While it’s impossible to pinpoint a cough just by how it sounds, there are some key differences to give you clues as to what’s going on.

By Hallie Levine and Maggie O'Neill
Updated January 27, 2020
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Allergies? A cold? Acid reflux? No matter what the cause, there's a simple reason behind all your hacking: “A cough is a protective mechanism to clear your airway,” explains Jonathan Parsons, MD, a pulmonologist at the Ohio State University Wexner Medical Center.

There are a number of ways doctors can get to the bottom of what's causing that cough. "First question we'd want to know is: Is [the] cough part of the daytime symptoms as well?" explains Joseph Khabbaza, MD, a pulmonologist at Cleveland Clinic.

While it’s impossible to always pinpoint a cough by how it sounds, there are some key differences to give you clues as to what’s going on. Here's how to tell what that cough really means.

Postnasal drip

Sounds like: Either a dry or wet cough. It’s caused by mucus dripping down your throat (due to either allergies or a cold), which tickles nerve endings, triggering coughing, Dr. Parsons says.

Sometimes this cough is worse at night. Additionally, a tickly feeling at the back of your throat can be a symptom of postnasal drip. If it’s due to allergies you may also have itchy eyes and sneezing.

If you suspect allergies, try an over-the-counter antihistamine. But if that doesn’t help after a couple weeks, see your doctor, who can refer you to an allergist for skin testing. If it’s due to a residual cold, you can try natural remedies like saline washes and steam to help relieve congestion, but if the cough lingers for more than a week see your doctor to rule out a sinus infection, which might require antibiotics.

Asthma

Sounds like: A dry cough that ends with a rattle or wheeze. People with asthma have inflamed airways, which can cause difficulty breathing as well as wheezing and coughing.

The cough gets worse at night or while exercising. Additionally, chest tightness, shortness of breath, and fatigue might accompany asthma.

To check for asthma, your doctor will most likely order spirometry, a lung function test, Dr. Parsons says. Two types of medications can treat it: quick-relief drugs (bronchodilators like albuterol, which make it easier to breathe) and drugs you take daily to keep asthma under control, such as leukotriene modifiers (like Singulair).

GERD

Sounds like: A dry, spasmodic cough. Short for gastroesophageal reflux disease, GERD is when acid from your stomach backs up into your esophagus. It’s actually the second most common cause of chronic cough, causing about 40% of cases, according to a 2006 review published in Nature.

If you're only coughing at night, acid reflux could quite possibly be to blame for your cough, Dr. Khabbaza says, since stomach acid can creep up when you lay down to go to sleep at night.

A GERD-induced cough gets worse when you’re lying down or eating. “The classic sign is coughing that starts as soon as you lie down in bed at night,” says Dr. Parsons. About 75% of GERD patients with chronic cough have no other symptoms, but if you do they can include heartburn and hoarseness.

Diagnostic tests may include an x-ray of your upper GI tract and/or an endoscopy (where your doctor inserts a thin, flexible tube down your throat to examine it). GERD is treated with OTC or prescription meds to reduce acid production, like Pepcid AC, Zantac, or Prilosec. Additionally, Dr. Khabbaza says, you might want to consider eating your least meal three or four hours before going to bed to avoid coughing throughout the night.

COPD

Sounds like: A chronic, hacking cough that produces a lot of mucus, particularly in the morning, Dr. Parsons says. COPD, or chronic obstructive pulmonary disease, includes both chronic bronchitis and emphysema; the main cause is smoking.

COPD coughing gets better as the day progresses. Patients with COPD also experience shortness of breath, especially with physical activity; wheezing; fatigue; and chest tightness.

Lung function tests such as spirometry and a chest x-ray are used to diagnose COPD. The disease is treated with meds like bronchodilators and inhaled steroids; it's also imperative to stop smoking. In extreme cases, you may need oxygen therapy.

Medication-related cough

Sounds like: A dry cough. A group of drugs known as ACE inhibitors are commonly prescribed to treat high blood pressure; they can cause cough in about 20% of patients.

A medication-related cough begins a few weeks after starting these meds, Dr. Parsons says.

If your cough is mild, you may be okay switching to a different ACE inhibitor, Dr. Parsons says, but if it’s severe, you’ll want to switch to another type of blood pressure medicine entirely, such as an angiotensin receptor blocker or ARB, like Cozaar.

Pneumonia

Sounds like: Initially a dry cough which after a few days turns to a wet cough with yellow, green, and/or red or rust-tinged mucus.

Additional symptoms include fever, chills, trouble breathing, and pain when breathing in deeply or coughing

Your doctor can usually tell if you have pneumonia by listening to your chest with a stethoscope, although she may order an x-ray and blood tests to determine if it’s viral or bacterial, Dr. Parsons says. Treatment for the latter is antibiotics; if it’s viral, the only remedy is rest, OTC cough meds, and chicken soup.

Whooping cough (pertussis)

Sounds like: A severe hacking cough that ends with a whooping sound as you breathe in. While this disease used to be extremely rare thanks to vaccines introduced back in the 1940s, it’s now seeing an upswing—in 2012, there were more than 48,000 cases reported, the most since 1955, according to the CDC.

The first symptoms are similar to the common cold: stuffy, runny nose, watery eyes, fever, and cough. But after about a week the classic coughing signs emerge, with hacking so intense you may throw up or turn red or blue, Dr. Parsons says.

Pertussis is diagnosed with blood tests and a chest X-ray. It’s treated with antibiotics.

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