The Kingsley Clinic

New Cough - Less than 8 weeks

In this article, we discuss the causes and treatment of a new, persistent cough that has been present for less than eight weeks. If your cough has been bothering you for more than eight weeks, it is best you start a conversation with a doctor to rule out more serious diseases. This article only addresses coughs that have been present for less than eight weeks. 

What Causes a Cough?

An acute cough can be caused by a variety of factors, or even multiple factors at the same time. It’s important to determine the underlying cause of your cough because it will inform your treatment plan. The vast majority of people who have had a cough for less than three weeks have one of the ten underlying causes listed below. 


Upper respiratory tract infection:

Most of us are familiar with the associated symptoms of runny nose, nasal obstruction, sneezing, sore throat, and headache. Below are various types of upper respiratory tract infections:  

  • COVID-19 infection: Symptoms are broad and severity varies  
  • Common cold: Mild symptoms and, rarely, fevers and body aches
  • The flu: The flu tends to cause body aches and high fevers

Acute bronchitis:

Typically preceded by an upper respiratory tract infection. This condition rarely causes fevers or coughs. 


Common symptoms include fever and a productive cough. Some pneumonia cases are mild (commonly referred to as walking pneumonia), while others can be life-threatening, especially for the elderly or those with underlying lung disease.

Post-nasal drip:

Patients often have a constant need to cough or clear their throat or feel the urge to swallow something in the back of their throat. Associated coughs are typically worse in the morning, and will clear by mid-day when all mucus has been expelled. 


Gastroesophageal reflux disease is a common, though overlooked, cause of coughing. If you have a history of reflux and can’t find any other explanation for your cough, GERD could be the cause. Patients typically have heartburn, pain, or difficulty swallowing, as well as episodes of regurgitation (not vomiting).  


Patients with a history of asthma often know when they are undergoing an asthma exacerbation, but those without a diagnosis often can’t identify the source of their cough. An asthma-related cough is typically accompanied by wheezing and shortness of breath. Asthma can be worsened by vigorous exercise, allergen exposure, and cold air. 

ACE inhibitor use:

Use of ACE inhibitors including lisinopril, benazepril, captopril, enalapril, fosinopril, quinapril, or ramipril can often lead to non-productive coughs. 

Heart failure:

Heart failure causes a cough when the heart is unable to keep up blood flow through the lungs. When the heart backs up, fluid accumulates in the air spaces of the lungs which prevents the exchange of oxygen and irritates the lungs, inducing a cough.   

Pulmonary embolism:

One possible cause of an acute cough is pulmonary embolism. This occurs when a clot formed elsewhere in the body travels up and through the right side of the heart and into the lungs. Associated symptoms include shortness of breath and a sharp chest pain that’s worse with deep inhalations. If the pulmonary embolism is severe, patients can occasionally cough up blood.  

Lung cancer:

Those who recently developed lung cancer will often present with an accompanying weight loss, a sense that their “smoker cough” has changed, and will sometimes cough up blood. Most, but not all, lung cancer patients have a significant smoking history.

How to Know What Is Causing Your Cough

Most of the above causes have obvious and distinctive symptoms. However, diseases don’t always present obvious symptoms. For example, asthma patients often have wheezing that can only be heard through a stethoscope. Additionally, it is possible to have multiple causes for your cough. Lastly, some care needs to be taken to distinguish between pneumonia, upper respiratory tract infections, and acute bronchitis. 

Acute bronchitis should be considered once pneumonia and upper respiratory tract infections have been ruled out. Pneumonia almost always presents with fevers, whereas upper respiratory tract infections will sometimes have fevers but other times won’t. Pneumonia and acute bronchitis can develop as consequences of existing upper respiratory tract infections or can occur on their own. If a fever is present, it is unlikely to be acute bronchitis. If you don’t have a sore throat, runny nose, congestion, or ear fullness, it’s unlikely you have an upper respiratory tract infection. If your cough is not producing phlegm/mucus, it is unlikely that you have pneumonia.  

What Type of Upper Respiratory Tract Infection Do I Have? 

Many viruses and bacteria can cause upper respiratory tract infections. As a rule, we separate them based on the treatment options. We care about the flu and coronavirus because we have treatment for the flu and because coronavirus is extremely contagious and has proven to be more deadly than the flu. Both the flu and coronavirus have rapid tests performed in most clinics. However, tests are not always necessary when the likelihood of the disease is high enough. This is because the probability of a false negative goes up with the incidence of disease. During the height of flu season, we do not recommend testing for the flu if you have classic flu symptoms, since any negative result has a higher chance of being a false negative and a patient might miss out on important, life-saving treatment.  

We also classify an upper respiratory tract infection based on whether it is bacterial or not. If cough and upper respiratory tract symptoms have persisted for more than 10-14 days — or were getting better but suddenly got worse — the infection may be bacterial, and the patient is prescribed antibiotics. In fact, we assume most upper respiratory tract infections are viral, so we recommend monitoring symptoms. There are exceptions to this, so be sure to consult with your doctor before beginning treatment.

How to Get Rid of a Cough

In general, there are two approaches:

  • Treat the underlying cause of the cough: This method takes longer, but it is a curative approach.
  • Treat symptoms using cough suppressants: This method is fast, but serves as a band-aid approach. 

The good news is that in most cases, both approaches can be taken at the same time. Treating symptoms provides relief, while the curative approach eradicates the illness. Both of the above approaches are not possible for all of the diseases listed above. For instance, a curative approach to lung cancer is not always possible. Similarly, acute bronchitis doesn’t typically have a curative treatment since most of the time it is a complication of a viral upper respiratory tract infection.

Other Causes of Ear Pain and Ear Fullness

There are two main types of ear infections: a middle ear infection and swimmer’s ear. Sometimes these can be mistaken for one another especially when the eardrum (tympanic membrane) is perforated or ruptured. The most obvious way to distinguish between the two is reproducible pain. The pain from swimmer’s ear is reproducible when you pull on your ear whereas with a middle ear infection you might feel some discomfort but it won’t be a full reproduction of the pain. Swimmer’s ear almost never accompanies sinus congestion, sore throat, fevers, etc.  If you are experiencing any of those other symptoms, then you are likely dealing with a middle ear infection.  

It’s important to note, the tympanic membrane separates the outer ear (the part infected by swimmer’s ear) and the middle ear (the part infected with a middle ear infection).  In either infection, the tympanic membrane itself can become infected and rupture. Allowing the infection to cross over and producing symptoms from both middle ear infection and swimmer’s ear.  Tympanic membrane rupture usually is accompanied by sudden relief of ear fullness as the pressure build-up is relieved and can occasionally cause a mucous discharge from the ear.  

Other infections can take hold deeper in the neck or head, causing ear pain. This pain is not an actual infection of the ear itself. Rather, it’s typically related to a compromised immune system or recent head or neck surgery.  

How to Treat a Cough

Treating a cough depends on what’s causing it. Below are the most common causes of coughs, along with their curative approaches (C), symptom treatment approaches (S), and preventative approaches (P). 

COVID-19 Infection

  • C: For the most part there is not a curative approach, however, newer treatments being used on patients in the hospital seem to be improving outcomes.   
  • S: Dextromethorphan or guaifenesi are used to treat a cough. Antihistamines at night can help prevent a morning cough related to post nasal drip that accumulates overnight. Codeine is an opiate-based cough medicine that has not shown to be superior to other medications and has abusive/addictive potential. It is a sedative that, when combined with alcohol or other sedatives, can lead to respiratory suppression or injuries while operating vehicles or equipment.

Common Cold

  • C: There is no curative approach to the common cold.  
  • S: Dextromethorphan or guaifenesin are used to treat a cough. Antihistamines at night can help prevent a morning cough related to post nasal drip that accumulates overnight. Codeine is an opiate-based cough medicine that has not shown to be superior to other medications and has abusive/addictive potential. It is a sedative that, when combined with alcohol or other sedatives, can lead to respiratory suppression or injuries while operating vehicles or equipment.

Acute Bronchitis

  • C: Acute bronchitis is nearly always caused by viruses, and while Z-Packs have become a favorite prescription for acute bronchitis, they have no effect on viruses and only serve to create antibiotic resistance in the community. Do not take antibiotics for acute bronchitis. 
  • S: Non-pharmacologic options should be tried first. Consider trying one or two of the following before requesting a prescription from your doctor.  
  • Throat lozenges
  • Hot tea
  • Honey
  • Avoiding smoking or smoked-filled areas 

Otherwise, dextromethorphan or guaifenesin are the mainstays of therapy. If you have underlying asthma or wheezing while breathing, albuterol might help. Avoid using ibuprofen, aspirin, Advil, or Aleve (all medications considered to be NSAIDS), as these are not known to help cough symptoms. Also, avoid steroids (prednisone or Medrol Dosepak), as they don’t help a cough and will likely suppress your immune system, making the infection more difficult to treat. 


  • C: Antibiotic selection depends on a few things. For patients under 65 years old who are otherwise healthy and have not used antibiotics recently, we recommend amoxicillin and azithromycin. For patients with penicillin allergies, we recommend a single antibiotic: doxycycline. For all other patients, we recommend levofloxacin. Please note that there are a lot of nuances in choosing the right antibiotic, so discuss with your doctor before taking any antibiotics.  
  • S: Dextromethorphan or guaifenesin are used to treat a cough. Antihistamines at night can help prevent a morning cough related to post nasal drip that accumulates overnight. Codeine is an opiate-based cough medicine that has not shown to be superior to other medications and has abusive/addictive potential. It is a sedative that, when combined with alcohol or other sedatives, can lead to respiratory suppression or injuries while operating vehicles or equipment.
  • P: The most important part of preventative treatment is to receive your pneumonia vaccine and your annual flu vaccine. While everyone should get their annual flu shot, only certain patients are recommended to receive a pneumonia vaccine. Patients should receive the pneumonia vaccine if they are 65 years or older; have chronic heart, lung, or liver disease; have a condition that weakens the immune system; or have an impaired spleen. Patients should receive re-vaccination every 5-10 years depending on their specific situation. Speak with your doctor to determine the correct interval.  

Post-Nasal Drip 

  • C: Postnasal drip is treated by addressing the upper respiratory infection or allergies causing the post nasal drip.
  • S: Antihistamines reduce mucus production and will thereby reduce the post nasal drip causing the cough.

Gastroesophageal Reflux Disease (GERD) 

  • C: Patients may try over-the-counter antacids like Tums initially, but if symptoms persist, Prilosec (omeprazole) or Protonix are preferred treatments. Medications like sucralfate, Pepcid, and Tagamet are considered inferior to Prilosec and Protonix and should not be used unless otherwise directed. For severe cases that don’t respond to Protonix or Prilosec, patients will need a referral to see a GI doctor who will likely schedule an upper endoscopy to examine the esophagus and stomach.     
  • S: Symptom treatment is the same as the curative treatment.
  • P: Lifestyle and diet modifications can help with mild to intermediate GERD. Lifestyle modifications include staying upright for 30-60 minutes after meals and avoiding heavy or large meals. 


  • C: We typically recommend oral steroids like prednisone for 5 days, as well as albuterol inhalers. Sometimes the symptoms are frequent enough that the patient needs to be seen by a lung doctor and prescribed daily inhaler medications like Advair. 
  • S: Symptomatic treatment is the same as the curative treatment.
  • P: Avoid exposure to the precipitating causes of asthma exacerbations when possible. For instance, avoid exercise, cold air, and allergens, and take albuterol during or shortly after exposure to help reduce the severity of the exacerbation. 

ACE Inhibitor Use

  • C: Talk to your doctor about stopping the ACE inhibitor and switching to another blood pressure medication. It’s important to not just stop this medication, as it might be keeping your blood pressure at healthy levels. If you were to suddenly stop taking it, your blood pressure could climb to dangerously high levels. 
  • S: Symptomatic treatment is the same as the curative treatment. 

Heart Failure  

  • C: Treatment for heart failure exacerbation requires hospitalization, administration of IV diuretics, and thorough diagnostics to determine the cause. 
  • S: Symptomatic treatment is the same as the curative treatment. 
  • P: Avoid consuming too much salt and reduce fluids. Most often, cardiologists recommend less than 2 grams of salt per day and less than 2 liters of fluids per day.    

Pulmonary Embolism  

  • C: Treatment for pulmonary embolism requires hospitalization and emergent imaging of your lungs, monitoring oxygen levels, and beginning blood-thinning medications. 
  • S: If oxygen levels are low, symptomatic treatment often involves oxygen administration. However, this should never substitute for immediate medical treatment for pulmonary emboli. 
  • P: The best way to prevent pulmonary emboli is to prevent clots. Blood clots can form from prolonged immobility during long car rides or hospitalizations, as well as recovering from surgeries to the lower extremities or hips.

Lung Cancer 

  • C: Lung cancer treatment is complex and depends on the stage of cancer. This should be determined by an oncologist.  
  • S: Symptomatic treatment should be determined through the help of your oncologist and lung doctor. 
  • P: The best way to prevent lung cancer is to stop smoking. Those who have been smoking for a long while should talk to their doctor about lung cancer screening through annual CT imaging of the lungs.  

Other Conditions We Treat

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