Apparently, it takes a village to explain a cough. Hillary Clinton’s coughing spells along the campaign trail have drawn attention from supporters and opponents alike. Though Democrats insist Clinton merely has seasonal allergies, Republicans argue her cough suggests a more problematic health issue. Meanwhile, everyone is left to sigh and wonder: When is a cough “just” a cough — and when do you need a doctor?
Your non-partisan guide to coughs
In the simplest situations, a cough is a reflex and your body’s basic safety check.
“It’s the body’s way of responding to irritants to protect the throat and airways,” said Dr. Sharon Bergquist, an internal medicine physician at Emory Healthcare.
In a nutshell, your body has detected something alien in its passageways and needs to clear it. So you cough and your body feels relieved: All systems go. Such a solitary cough causes no concern.
But sometimes, you develop a more extensive cough, one that begins suddenly and lasts up to two to three weeks. This would generally qualify as an “acute cough” in doctors’ lingo. Mostly, people suffer an acute cough as a symptom of a cold, the flu, or even bronchitis.
“It used to be that bronchitis was considered a bacterial infection… but it’s really just a cough,” said Dr. Dan Merenstein, an associate professor at Georgetown University Medical Center. He added that since bronchitis usually is just the “cough of a cold,” like a cold, it doesn’t respond to antibiotics.
Going deeper into cough territory, some patients develop a “chronic cough,” which lasts longer than two to three weeks. “There are lots of different things that can cause a chronic cough,” said Dr. Richard J. Castriotta, a pulmonologist with McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. Possible causes include conditions like chronic sinusitis, post-nasal drip and other conditions or sicknesses inflaming or otherwise affecting the airways. Asthma can also produce chronic hacking, though most likely it would also include wheezing, explained Castriotta.
Chronic coughing also can be “related to the environment, such as poor air quality or passive smoke,” said Bergquist.
Another cause? Though it may seem unlikely, acid reflux can generate a lasting cough in some sufferers, noted Merenstein. Stress is another possible cause, said Castriotta, along with some medications. Beta blockers and blood pressure drugs both include coughing as a possible side effect.
“Lots of sputum coming up is usually a sign of a less dangerous cough,” added Castriotta. While this additional feature of a cough scares many a patient, sputum is simply mucus and this generally signals an irritation in the airways.
More serious causes of chronic cough include lung diseases, such as chronic obstructive pulmonary disease, or COPD, and chronic lung infections, such as tuberculosis. Older folks may also develop atypical bacterial infections which may also lead to chronic coughing, said Castriotta.
Finally, the most dangerous cause of a perpetual cough is an anatomic obstruction, such as a tumor, explained Castriotta. This, he added, is rare.
When do you dial your doctor?
“You should not see a doctor the first few days of a cough,” said Merenstein, adding that his advice applies to people who are generally healthy. “If you have a cough for a few days, even a week to 10 days, and you’re going to work, or you’re a kid and going to school, and doing your other activities, you don’t need someone.”
A deep chesty cough or one that includes a fever of more than 100 degrees requires a visit to a doctor. Coughing up blood is also a reason to consult a physician.
“With any cough, you have to think of both the context in which the cough occurs and duration,” said Bergquist, explaining you have to look at whether other symptoms are involved. A person experiencing a cold or acid reflux might be expected to cough so then it is “less worrisome,” she explained.
While a chronic cough could be dangerous, it also could be easily treated, said Castriotta. You need to see a doctor, he noted, if the cough is unexplained. Bergquist advises seeing a doctor for any cough that “lasts more than three weeks” in order “to make sure there are no complications.”
That said, many coughs do not require medicine. “The main thing is don’t overuse antibiotics,” said Merenstein, who noted a cough is among the top reasons people receive prescriptions for these drugs. Truth is, antibiotics are not needed and not good for you in many coughing cases, said Merenstein.
“This is one of those cases where home remedies are just about as good as over-the-counter medications,” said Bergquist, who recommends “staying well hydrated and keeping the air moist with a humidifier.” Since an irritated throat makes matters worse, Castriotta suggests people “try to stop talking.”
Merenstein recommends Tylenol in cases where coughing is the result of an irritated throat, while cough drops and cough syrups — or even honey — work well in other situations. They can relieve pain or coat the throat, respectively.
According to Bergquist, studies comparing honey to leading over-the-counter cough syrups find they both work about the same.
“Honey is really quite effective,” she said.
