9 types of cough and how to treat them

Cough is the most common complaint of all at my busy Urgent Care — during all seasons of the year, and even more during the winter months.

So, I thought it would be helpful to look at the several different types and causes of coughs and their treatments since we’re not always sure when we should get checked out.

Just remember, it’s always best to err on the side of precaution, especially now that COVID is part of the picture. Some people who get COVID can develop pneumonia and need specific care. However, if you’ve tested negative for COVID and still have an annoying cough, you may find this list helpful…

1. URI with cough and congestion

Upper respiratory infection (URI) with cough and congestion definitely tops the list. It typically begins with a scratchy sore throat, worse at night, followed by a dry cough with a stuffy/runny nose. Appetite is unchanged, there is no fever or chills, and energy levels remain near normal. Lung examination reveals normal breath sounds.

Why do people come to see a doctor for this condition? They are either in fear of getting pneumonia (rare), mistakenly believe antibiotics will cure their viral condition, or simply want a strong prescription cough medicine so they can sleep.

My favorite prescription cough suppressants for this condition are Tessalon Perles (benzonatate) for the daytime (non-sedating) and Promethazine DM at bedtime (somewhat sedating). You can add Nyquil (over the counter) which contains the sedating ingredient diphenhydramine (a.k.a. Benadryl).

2. Influenza A

The flu causes body aches, fever, chills, lack of appetite (“malaise”), severe fatigue and a painful bronchitis cough. Green, yellow, brown, or bloody sputum can present in the first few days (I had this two years ago). Lung examination reveals normal breath sounds.

My favorite prescription medicines for this condition are a) Tramadol for pain, b) suppressants used for URI cough (see above) and c) Tamiflu if started within the first 48 hours of symptoms onset.  

Related: The little berry that offers big protection against the spring flu

3. Bronchitis

Viral bronchitis is simply a chest cold in nearly all cases. It causes coughing with colored sputum and fatigue. However, appetite is normal and there is no lateral chest pain or shortness of breath. Lung examination reveals normal breath sounds.

My favorite prescription cough suppressants for this condition are Tessalon Perles (benzonatate) for the daytime and Promethazine DM at bedtime.

4. Allergic rhinitis

Appetite is unchanged, there are no fever or chills, and energy level remains near normal. Lung examination reveals normal breath sounds. Cough is dry or wet, with the hallmark symptom of stuffy/runny nose, lasting much longer than a virus (URI) lasts… often for months and usually worse during the spring season.

This is caused by something in the environment or even food. Consider doing a simple targeted “food elimination” experiment. Begin by eliminating gluten (bread, pasta, cereals with wheat flour, etc.) for 4 weeks. Then reintroduce gluten food products back into your diet for at least 3 days and watch for a recurrence of symptoms. You may have an answer quickly with the recurrence of a symptom involving your skin, joints, pain level, sleep, mood, or energy level.  Then, do the same with foods containing dairy, peanuts, soy, eggs, corn, and even with refined sugar foods (the top 7 allergy-causing foods).

For rapid treatment of symptoms, there are the over-the-counter antihistamines and Flonase nasal spray or move to the prescription prednisone as described for asthma below.

5. Asthma

This is easy to diagnose by watching the patient breathe. Appetite is unchanged, there is no fever or chills, energy levels remain near normal and their cough is dry. Lung examination reveals wheezing on inspiration, expiration, or both.

This too is caused by something in the environment or even foods. Consider doing a simple targeted “food elimination” experiment as described above.

The treatment is almost always a short course of high dose prednisone (corticosteroid) such as 60 mg daily for 3-4 days, and tapering, for 7 to 10 days. Also, albuterol, inhaled or nebulized, can open the small airways every 4-6 hours until prednisone is effective (takes 3 days).

6. Pneumonia

This is the easiest to diagnose and treat. There is a fever longer than 5 days, a lack of appetite, fatigue, and lateral chest pain with a wet cough. Lung examination reveals rough “rhonchi” sounds (or just decreased airway movement) in the affected lung.  The treatment is simple: antibiotics such as Amoxicillin, Doxycycline, or Azithromycin; and lots of fluids by mouth and rest.

7. COPD

This chronic dry or wet cough condition can turn to pneumonia when an acute exacerbation of symptoms occurs, typically due to a viral infection. The treatment is usually a short course or Prednisone to open the airways, and an antibiotic (e.g. Amoxicillin).

8. Whooping cough (pertussis)

This is not a common condition, but in rare cases can be very scary (death) in babies.  The persistent coughing followed by an inspiratory “whoop” is the classic presentation. The challenge with whooping cough is that it is contagious in the very early stages of the illness… sometimes even before symptoms become evident. Therefore, antibiotics should be started even before test results are known.

9. Congestive heart failure (CHF)

This subtle chronic cough is accompanied by shortness of breath, weight gain, leg swelling, and wet-sounding lungs on examination.  Prescription diuretic medications and close follow-up by a cardiologist are needed. Cough suppressants don’t do much for this.

There are many other lung conditions that produce a cough, such as pulmonary tuberculosis and other infections, pulmonary emboli, or even lung cancer. Remember, if a cough persists longer than a month, you should be seeing your doctor to learn why and what to do about it.