Cough is one of the most common reasons for visits to health care providers. Normal coughing is important to keep your throat and airways clear. However, excessive coughing may mean you have an underlying disease or disorder. Coughs generally fall into one of the two following categories.

Acute coughs (typically lasting no longer than three weeks) usually begin suddenly because of a cold, flu, or sinus infection.

Chronic coughs (lasting longer than three weeks) are most commonly caused by cigarette smoke, airborne pollutants, postnasal drip, asthma, and bronchitis.

Depending on the condition causing it, a cough may be accompanied by the following.

• Upper respiratory tract infection (URI)
• Postnasal drip
• Wheezing (possible asthma)
• Heartburn
• Vomiting
• Fever, chills, night sweats
• Edema, or fluid retention

• Upper respiratory tract infection
• Irritants inhaled into the airway passages
• Postnasal drip
• Certain heart disease or blood pressure medications
• Aspiration (foreign matter drawn into the lungs)
• Congestive heart failure
• Lung tumor, in rare cases

Your health care provider will conduct a physical examination, including a careful, detailed history of your symptoms. He or she will examine your nasal passages, throat, and lungs.

Your health care provider may suggest the following.

• Stay away from cigarette smoke and airborne irritants that may be present in your home or workplace.
• Stop taking medications that trigger the cough reflex.
• Take a trial period of medication to treat suspected illnesses.

Your provider may prescribe medications such as cough suppressants, inhalers, antibiotics, anithistamines, or expectorants, depending on the type of cough you have and its cause. The goal of treatment is not only to soothe your cough, but to treat its underlying cause.

• Cough suppressants: Oral (codeine [15 mg 4 times a day] or dextromethorphan [15 mg 4 times a day]); inhaled anticholinergic agent (ipratropium bromide [2 to 4 puffs 4 times a day]); inhaled corticosteroids (beclomethasone or triamcinolone [8 to 16 puffs a day])
• Expectorants/bronchodilators—(inhaled ipratropium)
• Antibiotics/antihistamines/decongestants—for upper respiratory infections
• Antihistamines/decongestants: for postnasal drip; intranasal steroids if no improvement
• Antibiotics—for chronic sinusitis (amoxicillin-clavulanate potassium, trimethoprim-sulfamethoxazole, oral cephalosporin)
• Bronchodilators, beta-agonists, or corticosteroids—for asthma
• Intranasal steroids—for allergic rhinitis
• Antibiotics (often prolonged)—for Haemophilus influenzae

While coughs due to severe underlying causes require medical treatment, alternative therapies can be useful in treating coughs secondary to viral URI, allergens, irritants, and asthma. In addition, alternative therapies can be used at the same time as conventional medications to optimize your recovery.

• Avoid foods that you are allergic to. Food allergy testing can help determine your food allergies.
• Eat less mucus-producing foods such as dairy, citrus, wheat, and bananas. Eat more fresh vegetables, fruits, and whole grains.
• Take vitamin C (250 to 500 mg two times a day), zinc (30 mg per day), and beta-carotene (100,000 IU per day) to support your immune system.

As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used singly or in combination as noted.

• Strong expectorants: horehound (Marrubium vulgare), thyme (Thymus vulgaris), and mullein (Verbascum densiflorum)
• Gentle expectorants: fennel (Foeniculum vulgare), sweet violet (Viola odorata), ginger (Zingiber officinale), and balm of Gilead (Populus candicans)
• Cough suppressants: wild cherry bark (Prunus serotina), coltsfoot (Tussilago farfara), and linden flowers (Tili cordata)
• Immune support: purple coneflower (Echinacea purpurea), licorice root (Glycyrrhiza glabra), garlic (Allium sativum), and onion (Allium cepa). Avoid licorice root if you have high blood pressure.
• Toning: Indian tobacco (Lobelia inflata)—especially useful for smokers, elderberry (Sambucus nigra), elecampane (Inula helenium), plantain (Plantago lanceolata), and gumweed (Grindelia camporum)

Thyme, eucalyptus, and pine oils can be applied to the skin to help with a cough. Make a chest rub with 2 to 4 drops of essential oil in 1 tbsp. of food grade oil (olive, flaxseed, sesame, almond, and the like). Or, make a castor oil pack with 4 to 6 drops of essential oil. Note that exposure to essential oils may keep homeopathic remedies from working.

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of coughs based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum�-- taken within the first 24 hours of a cough that comes on suddenly, particularly if symptoms develop following exposure to cold weather; this remedy is considered most appropriate for individuals with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and symptoms that worsen in the cold or when the individual is lying on his or her side
• Spongia -- for harsh, barking cough without mucus production; this type of cough is associated with a tickling in the throat or chest; it tends to worsen when the person is lying down and improves when the individual eats or drinks warm liquids; this remedy is often used if a trial of Aconite was not successful
• Drosera�-- for dry, spasmodic cough accompanied by sharp chest pain and a tickling sensation in the throat that may cause the individual to gag, choke or vomit; the individual may be hoarse or may perspire in the evenings and symptoms may worsen when the individual is lying down
• Rumex -- for dry, shallow cough that begins with a tickling sensation in the throat or with the inhalation of cold air
• Ipecacuanha�-- for deep, wet cough—often with gagging, nausea, and vomiting; this remedy is especially useful for bronchitis in infants
• Phosphorous�-- for chest tightness associated with a variety of coughs, particularly a dry, harsh cough with a persistent tickle in the chest and significant chest pain; symptoms tend to worsen in cold air and when the individual is talking; this remedy is most appropriate for individuals who are often worn out and exhausted, suffer from unnecessary anxiety (even fear of death), and require a lot of reassurance
• Causticum�-- for laryngitis and a cough that cannot dislodge mucus in the chest and may cause the individual to leak urine during coughing fits; symptoms tend to improve with sips of cold water but worsen with cold air
• Antimonium tartareicum -- for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when the person is lying down; this remedy is generally used during the later stages of a cough and is particularly useful for children and the elderly
• Bryonia -- for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable

Acupuncturists treat people with coughs based on an individualized evaluation of the excesses and deficiencies of qi located in various meridians as well as an assessment of the quality of food choices. In the case of most coughs, a qi deficiency is usually detected in the lung, spleen, and liver meridians. A variety of other treatments to clear qi blockage in the chest area are also administered. Such treatments may include specialized massage, moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points), breathing exercises, lifestyle counseling, and suggestions about herbal remedies.

Use the remedies that work best for you and follow the instructions of your health care provider. Be sure to get rest and drink plenty of water.

Severe coughing can cause rib fractures, in which case your provider will investigate the possibility of bone disorders, such as osteoporosis.

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