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Coughs, Age 12 and Older

Topic Overview

Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of your cough can be determined only when other symptoms are evaluated.

For information about coughs in children, see the topic Coughs, Age 11 and Younger.

Productive coughs

A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses or may have come up from the lungs. A productive cough generally should not be suppressed—it clears mucus from the lungs. There are many causes of a productive cough, such as:

Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat.
Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis, sinusitis, or tuberculosis.
Chronic lung disease. A productive cough could be a sign that a disease such as chronic obstructive pulmonary disease (COPD) is getting worse or that you have an infection.
Stomach acid backing up into the esophagus. This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken you from sleep.
Nasal discharge (postnasal drip) draining down the back of the throat. This can cause a productive cough or the feeling that you constantly need to clear your throat. Experts disagree about whether a postnasal drip or the viral illness that caused it is responsible for the cough.
Smoking or other tobacco use. Productive coughs in a person who smokes or uses other forms of tobacco is often a sign of lung damage or irritation of the throat or esophagus.

Nonproductive coughs

A nonproductive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a nonproductive cough, such as:

Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night.
Bronchospasm. A nonproductive cough, particularly at night, may mean spasms in the bronchial tubes (bronchospasm) caused by irritation.
Allergies. Frequent sneezing is also a common symptom of allergic rhinitis.
Medicines called ACE inhibitors that are used to control high blood pressure. Examples of ACE inhibitors include captopril (Capoten), enalapril maleate (Vasotec), and lisinopril (Prinivil, Zestoretic, or Zestril).
Exposure to dust, fumes, and chemicals in the work environment.
Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Teens and Adults.
Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed or Inhaled Objects.

Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not alter the course of viral infections. Unnecessary use of an antibiotic exposes you to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

A careful evaluation of your health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of your cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If you have other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Topics section.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Do you have a cough?

Yes

Cough

How old are you?

Less than 12 years

12 years or older

Are you male or female?

Male

Female

Have you had surgery in the past 2 weeks?

Surgery can cause problems that make you cough.

Yes

Recent surgery

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Would you describe the problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Do you have a chronic health problem that affects your breathing, such as asthma, allergies, or COPD?

A breathing problem may be more of a concern if you normally do not have breathing problems.

Yes

Has chronic breathing problems

Are the breathing problems you're having right now different than what you are used to?

Yes

Breathing problem is different than usual symptoms

Is your ability to breathe:

Quickly getting worse (within minutes or hours)?

Breathing problems are quickly worsening

Slowly getting worse (over days)?

Breathing problems are slowly worsening

Staying about the same (not better or worse)?

Breathing problems are unchanged

Getting better?

Breathing problems are getting better

Do you have symptoms of a serious illness?

Yes

Symptoms of serious illness

Do you have pain in your ribs or the muscles of your chest?

This type of pain may feel worse when you press on or move the area or when you take a deep breath.

Yes

Pain in chest wall

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Do you have pain deep in one leg?

Sudden chest pain that occurs with deep pain or swelling in one leg can be a symptom of a blood clot that has moved from the leg to the lung.

Yes

Leg pain

Has the chest pain lasted for more than 4 days?

Yes

Pain in chest wall for more than 4 days

Do you think you may have a fever?

Yes

Possible fever

Did you take your temperature?

Yes

Temperature taken

How high is the fever? The answer may depend on how you took the temperature.

High: 104°F (40°C) or higher, oral

High fever: 104°F (40°C) or higher, oral

Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral

Mild: 100.3°F (37.9°C) or lower, oral

Mild fever: 100.3°F (37.9°C) or lower, oral

How high do you think the fever is?

High

Feels fever is high

Moderate

Feels fever is moderate

Mild or low

Feels fever is mild

How long have you had a fever?

Less than 2 days (48 hours)

Fever for less than 2 days

At least 2 days but less than 1 week

Fever for at least 2 days but less than 1 week

1 week or more

Fever for 1 week or more

Do you have a health problem or take medicine that weakens your immune system?

Yes

Disease or medicine that causes immune system problems

Do you have shaking chills or very heavy sweating?

Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off you or soaking through your clothes.

Yes

Shaking chills or heavy sweating

Are you coughing up mucus, phlegm (say "flem"), or blood from your lungs?

This is called a productive cough. Mucus or blood draining down your throat from your nose because of a cold, a nosebleed, or allergies is not the same thing.

Yes

Coughing up sputum or blood

Are you coughing up blood?

This means blood that is coming up from your chest or throat. Blood that is draining down from your nose into your throat (because of a nosebleed, for example) is not the same thing.

Yes

Coughing up blood

How much blood is there?

A lot of bright red blood [2 tsp (10 mL) or more]

Large amount [2 tsp (10 mL)] of bright red blood in sputum

Streaks of bright red blood

Streaks of bright red blood in sputum

Specks or spots of blood

Specks or spots of blood in sputum

Has this been going on for more than 2 days?

Yes

Specks or spots of blood in sputum for more than 2 days

Do you take a medicine that affects the blood's ability to clot, such as aspirin, warfarin (such as Coumadin), enoxaparin (Lovenox), or clopidogrel (Plavix)?

These medicines can cause bleeding and can make it harder to control bleeding.

Yes

Takes medicine that affects blood's ability to clot

Is this cough normal for you because you have a lung problem like chronic bronchitis or emphysema?

Some people with chronic lung problems have a productive cough all the time.

Yes

Typical productive cough

Have you been coughing up phlegm for more than 3 days?

Yes

Coughing up sputum for more than 3 days

Did the cough start after a recent choking episode?

The cough could mean that something is still stuck in the throat.

Yes

Recent choking episode

Have you had a cough for more than 2 weeks?

Yes

Cough for more than 2 weeks

Is your cough:

Getting worse?

Cough is getting worse

Staying about the same (not better or worse)?

Cough is unchanged

Getting better?

Cough is improving

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Postoperative Problems

Temperature varies a little depending on how you measure it. For adults and children age 12 and older, these are the ranges for high, moderate, and mild, according to how you took the temperature.

Oral (by mouth) temperature

High: 104 °F (40 °C) and higher
Moderate: 100.4 °F (38 °C) to 103.9 °F (39.9 °C)
Mild: 100.3 °F (37.9 °C) and lower

Ear or rectal temperature

High: 105 °F (40.6 °C) and higher
Moderate: 101.4 °F (38.6 °C) to 104.9 °F (40.5 °C)
Mild: 101.3 °F (38.5 °C) and lower

Armpit (axillary) temperature

High: 103°F (39.5°C) and higher
Moderate: 99.4 °F (37.4 °C) to 102.9 °F (39.4 °C)
Mild: 99.3°F (37.3°C) and lower

Severe trouble breathing means:

You cannot talk at all.
You have to work very hard to breathe.
You feel like you can't get enough air.
You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It's hard to talk in full sentences.
It's hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.
It's becoming hard to breathe with activity.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Symptoms of serious illness may include:

A severe headache.
A stiff neck.
Mental changes, such as feeling confused or much less alert.
Extreme fatigue (to the point where it's hard for you to function).
Shaking chills.

Coughs, Age 11 and Younger

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

If you're not sure if a fever is high, moderate, or mild, think about these issues:

With a high fever:

You feel very hot.
It is likely one of the highest fevers you've ever had. High fevers are not that common, especially in adults.

With a moderate fever:

You feel warm or hot.
You know you have a fever.

With a mild fever:

You may feel a little warm.
You think you might have a fever, but you're not sure.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Home Treatment

Coughing is your body's way of removing foreign substances and mucus from your lungs and upper airway passages. Productive coughs are often useful, and you should not try to eliminate them. Sometimes, though, coughs are severe enough to impair breathing or prevent rest. Home treatment can help you feel more comfortable when you have a cough.

Home treatment for adults

Prevent dehydration. Fluids may help thin secretions and soothe an irritated throat. Dry, hacking coughs respond to honey in hot water, tea, or lemon juice.
Elevate your head with extra pillows at night to ease a dry cough.
Try a cough drop to soothe an irritated throat. Expensive medicine-flavored cough drops are no better than inexpensive candy-flavored drops or hard candy. Most cough drops have no effect on the cough-producing process.
Use a humidifier to add moisture to the air. Use only water in the humidifier.
Quit smoking and do not use other forms of tobacco, especially while you have a cough. For more information on quitting smoking, see the topic Quitting Smoking.
Avoid exposure to inhaled irritants, such as smoke, dust, or other pollutants, or wear a face mask that is appropriate for the exposure. Many kinds of face masks are available. Check with your doctor or pharmacist to determine which type of face mask will provide you with the most benefit.
If you suspect problems with stomach acid may be contributing to your cough, see the topic Heartburn.

Cough preparations may help your cough. Avoid cold remedies that combine medicines to treat many symptoms. It is generally better to treat each symptom separately. There are two kinds of cough medicines: expectorants and suppressants.

Expectorants help thin the mucus and make it easier to cough mucus up when you have a productive cough.
- Use an expectorant if you have a cough that produces thick mucus and you are having trouble coughing the mucus up. Don't depend entirely on an expectorant to thin the mucus. Drink plenty of water also.
- Look for expectorants containing guaifenesin, such as Robitussin, Mucinex, and Vicks 44E.
Suppressants control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake.
- Use cough suppressants wisely. Don't suppress a productive cough too much, unless it is keeping you from getting enough rest. Coughing is useful because it brings up mucus from the lungs and helps prevent bacterial infections. People with asthma and other lung diseases need to cough.
- If you have a dry, hacking cough, ask your doctor about an effective cough suppressant medicine.
- Look for suppressant medicines containing dextromethorphan, such as Robitussin-DM or Vicks Dry Hacking Cough. Studies show that over-the-counter cough medicines do not work very well. And some of these medicines can cause problems if you use too much of them. It is important to use medicines correctly and to keep them out of the reach of children to prevent accidental use.

Cough preparation precautions

Cough preparations can cause problems for people with other health problems, such as asthma, heart failure, high blood pressure, glaucoma, or an enlarged prostate. Cough preparations may also interact with other medicines, such as sedatives and certain antidepressants. Read the package carefully or ask your pharmacist or doctor to help you choose one.
Use cough preparations with caution if you are older than 60 or if you have chronic respiratory problems.
Read the label so you know what you are taking. Some cough preparations contain a large percentage of alcohol. Others contain codeine. There are many choices. Ask your pharmacist to advise you.
Do not take someone else's prescription cough medicine.

For more information on home treatment of respiratory problems, see the Home Treatment section of the topic Respiratory Problems, Age 12 and Older.

**Medicine you can buy without a prescription**
Try a nonprescription medicine to help treat your fever or pain:
Acetaminophen, such as Tylenol Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, such as Advil or Motrin Naproxen, such as Aleve or Naprosyn Aspirin (also a nonsteroidal anti-inflammatory drug), such as Bayer or Bufferin

**Safety tips**
Be sure to follow these safety tips when you use a nonprescription medicine:
Carefully read and follow all directions on the medicine bottle and box. Do not take more than the recommended dose. Do not take a medicine if you have had an allergic reaction to it in the past. If you have been told to avoid a medicine, call your doctor before you take it. If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to. Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Other symptoms develop, such as moderate to severe chest wall pain with coughing, trouble breathing, a productive cough, or fever.
You start coughing up blood.
A cough lasts longer than 2 weeks without other respiratory symptoms.
Symptoms become more severe or more frequent.

Prevention

There is no sure way to prevent a cough. To help reduce your risk:

Wash your hands frequently during the cold and flu season. This helps prevent the spread of a virus that may cause a cold or influenza.
Avoid people who have a cold or influenza if possible.
Don't smoke or use other forms of tobacco. A dry, hacking "smoker's cough" means your lungs are constantly irritated. For more information, see the topic Quitting Smoking.
Avoid exposure to secondhand smoke, both at home and in the workplace.
Increase your fluid intake. This helps keep the mucus thin and helps you cough it up. It also helps prevent dehydration.
Get a flu shot (influenza vaccine) each year. For more information, see the topic Influenza (Seasonal Flu).
Get a pneumococcal shot if you are age 65 or older; if you have chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD); if you smoke; or if you have a health risk that increases the seriousness of your symptoms.
Make sure your immunizations are current, such as pertussis to reduce your risk of getting whooping cough. For more information, see the topic Immunizations.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

How long have you had the cough?
How often do you cough?
Does the cough have a pattern, such as worsening at night or becoming more frequent in the morning?
What situations increase your coughing?
Are you exposed to any irritants, such as smoke, dust, or chemicals, in your home or workplace?
Is the cough productive (brings up sputum) or nonproductive (dry and hacking)? Be prepared to describe the color (bloody, rusty, white, yellow, or green), amount, and consistency of any sputum.
Do you have other symptoms that may be related to your cough, such as nasal drainage, fever, shortness of breath, wheezing, or other suspected cold symptoms?
What home treatment have you tried? Did it help?
What prescription and nonprescription medicines or other treatments have you tried? Did they help?
What prescription and nonprescription medicines do you take regularly?
Have you ever been diagnosed with allergies or asthma? Does anyone else in your family have allergies or asthma?
Have you traveled recently?
Do you have any health risks?

Related Information

Credits

By	Healthwise Staff
	William H. Blahd, Jr., MD, FACEP - Emergency Medicine
	David Messenger, MD
Last Revised	May 9, 2013

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Next Section:
Check Your Symptoms

Last Revised: May 9, 2013

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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