Everybody coughs—it’s the number one illness-related reason people go to the doctor, according to the Centers for Disease Control and Prevention. Most cases of cough are temporary, says Peter Dicpinigaitis, MD, director of the Montefiore Cough Center and professor of clinical medicine at Albert Einstein College of Medicine in New York City. But even a short-term cough can be a sign of a bigger health issue that needs to be addressed by a doctor. Here’s how to narrow down the possible culprits—from asthma to pneumonia to whooping cough—so you can get better, fast.
A cold virus
A cough you’ve had for three weeks or less is most likely due to the common cold. Unfortunately, this cough—which is mainly a dry cough, with some clear mucus—can persist for a month or more after the rest of your symptoms are gone. “The virus irritates nerve endings in your air passages, and they can stay sensitive for quite some time,” says Dr. Dicpinigaitis.
How to treat a cold virus cough: There’s no cure for viral infections, so you’ll have to wait this one out. If your barking is serious and over-the-counter cough suppressants don’t provide relief, your doc may prescribe medicine to calm your cough reflex, says Gerard W. Frank, MD, clinical professor of medicine in pulmonary disease at UCLA. Over-the-counter decongestants or expectorants can also help thin out mucus so you can cough up more of it.
If you’ve got a cough (wet or dry) that has lasted eight weeks or longer, you could be suffering from chronic postnasal drip—mucus that accumulates in the sinuses and drips down the back of the throat, creating a tickling sensation that triggers a cough. There’s no test for postnasal drip, says Dr. Frank, but you may also have a runny nose or congestion (from allergies or lingering cold symptoms, for example). Other signs include frequent throat clearing and a sore throat. Because it’s so common, doctors will often try treating it even if they’re not sure of a diagnosis, says Dr. Frank.
How to treat a postnasal drip cough: A nasal saline rinse may help clear up the problem, or your MD may recommend steroids or antihistamines to reduce inflammation. Pay attention to the color of your mucus: “Coughing up yellow or green mucus means your immune system has really kicked in, which could suggest a bacterial infection, like sinusitis,” says Dr. Frank. In that case, you’ll need antibiotics.
Asthma usually shows up as wheezing and shortness of breath. But in people with cough-variant asthma, a dry, persistent cough may be the only sign. It’s often worse at night, during or shortly after exercise, when you’re breathing cold air or when you’re around an allergen, like pet dander or pollen.
How to treat an asthma cough: Your doctor may give you breathing tests to diagnose asthma or recommend using an inhaler twice a day for a few weeks to see if your cough subsides. Antihistamines or allergy shots may also help.
Gastroesophageal reflux disease (GERD) is linked to an estimated 25% of chronic cough cases. When acid flows back up into the esophagus, it can irritate nerve endings, triggering a persistent cough. But it can be hard to diagnose. “Not everyone with GERD gets heartburn,” says Dr. Dicpinigaitus. “If you’re coughing after a meal, when you lie down at night, or upon arising in the morning, or if you have an intermittently hoarse voice along with the cough, these are hints it might be reflux.”
How to treat a chronic cough due to GERD: Most cases of GERD are relatively easy to remedy with antacid medications, but cough-prevalent GERD can be more stubborn, and you’ll need to get checked out by your MD, says Dr. Dicpinigaitis. You might require larger doses of Rx medicine, and it may take six to eight weeks for you to feel better. Overweight? Slimming down sometimes helps with GERD. Try elevating the head of your bed when you sleep, too.
Sometimes a cough may signal a more severe illness. Pneumonia can develop when a respiratory infection spreads to the lungs, causing the lungs’ air sacs to fill with pus. This makes it hard to breathe and produces a wet-sounding, sometimes painful cough. Your condition can become life-threatening in a matter of days. If you’re coughing up lots of green phlegm or blood, are short of breath and/or have chest discomfort, go to your doctor—or an ER if you can’t be seen right away. Fever and chills are other warning signs.
How to treat pneumonia: A chest X-ray is the only way to know for sure whether you have pneumonia, but some doctors will diagnose it by listening to your lungs with a stethoscope, says Dr. Frank. Most serious cases in adults are bacterial and treated with antibiotics.
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This highly contagious disease is making a comeback, with more than 18,000 cases in the U.S. reported in 2015. The name comes from the “whoop” sounds some people make as they gasp for breath after a long, intense fit of coughing. You can get whooping cough, aka pertussis, even if you’ve been vaccinated (because the shot’s protection weakens over time).
How to treat whooping cough: If you start them within three weeks of infection, antibiotics may lessen symptoms. They can also keep you from spreading the bacteria to other people—which is crucial because an infection can lead to serious illness, even death, in babies.
For coughs that don’t respond to the treatments above, your doctor may order a chest X-ray or a CT scan of your lungs or sinuses. This can help rule out serious conditions like chronic obstructive pulmonary disease or lung cancer.
If your hacking appears only at certain times or places, consider allergies or sensitivity to irritants like mold, pollution, or smoke. Think about your meds, too: Up to 20% of people who take ACE inhibitors (for conditions such as high blood pressure) develop a dry cough.
Finally, some chronic cough can be explained by cough hypersensitivity syndrome. This means you may develop a cough as a result of triggers that don’t cause coughing in most people, says Dr. Dicpinigaitis. Women tend to have a more sensitive cough reflex than men. But in most cases, the culprit (and the cure) is there; you just need some trial and error to find it.
Homemade remedies for coughing
Need short-term relief while you’re riding out a cold or the flu? A few treatments that are worth trying:
Honey: “Thick, sweet liquids, even without medication, can soothe and diminish cough,” says Dr. Dicipinigaitis.
Cough drops: “Menthol, found in many over-the-counter lozenges, creates a cooling sensation and has been shown to help suppress coughing. Other cough drops may coat your throat and alleviate soreness, but there’s little evidence to suggest they prevent hacking any better than hard candy.
Steamy showers: Taking a hot shower or inhaling steam from a bowl of hot water (be careful not to burn your face!) may help loosen mucus and make it easier to cough up, says Dr. Frank.
Coffee: Caffeine is a bronchodilator, meaning it can help open airways, and has been studied (with inconclusive results) as a potential asthma remedy—but it should never take the place of an inhaler for someone who needs one, warns Dr. Frank. It may help ease a cough, though: In one study, coughers got more relief from drinking a imxture of instant coffee and honey than mixtures containing a common expectorant or a steroid.