Severe Cough: Causes of Attacks and When It Is Dangerous

Cough is an innate protective reflex, part of the immune system (Wikipedia). It clears the airways of foreign substances (Wikipedia). A severe cough is not a disease but a symptom: it accounts for 30–40 % of visits to general practitioners (Wikipedia).

Why a severe cough occurs

The mechanism is the same: a forced exhalation through the mouth due to contraction of the respiratory muscles (Wikipedia). Irritation receptors are located in the nose, sinuses, pharynx, larynx, trachea, bronchi and pleura (Wikipedia). The cough center is controlled by the cerebral cortex (Wikipedia).

Most often cough is caused by a cold or flu (British health service). Other causes: smoking, acid reflux, allergy, bronchitis, COVID-19, postnasal drip (British health service). Cough rarely hides a serious disease such as lung cancer (British health service).

By duration, cough can be acute — up to two weeks, prolonged — 2–4 weeks, subacute — 4–8 weeks, chronic — longer than two months (Wikipedia). Usually cough resolves on its own within 3–4 weeks (British health service).

Paroxysmal and suffocating cough: possible causes

Acute cough begins suddenly and lasts no more than 2–3 weeks; it is typical of a cold, flu and acute bronchitis (MedlinePlus). Cough lasting longer than 2–3 weeks is considered chronic; its causes are chronic bronchitis, asthma, allergy, COPD, reflux, smoking, throat diseases, certain medications (MedlinePlus).

An attack is provoked by a foreign body in the airways, aspiration in reflux, irritation of the ear canal, diaphragm or pericardium (Wikipedia). By intensity, cough is divided into a slight cough and a hacking cough (Wikipedia). In young children, attacks are caused by croup — a throat disease (MedlinePlus).

In 10–38 % of cases the true cause of cough cannot be identified (Wikipedia).

Dry and wet cough with sputum: what is the difference

A dry, or nonproductive, cough produces no discharge. A wet, or productive, cough comes with sputum (Wikipedia). Sputum is assessed by character, consistency and volume: mucous, serous, purulent, bloody, viscous, clotted, scanty, "full mouth" (Wikipedia).

Bloody sputum — hemoptysis — is a reason for urgent evaluation (British health service). The doctor listens to the chest with a stethoscope and may take a sputum sample (British health service).

Timbre is also informative: cough can be barking, hoarse, muffled, soundless (Wikipedia).

Severe cough without fever

Among the causes of cough there are conditions usually not associated with infection: allergy, reflux, smoking (British health service, MedlinePlus). In spring and autumn cough is more often associated with allergy (Wikipedia).

Evening cough occurs with pneumonia and bronchitis (Wikipedia). The absence of fever by itself does not exclude respiratory disease.

Severe cough in a child

In young children, one of the causes of attacks is croup, in which the throat is affected (MedlinePlus). A child's cough is assessed by duration, productivity, timbre and time of onset (Wikipedia).

Age limits for cough remedies: they are not intended for children under 4 years, for some — the limit is 12 years (MedlinePlus, British health service). Any remedy is discussed with a doctor.

Warning signs and when to see a doctor

You should see a general practitioner if (British health service):

• the cough lasts longer than 3 weeks;
• weight decreases without reason;
• immunity is weakened — for example, due to chemotherapy or diabetes.

Urgent medical attention is needed if the cough is very severe or rapidly worsening — with attacks that do not stop, if the person feels very unwell, or if a painful swelling has appeared on the side of the neck — enlarged lymph nodes (British health service).

At the appointment the doctor listens to the chest and, if necessary, orders an X-ray, an allergy test, a lung function test, and rarely — a consultation with a specialist in a hospital (British health service). Antibiotics for cough are usually not prescribed (British health service).

Cough by itself is not a reason to call an ambulance; 103/112 — if it is hard to breathe, blood has appeared in the sputum, or the chest hurts (British health service).

Terms: productive cough — with sputum discharge; nonproductive — without it; acute — up to 2 weeks; chronic — longer than 2 months; hacking — one of the gradations of cough intensity, along with a slight cough (Wikipedia).

The material is for reference: it describes causes and signs but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer