Cough: Online Diagnosis and Treatment

A cough does not usually indicate a serious medical condition, but it can certainly affect your quality of life and ability to sleep. Coughing is a reflex action that is intended to keep your airways clear of mucus and other irritants. However, it also transmits respiratory infections between people.¹

Short-term coughs are common, especially when associated with a viral respiratory infection or allergies. While less common, long-term coughing can be more difficult to diagnose and manage.

About one in every 8 to 10 adults lives with a chronic cough.² Coughs can be dry and hacking, or deep and productive. They may trigger shortness of breath or vomiting. A cough can be in response to polluted air and stop once the environment is cleared, or it may be secondary to a medical condition and be prolonged. While the coughing reflex is the same for everyone, the trigger for coughing is varied.

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform is a simple and convenient way to get your cough diagnosed and treated. You will receive a diagnosis, treatment protocol, and an appropriate online prescription to treat your cough. Telehealth for cough treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your cough quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you might have a cough and a personalized treatment plan to recover quickly.

What Is a Cough?

A cough is a complex reflex that can be in response to an irritant in the airway or as an independent event. When the airway or surrounding structures are stimulated, the vagus nerve carries nerve impulses to a specialized cough center located in the base of the brain. The nerve impulse is transmitted to the pulmonary muscles, causing contraction and a rapid expelling of air from the lungs.¹

A cough can be divided into three phases:⁴

• Deep inhalation: in this phase, you take a deep breath to generate enough air volume for an effective cough.
• Compression phase: the diaphragm (the large muscle between the chest and abdomen) contracts against a closed airway to increase pressure in the lungs.
• Expiratory phase: the airway opens, and there is a large outrush of air. The rapid outflow of air makes the distinctive sound associated with a cough.

A cough is classified as acute, subacute, or chronic.^2,3

• Acute cough: up to three weeks in duration; typically, in response to an acute upper or lower respiratory tract infection or a worsening of a chronic respiratory condition.
• Subacute cough: between 3 and 8 weeks in duration; typically, a prolonged cough after an infection such as pertussis or a worsening of a chronic respiratory condition.
• Chronic cough: longer than eight weeks in duration; typically, due to chronic respiratory conditions such as asthma, chronic obstructive respiratory disease, or gastroesophageal reflux disease.

What Are the Common Symptoms Associated with Coughing?

Depending on the underlying cause of your cough, you may have a variety of symptoms. However, it is also common to have a cough as your only symptom.

Symptoms associated with coughing include:

• Runny nose
• Congestion
• Headache
• Vomiting
• Shortness of breath
• Itchiness
• Fever
• Urinary incontinence
• Chest pain
• Heartburn
• Sore throat
• Fatigue

Can Cough Be Treated Through Telehealth?

Consulting a medical professional via telehealth is a convenient way to diagnose and treat your cough. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your symptoms and call your online prescription to a local pharmacy. Online doctors who prescribe treatment medications for cough provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Are Some People at Increased Risk for Chronic Coughing?

A chronic or persistent cough can be categorized as:

Infectious or postinfectious:

• Sinusitis
• Pneumonia
• Bronchitis
• Laryngopharyngitis

Immunological:

• Allergies: pollen, dust mites, pet dander, mold, food allergies
• Asthma: inflammation of the airway causing coughing, wheezing, and shortness of breath             

Lung-related:

• Chronic obstructive pulmonary disease (COPD): a chronic lung disease, usually as a response to long-term irritants such as cigarette smoking; COPD is associated with coughing, wheezing, shortness of breath, and chest tightness.
• Chronic bronchitis: associated with a persistent cough and excessive mucus production, chronic bronchitis is due to inflammation and irritation of the bronchial tubes.
• Bronchiectasis: a chronic lung disease in which the bronchial tubes become widened, thickened, and damaged; this can lead to chronic infections.
• Interstitial lung disease: this group of lung diseases is characterized by inflammation and scarring in the lung tissue; interstitial lung disease is associated with progressive shortness of breath, fatigue, and chronic cough.

Gastroesophageal related”

•  Gastroesophageal reflux disease: stomach acid refluxes into the esophagus and can irritate the airway, triggering the cough reflex.
• Hiatal hernia: a part of the stomach protrudes through the diaphragm into the chest cavity, increasing the risk of gastroesophageal reflux disease.

Other:

• Irritants: pollution and smoke can irritate the airways causing bronchial damage and a chronic cough.
• Comorbid conditions: heart disease can cause excess fluid to accumulate in the lungs, leading to a cough.
• Medications: angiotensin-converting enzymes are frequently used to lower blood pressure but is known to trigger chronic coughing in sensitive people.⁴
• Foreign body: in children and impaired adults, a small foreign object can become lodged in the airway and cause a cough.

How Do You Diagnose The Cause of Chronic Cough?

A diagnosis of cough is typically based on information from your medical history, your physical exam, and the results of a chest x-ray.⁴

Questions your doctor may ask:

• Is your cough productive or dry? A productive cough brings up phlegm. It sounds wet, and you may hear mucus moving in the lungs. A dry cough is hacking and irritating.
• How long have you been coughing? Depending on the duration, a cough can be classified as acute, subacute, or chronic.
• Do you have other symptoms associated with your cough? Symptoms such as wheezing, itchy eyes or nose, recent infectious contacts, or heartburn can be clues as to the cause of your cough.
• Do you smoke or work in a place where you are exposed to occupational irritants? Smoking, vaping, and pollution can trigger a chronic cough.

How Do You Treat Cough?

For acute cough, try a home remedy such as the following:

• Humidifier
• Honey with or without lemon juice, but only if over age one
• Cough drops or cough lozenges
• Steam
• Vicks VapoRub
• Avoid environmental irritants
• Stay hydrated
• Elevate the head of your bed

Medications used to treat cough are classified as:

• Antitussives: suppress the cough reflex; they are often used to treat dry, nonproductive coughs.
• Expectorants: thin and loosen secretions to make them easier to expel from the lungs.
• Bronchodilators: relax the smooth muscle surrounding the airway tubes entering the lung; by relaxing these muscles, the airways widen and ease breathing.
• Inhaled corticosteroids: reduce airway inflammation; they are commonly used to treat asthma and chronic obstructive airway disease.
• Acid-suppressing medications: suppress acid production in the stomach; reflux of stomach acid into the esophagus and airway can trigger a cough.
• Immunomodulators: modify the immune response, decrease inflammation, and treat conditions such as eosinophilic esophagitis.  

Prescription medications for treating acute cough include:

• Dextromethorphan
• Codeine
• Benzonatate

If you are smoking, talk to your doctor about smoking cessation treatment options. Smoking cessation medications ease symptoms of nicotine addiction so you can slowly withdraw from its use.

For chronic cough, the treatment depends on the cause, so it is important to identify and address the specific cause of your cough. Cough treatment depends on the cause:⁴

• Asthma: bronchodilators and inhaled glucocorticoids
• Gastroesophageal reflux disease: dietary changes, lifestyle modifications, and prescription proton-pump inhibitors to suppress stomach acid production
• Allergies: antihistamines, intranasal steroids, allergy testing

When Should You See a Doctor for Coughing?

You should see a doctor for cough if your symptoms impact your daily life and ability to sleep or if you are unsure what is causing your cough symptoms.

Some “red flags” associated with a cough that should be evaluated more emergently include the following:²

• Coughing up blood
• Over age 45, history of smoking, with a new cough, change in cough, or a change in voice quality
• Aged 55 to 80 with a heavy smoking history
• Shortness of breath at night
• Shortness of breath at rest
• Fever
• Weight loss
• Swelling of hands or feet
• Trouble swallowing
• Vomiting
• Recurrent pneumonia
• Coughing up green, purulent sputum
• Having a condition that suppresses your immune response

Do you have a cough that needs to be evaluated and treated? Telehealth for cough is the perfect option. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis based on your cough quality, severity, and duration. Your virtual doctor can give you tips on reducing cough symptoms and call in a prescription to a local pharmacy. Online doctors who treat coughs provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a chronic cough treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for cough treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your cough treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for your cough, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Canning BJ, Chang AB, Bolser DC, Smith JA, Mazzone SB, McGarvey L; CHEST Expert Cough Panel. Anatomy and neurophysiology of cough: CHEST Guideline and Expert Panel report. Chest. 2014 Dec;146(6):1633-1648. doi: 10.1378/chest.14-1481. PMID: 25188530; PMCID: PMC4251621.

2. Irwin RS, French CL, Chang AB, Altman KW; CHEST Expert Cough Panel*. Classification of Cough as a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest. 2018 Jan;153(1):196-209. doi: 10.1016/j.chest.2017.10.016. Epub 2017 Nov 10. PMID: 29080708; PMCID: PMC6689094.

3. Song WJ, Chang YS, Faruqi S, Kim JY, Kang MG, Kim S, Jo EJ, Kim MH, Plevkova J, Park HW, Cho SH, Morice AH. The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J. 2015 May;45(5):1479-81. doi: 10.1183/09031936.00218714. Epub 2015 Feb 5. PMID: 25657027.

3. Alhajjaj MS, Bajaj P. Chronic Cough. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430791/