Chesty, tickly or dry? We consult the experts on what different cough variations mean, and how best to treat them.
When we’re in good health, we typically cough an average of 18.6 times a day – a number which rises to 275 times when we’re ill. And with the change of season, the sounds of all kinds of coughs – from dry or rattling to hacking, wheezy and hoarse – are only going to ramp up.
Yet despite what our grannies may have believed, coughs – like the sore throats they’re so often accompanied by – are not caused by going out in the cold or sleeping with wet hair.
“This remains a common health myth that I overhear parents telling their children in the clinic,” says Dr Nisa Aslam, a GP and the chief medical officer at Inuvi. “It’s not true though. Research shows that exposure to cold alone does not trigger these illnesses.”
Instead, common triggers include viruses (such as colds, flu and Covid), bacteria (pneumonia, strep) which are spread by direct contact with saliva or mucus, allergens or pollutants, and even acid reflux.
What your cough is telling you about your health
During the pandemic, even the clearing of one’s throat would empty out a room and have us reaching for a Covid test. But a cough, also known as a tussis, isn’t necessarily a bad sign.
“Essentially a cough is a protective reflex and usually shows that your lungs and immune system are doing their job,” says Aslam. “When nerves in your airways detect a problem, your brain triggers a forceful expulsion of air – the cough – to clear away irritants like mucus, dust, smoke, or germs.”
Here are the different types, what they mean for your health and how to treat them:
Dry cough
A tickling or irritating sensation deep in the throat or a sudden urge to cough are marks of a dry cough. And often it becomes worse at night. “This type of cough won’t have any mucus and is usually caused by viral infections like the common cold or flu,” says Kiran Jones, a clinical pharmacist at Oxford Online Pharmacy. However, she adds: “A more consistent dry cough could also be caused by regular exposure to smoke, dust, pollution or asthma.”
Best treated with: suppressants to reduce the urge to cough, especially at night.
Tickly cough
“This is a more specific type of dry cough where people often feel a consistent itch or tickly sensation in the throat, triggering a repeated cough,” says Jones. “Most often these are caused by inflammation of the airway, allergies, or dry air.”
Best treated with: suppressants to soothe the irritation.
Chesty cough
“A chesty cough will produce mucus to clear it from congested lungs and airways. It’s our body’s natural response to getting rid of infections like colds or bronchitis,” says Jones. “They can be uncomfortable and even verge on painful, but they’re important for part of our recovery when we have a particularly rough cold or flu.”
Best treated with: an expectorant to help loosen the mucus, making it easier to cough up and expel.
Wet cough
You will be able to tell from the sound you’re making that the cough is not “dry” and likely is producing mucus or phlegm “usually from chest infections or post-nasal drip”, says Aslam.
Best treated with: expectorants.
Whooping cough
“This is a highly contagious bacterial infection that can cause intense coughing fits and a ‘whooping’ sound when breathing in,” says Jones. “Anyone experiencing this type of cough should seek medical advice as soon as these symptoms are recognised, as it’s a particularly dangerous infection for babies and young children, but it can affect adults too.”
Best treated with: don’t attempt to use over-the-counter medicines – you need to see your GP as antibiotics are the best course of treatment, and the sooner the better.
Chronic cough
“Any cough that lasts over eight weeks can be considered a chronic cough,” Aslam says. “Unlike other coughs that typically subside after a few days or weeks, these persistent coughs may indicate a more serious underlying health concern. This type of cough should also be discussed with a GP or medical professional if it lasts for over 8 weeks.”
Best treated with: another one that needs a GP’s opinion rather than over-the-counter medicines.
How cough medicines work
Not all coughs are equal, and recognising which type of cough you have can help you choose the best remedy for it.
Cough suppressant medicines
These are medications specifically formulated to suppress the cough reflex temporarily. They typically do this by targeting the region of the brain which controls coughing, reducing the nerves’ sensitivity to triggering the cough reflex. By helping to relieve the constant urge to cough, it can provide a break from the discomfort and irritation associated with persistent coughing. Being able to sleep, for instance, can see off a cough faster.
Cough expectorants
A cough “expectorant”, on the other hand, helps to loosen and thin the mucus or phlegm in the respiratory tract, making it easier to cough up and expel and so alleviate congestion and improve breathing. While they provide relief, these don’t treat the underlying cause of the cough.
Cough combination medicine
As the name suggests, cough “combination” medicines commonly include ingredients like dextromethorphan (a suppressant), as well as guaifenesin (an expectorant), along with decongestants for nasal congestion, antihistamines and pain relievers.
“Combination medicines containing both suppressant and expectorant are useful if your cough changes type. It’s certainly not always necessary to take them, but some people like to feel they’re doing something and it can offer relief from symptoms,” says Aslam.
Jones says a trip to your chemist is a good place to ask for advice if you’re unsure. “Pharmacists are trained to advise you on what over-the-counter medications are most suitable, and he or she can also help decide whether you need to consult a GP if it’s more serious.”
The best natural remedy to try, according to a GP
Honey and lemon drink (for sore throats)
Honey and lemon mixed with hot water and cooled to drinking temperature can’t be beaten if you’re looking for temporary relief remedies using ingredients already likely to be in your cupboard, says Aslam.
Honey soothes the throat and may have mild antibacterial properties, while lemon can boost hydration, provide some vitamin C and cut through mucus. There is evidence to suggest honey helps coughs, especially at night.
The best natural remedies to try, according to a pharmacist
Saltwater gargle (for sore throats)
Salt can draw out fluid from inflamed tissues in your throat to help reduce swelling and clear mucus, says Jones. He suggests mixing half a teaspoon of salt with 300ml of warm water and swishing it in your mouth for 20-30 seconds before spitting out.
“It can help ease overall discomfort,” adds the pharmacist, “but won’t treat it as directly as other treatments will.”
Steam inhalation (for coughs)
According to Jones, steam inhalation helps soothe irritated airways and loosen mucus, making it easier to cough up and spit out. The warm and moist vapour can also relax the throat and improve breathing, but Jones warns it’s only a short-term measure. “Steam is effective, but should be used alongside medications and other treatments to support full recovery.”
Peppermint tea (for coughs)
Peppermint contains menthol, which is a natural decongestant that can help relieve mild cough symptoms, “but will need to be used with additional treatments for other coughs”, says Jones.
Are coughs a sign of a weakening immune system?
Most coughs are harmless, says Aslam, but persistent, severe or unusual coughing can signal something more serious such as asthma, chronic obstructive pulmonary disease (COPD) or heart issues, caused by a build-up of fluid in the lungs.
“In children, habitual coughs may follow infection, or may be psychogenic, what’s known as a ‘habit cough’, which I see a lot in the clinic,” Aslam says. “More rarely, they can indicate underlying lung disease like asthma or cystic fibrosis.”
When is a cough a sign of something more serious?
Most coughs are nothing to worry about, and viral, so you don’t need antibiotics to get over them, though some medicines can help ease symptoms while you’re getting better.
But a persistent cough – lasting for more than three weeks – or one that changes and gets worse can be a sign of lung cancer, as cancerous cells can irritate and block airways. See a GP if yours is lingering.
Tonsillitis is a common cause of sore throats, but it doesn’t cause all of them. And tonsillitis is usually caused by viruses, which will improve on their own within a few days.
A doctor may prescribe antibiotics if tonsillitis is confirmed (from a swab) to be bacterial, especially if it is severe or your symptoms aren’t improving after a few days. In children, antibiotics may be given if group A streptococcus is confirmed or if there are other concerning symptoms.
Generally we should pay attention to:
- Persistence: a cough lasting more than three to four weeks, or not improving with usual remedies.
- Severity: very strong, painful, or disruptive coughs.
- Accompanying symptoms: blood in phlegm, unexplained weight loss, night sweats or fevers, difficulty swallowing or persistent hoarseness.
- Pattern changes: A new cough in someone who smokes, or a sudden change in a chronic cough.
If any of the above symptoms are present, seek medical advice, says Aslam.
Why do we sometimes get a cough or feel a sore throat coming on at the end of the week?
“Many people wonder why a sore throat or cough seems to hit on Fridays, and waiting rooms are often full of patients coming in just before the weekend,” says Aslam.
She believes there is a mixture of factors at play.
“By the end of a busy week, the accumulation of stress, lack of sleep and making poor food choices while on the hoof can all slightly weaken our immune system, making us more sensitive to irritants or lingering viruses.”
In addition, exposure to dust, pollen, office air-conditioning or mild viral particles can all build up over the week, irritating the throat and airways.
“Prolonged talking or long hours in an office can also make our throats feel sore – and there’s a psychological element too. When we’re busy and focused, we may not notice mild irritation early in the week. By Friday, fatigue makes it more noticeable."