection?

Cough is a common way infection spreads from one person
to others. Influenza (the flu), SARS-CoV-2 (COVID-19), andtuberculosis (TB) are examples of infections that can be spreadby coughing infected droplets into the air. Viruses can also bespread to others by hand-to-face contact. Hand-to-face contact
is when you shake hands with someone who has the infection
or touch something that has the virus on it and then your touch
your mouth, nose or eyes.
To help decrease the spread of infection, you should:

a Cover your mouth and nose with a tissue or into your upper
sleeve or elbow when coughing or sneezing.

a Dispose of used tissues into a waste basket.
a Avoid spitting as it can cause a mist that may infect others.
a Wear a facemask if you are coughing or have cold symptoms.
a Wash your hands often and for at least 20 seconds using soapand water. Use an alcohol-based hand rub (sanitizer) when soap
and water are not available.
a Limit your close contact with others when you have an infectionthat is contagious such as COVID.

Acute, Sub-acute and Chronic Cough

There are three time periods to use as you describe how long you
have had your cough: acute (lasts less than 3 weeks), sub-acute(lasts 3 to 8 weeks) or chronic (lasts more than 8 weeks and does
not let up).

a An acute cough is most often caused by an upper respiratory

infection or common cold. This cough slowly starts to improveby the third to fifth day. Cough from a cold usually is not aserious threat to health and usually does not last longer thana A sub-acute cough most commonly happens after a respiratory
infection (often from a virus). Other common reasons for a
sub-acute cough are: whooping cough (pertussis) and flareups of conditions such as asthma, chronic bronchitis, chronic
obstructive lung disease (COPD), sinusitis or bronchiectasis.

a A chronic cough can happen to you for many reasons or a

combination of problems. Some common causes of chroniccough include:– Inflammation of nose or sinuses from allergy or infection(rhinitis or sinusitis)– Poorly controlled asthma– Lung problems with infection such as bronchiectasis or cysticfibrosis (cough is often wet or ‘phlegmy’)– Smoking tobacco or marijuana or vaping– Gastro-esophageal reflux (when stomach contents back up
into esophagus)

When should I contact my healthcare provider
about my cough?

Any time that your cough concerns you, you should discuss it withyour healthcare provider. It is very important that you contact yourhealthcare provider if:a You spit up blood when you cough.
a You have chest pain or trouble breathing (shortness of breath)when you cough.

a Your coughing makes you vomit.
a You have an unexplained weight loss.
a Your cough began after you were in close contact with someone
who has whooping cough.

a Your cough lasts more than 8 weeks.
a Your cough starts to get better and then gets worse.
a If you have a lung problem such as asthma or cystic fibrosis (CF)and have frequent or chronic cough.

Am J Respir Crit Care Med Vol. 194, P15-P16, 2016

Online version updated July 2022

ATS Patient Education Series © 2016 American Thoracic Society

www.thoracic.org

ATS Patient Education | Information Series
Sometimes frequent bouts of cough or a forceful cough may leadto vomiting. Pertussis (whooping cough) is an infection that is
typically associated with coughing that provokes vomiting. If you
have such a cough-vomit syndrome, ask your healthcare provider
about the possibility of pertussis. See also ATS fact sheet onPertussis (whooping cough).

management. These centers not only have the experience withthe latest medications to treat chronic cough; they often alsouse non-drug treatments. These may include behavioral coughsuppression therapy and other complementary or alternativemeans. You also may have the opportunity to enroll in a researchstudy related to chronic cough.

When might I need specialist care?

You are not alone. Others who have had chronic cough have foundhelp with cough specialists and support groups offering a teamapproach to your care.

Your primary healthcare provider often will be able to answer
your questions about your cough. If your primary healthcare
provider is unable to find the reason for your cough or find waysto stop or improve your cough, you may be referred to a lungspecialist (pulmonologist) or a cough specialist. Sometimes, acomplete evaluation of your cough may include more than justyour respiratory system. You may, for example, need an evaluationof your gastrointestinal (GI) tract. You may also need to see anotolaryngologist (specialist who deals with the nose, sinuses, ears,and throat).

Frequently asked questions about coughCan medications cause cough?

Yes, some medications can cause you to cough. A common cause
is from a category of drugs called angiotensin converting enzyme
inhibitors, also referred to as “ACE inhibitors”. These drugs arecommonly given for high blood pressure or heart failure. If youstart coughing after you start a new medicine, tell your healthcare
provider.

Should I take over-the-counter cough medications?

Over-the-counter (OTC) cough and cold medications are drugs
that you can buy without a prescription. If you have lungdisease, you should discuss using them with your healthcare
provider before using them. In adults, if you choose to use OTC
medications for cough due to the common cold, the use of one of
the antihistamines such as diphenhydramine, brompheniramineor chlorpheniramine or a non-steroidal anti-inflammatory drugs(NSAID) may be tried as long as there is no reason why you should
not take them. These drugs can cause side effects or problems
for some people, such as an allergy, possible drug interaction,or other health problems. For example, chlorpheniramine or
brompheniramine can cause problems with glaucoma or anenlarged prostate. NSAID medications such as ibuprofen or
naproxen can cause kidney problems or stomach irritation orworsen other health problems such as heart failure. If you take an
OTC cough medicine and your cough does not get better or you
begin to feel worse, contact your healthcare provider.
Since 2008, the US FDA has recommended that cold and coughproducts not be used in children under the age of 2 because of
the risk of serious and potentially life-threatening side effects.

Are there any vaccines that can help prevent cough inadults?

Yes, consider getting the influenza (flu) shot each year. Those withallergies to eggs should speak to their healthcare provider before
getting this shot. Other important vaccines for adults include
the COVID, pneumonia (pneumococcal) and the whooping cough(pertussis) vaccines. Ask your healthcare provider if and when you
should get these shots. For more information on these vaccines,
see the ATS Patient Information Series at www.thoracic.org/patients/.

What should I do if I am told to “live with” my chronic
cough?

Action Steps:c Pay attention to your cough pattern and othersymptoms and when to contact a healthcare provider.
c Get recommended immunizations such as annual flu
vaccine and COVID vaccines.
c Cover your nose and mouth whenever you cough orsneeze.
c Do good handwashing regularly.
c Do not smoke or vape and avoid contact withsecondhand smoke, strong fumes and air pollution.
Healthcare Provider’s Contact Number:

Authors: Manvi Bansal, MD, Cynthia T. French, PhD, ANPBC, Richard S. Irwin, MD, Sarah Micklewright, MD, Kristen
Szymonik, BS, RRT
Reviewers: Suzanne Lareau, RN, MSN, Marianna Sockrider
MD, DrPH

Resources:
American Thoracic Society (ATS)f https://www.thoracic.org/patients– Pertussis (whooping cough)– Influenza (flu)– Covid vaccines– COPD– COPD Medicines– Asthma & Allergens– Asthma & Exercise– Asthma Treatment– Asthma & IrritantsCenters for Disease Control and Prevention. Cough.
f https://www.cdc.gov/hygiene/personal-hygiene/coughing-sneezing.html
National Institutes of Health. Coughf http://www.nhlbi.nih.gov/health/dci/Diseases/cough/cough_whatis.html
This information is a public service of the American Thoracic Society.
The content is for educational purposes only. It should not be used as a substitutefor the medical advice of one’s healthcare provider.

While some conditions may lead to a daily cough, if your coughremains unexplained, it is appropriate to request a referral toa multi-specialty cough center for further investigation andwww.thoracic.org