These Subtle Differences Between Coughs Can Reveal A Lot About Your Illness
A cough can feel like a particularly annoying symptom to deal with, especially if it’s keeping you awake at night or lingering for weeks on end. But there’s probably a good reason you have that cough — and it can tell you a lot about what’s going on in your body.
“Essentially, what vomiting is to the stomach, a cough is to the lungs,” said Dr. Panagis Galiatsatos, a pulmonologist at Johns Hopkins Medicine. “It is your lung’s ... protection of getting something out of it that it doesn’t want.”
Coughs help protect your body by getting mucus, dust or germs out of your airways, according to the American Lung Association. And the mucus production, timing and other subtleties of your cough can reveal what’s causing it.
We talked to doctors about how to identify different types of coughs and how to treat them. Here’s how to determine what your cough is telling you.
Is your cough dry or productive?
You know those coughs that feel pretty dry and may tickle your airways or the back of your throat? These are generally known as non-productive coughs and don’t bring up any mucus.
You may have a dry cough for a number of reasons, from a viral infection like COVID or flu to asthma, allergies, irritants or gastroesophageal reflux disease (GERD), according to Dr. Jiyeon Seo, a pulmonary, critical care and sleep medicine specialist at Cedars-Sinai.
“If you have started on a new medication and you notice that all of a sudden you’re starting to have a new … non-productive cough, it may [also] very well be related,” noted Dr. Doreen Addrizzo-Harris, a pulmonologist at NYU Langone Health.
Some common drugs may lead to short-term coughs, while others may actually lead to scarring in the lungs. If you do notice you have a dry cough after you start a new medication, it’s important to notify your physician so they can monitor, Addrizzo-Harris said.
If your cough brings up mucus, this is a sign of what experts call a productive cough. The type of sputum (a mix of mucus and saliva) that you cough up can hint at what’s causing it.
“Is it clear? Is it … yellow or green? Is it bloody? … Usually the darker the color [and] the thicker the sputum, there’s a lot more inflammatory cells in [it], often white blood cells mixed with bacteria,” Addrizzo-Harris said.
If you notice the color of your sputum is starting to change color, this could be an early sign of a bacterial infection.
If this happens, reach out to your doctor because you may need to start antibiotics, she advised. They can send the sputum to a lab to determine what type of bacteria and other organisms are in it and how to treat it.
Bronchitis, bacterial bronchitis or bacterial pneumonia are the most common causes of a productive cough. But it could also be due to bronchiectasis (a disease where the airways of the lungs are dilated and aren’t able to clear out sputum as well), chronic obstructive pulmonary disease (COPD) or lung cancer (although less common).
How long have you had the cough?
“Timing is really… [a] key thing to differentiate coughs,” Galiatsatos said. One of the first things your doctor will probably ask is, “Tell me when this cough began.”
Depending on how long a cough has been going on, it can be categorized as acute, subacute or chronic, Seo explained.
An acute cough is one that comes on suddenly and lasts for less than three weeks. It’s “usually caused by an acute upper or lower respiratory tract infection, allergies or irritant,” she said. But it also could occur if you have chronic conditions like asthma or COPD and your symptoms are exacerbated.
If you have a dry cough with a viral illness and then about 10 days later develop a “heavy, productive” cough, this could be a sign of a bacterial infection, like bronchitis or pneumonia, Addrizzo-Harris said.
“The airways [can] become compromised [when you have] the flu [or other virus] and the regular bacteria that are living within the lung aren’t … cleared out as well,” she explained. “As they grow, the chance of getting a bacterial [infection is higher].”
A subacute cough can last for three to eight weeks. While it can be an exacerbation of an underlying disease, it could also be a post-infectious cough lingering even after a respiratory infection is over, Seo said.
“The infection [may have] caused some lung damage and the lungs are repairing themselves,” Galiatsatos added.
Lastly, a cough is generally considered chronic if it lasts for more than eight weeks and could indicate conditions like asthma, COPD, GERD or a more serious lung disease, like lung cancer, Seo said.
Do you have other symptoms with the cough?
In addition to timing, any accompanying symptoms can be helpful clues for why you have a cough.
For example, if you have a cough with a stuffy or runny nose, sore throat or body aches, you could very well have a viral infection like a cold, flu or COVID. Feeling a burning sensation in your chest and a sour taste in your mouth with coughing? This could mean you have GERD.
For people who have pneumonia, “they usually feel run down, drained, fatigued, fevers … it really takes a toll on an individual in addition to the cough,” Galiatsatos said.
Another symptom you may experience with coughing is wheezing, a whistling sound when you’re breathing.
“During inspiration, wheezing usually means something’s going on in the throat, maybe your tonsils are really swollen or [there’s] some inflammation around the vocal cords,” Galiatsatos explained. “Wheezing in the lungs usually occurs when you’re breathing out.”
You may hear this sound if your airways aren’t flowing properly, like if they’re partially blocked by phlegm or sputum. This could be a sign of bronchitis, asthma, allergies or other other health conditions, according to Cleveland Clinic.
What time of day are you coughing most frequently?
It’s helpful to watch for any patterns of when you’re coughing the most, especially if it develops more gradually, Galiatsatos said.
“Does your cough come within hours of … going to bed and recently eating a meal? This would clue me in that it could be acid reflux,” he said. “Does your cough wake you up in the middle of the night, like hours into sleep? That tells me maybe that’s a little bit more asthma.”
That said, the frequency (and severity) of a cough also really vary depending on the individual, Seo said.
“For example, the influenza virus may trigger a mild, short-lived cough in a healthy young person, but in an older individual with a weakened immune system … it can lead to a severe, potentially life-threatening cough and illness,” she explained.
So... what’s the best way to treat your cough?
“The best management is really trying to understand why you have the cough,” Galiatsatos said. “Treating a cough with a cough suppressant without trying to figure out the underlying cause of it is like just taking pain meds without giving a second thought of why you’re having chest pain, for instance.”
You should see a doctor promptly if your cough is accompanied by fevers, chills, night sweats, coughing up blood, shortness of breath, chest pain or unintentional weight loss, Seo said. Depending on what is causing the cough, your doctor can recommend the best treatment.
“The most important thing is … really figuring out what the cough is from [and] paying attention to it in enough detail,” Addrizzo-Harris said. That’s what really matters.
