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Cough: causes, forms, help

by Josephine Andrews
Published: Last Updated on 442 views

Basically, coughing is an important protective mechanism: Anyone who coughs expels air at up to 480 kilometers per hour to remove mucus, dust and other foreign bodies from the respiratory tract. However, a cough can also be a symptom of illnesses such as the common cold, bronchitis or asthma. It can occur as a dry, irritating cough or a cough with sputum. Read more about cough causes and treatment.

quick overview

  • What is cough? Rapid, violent expulsion of air; can be acute or chronic, with or without sputum production
  • Causes: e.g. B. Cold, flu (influenza), bronchitis, allergy, asthma, Covid-19 , pulmonary embolism , tuberculosis, heart failure
  • When to the doctor? including chest pain, shortness of breath, high fever, coughing up large amounts of blood
  • Diagnostics: Patient consultation, physical examination, possibly throat swab, blood test, X-ray , lung function test, etc.
  • Treatment: treat the underlying disease (e.g. pneumonia, asthma), otherwise general measures such as water vapor inhalation, home remedies such as tea, possibly cough-relieving or cough-suppressing medication

Cough: description

Barking, wheezing, painful, excruciating, with or without sputum, occurring all day, only at certain times of the day, or when eating certain foods – there are many different types of cough. On the one hand, it can be divided according to the duration (acute and chronic cough) and, on the other hand, with regard to the coughing up of secretions (dry, productive and blood cough).

Acute and chronic cough

According to the duration of the cough, doctors differentiate between acute and chronic coughs:

  • Acute cough lasts up to eight weeks. The cause is usually respiratory infections (colds, bronchitis, etc.). In addition, acute coughing can occur as a result of an allergy, pulmonary embolism, when swallowing or inhaling a foreign body or in the event of acute poisoning by harmful substances (e.g. in a fire).
  • Chronic cough lasts more than eight weeks. Possible causes are, for example, asthma, chronic bronchitis, the chronic lung disease COPD and lung cancer.

Dry cough (irritable cough)

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

  • Acute dry cough can occur at the beginning of acute bronchitis, with small pulmonary embolisms (blockage of a pulmonary blood vessel), pleurisy and when inhaling irritant gases, dust and other foreign bodies.
  • Chronic dry cough can be caused, for example, by a chronic cold 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 phlegm)

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

  • Acute productive cough can occur, for example, in the context of pneumonia and in the later stages of acute bronchitis.
  • Chronic productive cough can be an indication of chronic bronchitis or COPD, among other things.

coughing up blood (hemoptysis)

Coughing with bloody sputum is basically a form of productive cough. Common causes of coughing up blood include severe bronchitis, pulmonary embolism, pulmonary tuberculosis, lung cancer and inhaling foreign objects. It is also possible (although rare) that left ventricular failure (a failure of the left side of the heart to pump) or a bleeding disorder (congenital or due to the use of anticoagulant medication) is behind coughing up blood.

Cough: causes and possible diseases

Overall, the main causes of cough are:

  • Common cold: A common cold is an upper respiratory tract infection with viruses . It is typically accompanied by a cough, runny nose , nasal congestion and general malaise.
  • Flu (Influenza): The real flu is also a viral infection of the respiratory tract. While there can be various pathogens in a cold, these are so-called influenza viruses. A real flu is more severe than a simple cold. The disease begins very suddenly with a high fever, headache, muscle and body aches, sore throat and difficulty swallowing, and a dry cough (often progressing to thick mucus). Sometimes patients also experience nausea.
  • Chronic sinusitis: Chronic sinusitis is accompanied by a mostly dry cough (irritable cough), which often gets worse when lying down. Incidentally, the inflammation often extends to the mucous membrane of the nasal cavity, so it is accompanied by a chronic cold (chronic rhinitis). Doctors therefore often speak of chronic rhinosinusitis overall.
  • Bronchitis: Bronchitis is an inflammation of the airways that is often accompanied by a nagging cough. In acute bronchitis, a dry, later productive cough occurs first. In addition, those affected have a runny nose and sore throat. Doctors speak of chronic bronchitis when someone has had daily cough and sputum production (productive cough) for at least three consecutive months for at least two consecutive years. Smoking is very often the cause of chronic bronchitis.
  • Inflammation of the lungs (pneumonia): Coughing can also indicate pneumonia. Initially it is mostly dry; later the patient coughs up phlegm. Other symptoms of pneumonia include shortness of breath, high fever, sudden chills and a feeling of being very sick.
  • Pleurisy (pleuritis): Doctors understand this to mean an acute inflammation of the lungs and/or pleura. Possible causes include infections, cancer, and pulmonary embolism. The dry form of pleurisy (pleuritis sicca) is accompanied by a dry, dry cough, severe, one-sided and breath-dependent chest pain and shallow, gentle breathing.
  • Swallowing or inhaling irritant gases, dust, etc.: If food or liquid accidentally ends up in the windpipe instead of the esophagus, a dry, hacking cough occurs – the body tries to cough the foreign bodies back up towards the oral cavity. The same happens when you breathe in (inhalation) or swallow (aspiration) irritant gases, dust or other foreign objects.
  • Allergy: Allergy -related coughing can occur, for example, with a mold allergy, food allergy and house dust mite allergy. People with a pollen allergy ( hay fever ) often also develop asthma later on, of which coughing and shortness of breath are the first signs.
  • Bronchial asthma: Asthma is a common, chronic condition characterized by inflammation and narrowing of the airways. The patients suffer from a predominantly dry cough (even at night) and attacks of shortness of breath. A whistling noise (wheezing) is also typical.
  • Chronic obstructive pulmonary disease (COPD): In COPD, too, the airways in the lungs are chronically inflamed and narrowed. The resulting symptoms are primarily chronic cough with sputum (productive cough) and shortness of breath during exertion. The main cause of COPD is smoking.
  • Lung collapse ( pneumothorax ): This leads to a pathological accumulation of air between the inner and outer pulmonary membrane, where there is normally no air. The reason for this is, for example, the bursting of air sacs in the lungs or an injury to the lungs. The affected lung collapses, recognizable by the sudden onset of pain in the chest area, which can radiate to the back. In addition, a dry cough, breathing-related pain and increasing shortness of breath with shallow breathing often develop .
  • Pulmonary embolism: Coughing can also be a sign of a pulmonary embolism, which is a blockage of a blood vessel in the lungs by a blood clot. Smaller pulmonary embolisms sometimes cause no symptoms or only a brief cough. In the case of larger blood clots, on the other hand, symptoms such as coughing (possibly bloody), shortness of breath, chest pain, tachycardia, dizziness, loss of consciousness and bluish discoloration of the skin and mucous membranes occur suddenly.
  • Lung cancer (lung and bronchial carcinoma): The term lung cancer includes various malignant growths of the lungs. Persistent cough is a relatively early symptom of such cancers, but it can also indicate many other diseases. Coughing up blood also occurs in some patients. The main cause of lung cancer is smoking.
  • Interstitial lung diseases: The term includes more than 200 different lung diseases that are caused by damage to the air sacs (alveoli) in the lungs. This leads to inflammation and a pathological proliferation of connective tissue (fibrosis) in the area of ​​the pulmonary interstitium, i.e. the thin tissue wall between the alveoli. Interstitial lung disease is accompanied by shortness of breath on exertion (dyspnea on exertion) and attacks of dry coughing.
  • Whooping cough (pertussis): Whooping cough is a serious respiratory infection caused by bacteria and is highly contagious. Patients suffer from spasmodic coughing fits followed by gasping for air (hence the name whooping cough).
  • Diphtheria : Diphtheria is also a severe acute bacterial respiratory infection. The pathogens produce toxins that damage the mucous membranes and, rarely, the heart , liver and kidneys. The disease usually begins with a sore throat, difficulty swallowing and a slight fever. If the larynx is affected, a barking cough, hoarseness and shortness of breath (due to swelling of the mucous membranes) also develop. A putrid-sweet mouth odor is also typical of diphtheria. Without treatment, there is a risk of death, but thanks to vaccination, the disease has now become rare.
  • Pseudo-croup: A dry, barking cough is typical of this virus-related inflammation of the upper respiratory tract. Other symptoms are hoarseness, whistling or squeaky breathing noises when inhaling and no or only a slight increase in temperature. Shortness of breath can also occur. Small children in particular suffer from pseudo-croup.
  • Tuberculosis (consumptive consumption): Tuberculosis (TB) is a chronic bacterial infection that mostly affects the lungs and more rarely other organs of the body. The characteristic symptoms of pulmonary tuberculosis include a persistent cough, either with (productive cough) or without sputum (dry cough). In the advanced stage of the disease, bloody sputum is coughed up (coughing up blood).
  • Bronchiectasis: Physicians refer to permanent enlargements of bronchial branches in the lungs as bronchiectasis. These sacs are either congenital or acquired (e.g. due to bronchitis, cystic fibrosis). The symptoms of bronchiectasis include a chronic productive cough with a lot of sputum, which is often yellow-green in color.
  • Mucoviscidosis (cystic fibrosis): In this congenital metabolic disease, the secretion of various bodily secretions such as mucus and sweat is disturbed. For example, thick mucus builds up in the airways, which increasingly causes shortness of breath. A chronic cough often develops (usually with mucus production, sometimes mixed with blood).
  • Heart failure: In the case of heart failure (heart failure), the heart can no longer supply the body with enough blood and oxygen. The organ weakness can affect the left side of the heart (left heart failure), the right side of the heart (right heart failure) or both halves (global heart failure). Chronic dry cough can occur in both left-sided and bilateral (global) heart failure, especially at night (cough worsens when lying down).
  • Reflux disease: It is characterized by the backflow of stomach acid or acidic stomach contents into the esophagus and is also called (gastroesophageal reflux). Those affected suffer from a chronic, dry cough (with and without heartburn), which often worsens when lying down. When the ascending gastric contents get into the airways (pulmonary aspiration), the body reacts even more with a cough. Inflammation of the airways (e.g. sinusitis or chronic bronchitis) and asthma can also develop.
  • Side effects of medication: Some medications can cause a chronic dry cough as a side effect, which often occurs in attacks. These drugs include, for example, ACE inhibitors and beta blockers. Both are used as cardiovascular drugs, for example for heart failure and high blood pressure. In addition, taking 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 list above, cough can also be a symptom of various chronic diseases.

Chronic cough in children

In children, chronic cough often results from:

  • Airway hypersensitivity following viral infection
  • bronchial asthma
  • Backflow of acidic stomach contents into the esophagus (gastroesophageal reflux) or inhalation of the stomach contents (pulmonary aspiration)
  • Overproduction of mucus in the nose and paranasal sinuses with mucus draining into the throat (“post-nasal drip”)

Rare causes of chronic cough in children are, for example, inhaling foreign objects, cystic fibrosis and inflammation of the smallest airways in the lungs (bronchiolitis) after a viral infection.

Chronic cough in adults

Common causes of chronic cough in adults include:

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

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

Cough: treatment

If a condition such as asthma, COPD, pneumonia, lung cancer or cystic fibrosis is responsible for the cough, the doctor will treat these diseases accordingly. As a result, the cough usually disappears as well.

In the case of an uncomplicated acute cough as a result of a cold, general measures are usually sufficient to relieve the symptoms, for example drinking enough water, inhaling water vapor (20 minutes at a water temperature of 43°C) and not smoking (actively and passively).

Cough medicines

Medicines are only given for a cough if it is absolutely necessary or if the symptoms are severely affecting the patient (such as a nagging cough). A cough suppressant or cough blocker is used as needed.

Sometimes such cough medicines are also used for serious advanced diseases such as lung cancer when a cure is no longer possible.

cough suppressant

If a lot of viscous mucus blocks the airways and is difficult to cough up, expectorants can provide relief: they liquefy the mucus and make it easier to cough up. This not only improves breathing, but also prevents disease-causing bacteria from settling in the mucus. The active ingredients acetylcysteine ​​(ACC), bromhexine and ambroxol are primarily used as cough suppressants .

cough suppressant

Cough blockers (cough suppressants, antitussives) are used for torturous, dry, dry coughs – i.e. unproductive coughs without sputum. They dampen the urge to cough and thus enable the irritated mucous membrane in the respiratory tract to recover. Cough blockers are often also given in the evening so that coughing attacks do not repeatedly wake the patient from sleep.

Cough suppressants found in medications include codeine , dihydrocodeine, pentoxyverine, and dextromethorphan . Some of them (codeine, a substance related to opium) can be addictive; Cough blockers can also cause constipation and poor concentration as side effects. Those affected should therefore not take antitussives for longer than a week. Particular care should be taken with these drugs when operating machinery or driving.

It should also be noted that cough blockers should never be used with a productive cough! By suppressing the urge to cough, the mucus in the respiratory tract is no longer coughed up, which can impede breathing and encourage bacteria to settle in the stuck mucus. For the same reason, an expectorant (cough expectorant) and a cough blocker should not be used at the same time when you have a cough.


If the cough is a sign of an acute bacterial infection, the doctor may prescribe antibiotics. Patients should take this consistently for as long as recommended by the doctor, even if the symptoms disappear before then. If antibiotic therapy is stopped prematurely, there is a risk that some bacteria will survive in the body and become insensitive (resistant) to the antibiotic. In the event of a renewed infection, the drug would then no longer work. By the way, antibiotics do not work against viral infections of the respiratory tract, such as those that occur with a cold or flu.

Homeopathy for cough

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

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

home remedies for cough

A natural help with coughing is medicinal herbal tea – if you prepare it with the right medicinal plants: If you have a dry cough, you should choose medicinal plants containing mucus to soothe the irritated mucous membranes, for example lime blossom , buckhorn or marshmallow. In the case of a productive cough, on the other hand, expectoration-promoting herbs are helpful, such as mullein , primrose or thyme .

In addition, home remedies for coughs include warm compresses or compresses for the chest and back – for example, a mustard compress for a dry cough and a ginger compress for a productive cough. Inhaling is another good tip, especially in the latter case: deep inhalation of warm vapors makes it easier to loosen mucus that is stuck in the airways.

Cough syrup is also a tried and tested home remedy for annoying coughs. You can prepare one yourself with onions or radishes, for example. You can find out how to do this and more about effective home remedies for dry and productive coughs in the article on home remedies for coughs .

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

Cough: when should you see a doctor?

If you have a persistent, long-lasting cough, you should see a doctor to be on the safe side – especially if you have no idea what the cause is (such as bronchitis, asthma).

You should consult a doctor immediately in the following cases of coughing:

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

If the cough is accompanied by other possible symptoms of Covid-19 (such as loss or disturbance of taste and smell or shortness of breath), you should call the responsible health department to discuss how to proceed. If you have any symptoms of Covid-19, do not go to the doctor yourself, otherwise you may infect other people on the way there or in the doctor’s office.

Cough: diagnosis

First, the doctor conducts a detailed discussion with the patient about the medical history (anamnesis). Examples of important information include:

  • How long has the cough been there?
  • Does the cough occur at the same time as other events, such as physical exertion or after contact with allergenic substances?
  • Are there any accompanying symptoms such as fever or shortness of breath?
  • Is it a cough with sputum? If so, how much secretion is coughed up and how is it made (color, smell, consistency)?
  • Are there special risk factors such as underlying diseases, smoking, swallowing disorders?
  • Are you taking any medication?

From this information, the doctor can often derive assumptions about the possible cause of coughing. Further investigations then bring clarity:

  • Physical examination: When listening to the chest ( auscultation ), the doctor can detect any secondary breathing noises – important information for the diagnosis. Pseudo-croup, for example, can usually be diagnosed on the basis of secondary breathing noises, a barking cough and hoarseness.
  • Throat swab: If diphtheria could be causing the cough, the doctor will take a throat swab. After creating a bacterial culture, it is examined under the microscope for diphtheria pathogens. The doctor can also take a throat swab (or nasal swab) to detect a possible infection with the novel corona virus.
  • Examination of the sputum (sputum examination): An examination of the sputum in a productive cough can identify, for example, tuberculosis or pleurisy as a trigger of the cough.
  • Blood tests: A blood sample from the patient is helpful if, for example, a cold or the real flu (influenza) could be causing the cough. In addition, an analysis of the blood gases (oxygen, carbon dioxide) can show whether the gas exchange in the lungs is disturbed, as is the case with asthma and COPD.
  • X- ray: An X-ray examination is indicated for suspected bronchitis, pneumonia, COPD, tuberculosis or cystic fibrosis as a possible cause of cough.
  • Lung function test: Here the doctor examines whether the cough is due to narrowing of the airways such as asthma, COPD or bronchiectasis. Various examination methods are available, including spirometry and body plethysmography .
  • Bronchoscopy : Here, the doctor inserts a tiny camera attached to a thin tube, or some type of metal tube, down the windpipe to look inside the lungs. This examination is indicated if a swallowed foreign body or lung cancer could trigger the cough. The examiner can also use the bronchoscope to obtain specific secretion or tissue samples for further examination.
  • Prick test: This skin test is used to clarify allergies. By applying various test substances, it can be checked whether, for example, house dust mites, mold or certain foods cause allergic coughing and other allergy symptoms.
  • Nasal endoscopy: It is indicated when a chronic cold/chronic sinusitis is responsible for the cough.
  • Sweat test: It is useful if cystic fibrosis is suspected as a trigger for coughing. 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 coughing could be due to the backflow of stomach contents into the esophagus (reflux disease), this can be determined by means of a gastroscopy.
  • Computed tomography (CT): CT can be used to clarify whether the cough is caused, for example, by chronic sinusitis, lung cancer or pulmonary embolism.
  • Heart ultrasound ( echocardiography ): The heart ultrasound shows whether a heart failure is behind the cough .

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