What is a paroxysmal cough?

Written by: Professor Suveer Singh
Edited by: Carlota Pano

In most cases, a cough is a simple reflex from the body to remove mucus, smoke or irritants from the airway. In some instances, however, certain types of coughs may indicate a more serious underlying condition and be a reason for concern.


Professor Suveer Singh, award-winning respiratory, sleep and critical care consultant, provides an expert insight into the different types of coughs and how they are identified.




What is a productive cough?

A productive cough, also known as a wet cough, is often produced by a postnasal drip that causes mucus to seep down the throat. Coughing starts, to prevent the mucus from travelling down and getting into the lungs. The presence of mucus in the lungs can lead to pneumonia, which is a more serious respiratory illness.


Causes of a wet cough include the flu, pneumonia, chronic obstructive pulmonary disease (including chronic bronchitis and emphysema), acute bronchitis and asthma.


Bronchiectasis, a lung disease where mucus pools in small balloon-like pouches, can also cause a persistent wet cough. Mucus from this disease cannot be cleared fully from the lungs.


A wet cough can either be acute or chronic.



What is a non-productive cough?

A non-productive cough, or a dry cough, is one that does not bring up mucus, is difficult to control in many cases and presents in long coughing fits.


This type of cough is usually caused by inflammation or irritation in the respiratory tract, often due to upper respiratory tract infections.


Croup, laryngitis, tonsillitis, sinusitis, asthma, gastroesophageal reflux disease and allergies are other conditions that can cause a dry cough. Exposure to irritants and ACE inhibitor drugs, such as enalapril and lisinopril, that cause a persistent cough in 20 per cent of people who use them, are other possible causes.



What is a paroxysmal cough?

A paroxysmal cough is the term used to describe intermittent attacks of uncontrollable, violent coughing that can feel exhausting and painful. Some people may vomit during or after a coughing episode.


The most common type of paroxysmal cough is pertussis (also known as whooping cough), a bacterial infection caused by the Bordetella pertussis bacteria that produces violent coughing fits. During a coughing episode, the release of all of the oxygen from the lungs will cause people to violently inhale with a ‘whoop’.


Compared to all group ages, babies are at a higher risk of contracting pertussis and will also experience more severe complications from it. Vaccination has been proven to be the best way to avoid falling ill with pertussis for those who are two months or older.


Besides pertussis, asthma, chronic obstructive pulmonary disease, pneumonia, tuberculosis and choking can also result in a paroxysmal cough.



What is a croup cough?

A croup cough is a viral infection that causes irritation and swelling in the airway. It usually affects children who are five years old and younger, because young children already have narrower airways and the infection can make it very difficult to breathe when swelling narrows the airway even more.


Symptoms include a characteristic ‘barking’ cough, a raspy voice and squeaky breathing noises – the latter two, due to swelling in and around the voice box. Children can struggle to breathe, breathe very quickly or make high-pitched noises during inhalation.



How is a cough diagnosed?

While coughing is a normal reaction and there are many different types of coughs, a cough could be a symptom for a more serious underlying condition.


A respiratory consultant may ask the following questions to try and find out the underlying cause for a cough:


• Do you notice mucus or blood in your cough?

• What is the colour of the mucus (for example, clear, yellow, green or brown)?

• How would you describe the consistency of the mucus?

• Since when do you have a cough? Was it caused by anything in particular?

• Are you aware of any allergies that could have caused the cough?

• Have you ever had pneumonia or any chest infections?

• Do you smoke or take any drugs?

• Are you taking any medication right now?


These questions will help the respiratory consultant make an accurate diagnosis and choose the correct treatment plan for each patient.



Professor Suveer Singh is an award-winning respiratory, sleep and critical care consultant based in London who specialises in a variety of respiratory infections and diseases. If you have symptoms of chronic cough and wish to seek expert treatment, don’t hesitate to visit Professor Singh’s Top Doctors profile today.

By Professor Suveer Singh
Pulmonology & respiratory medicine

Professor Suveer Singh is a prominent, award-winning respiratory, sleep and critical care consultant based in central London, who specialises in bronchoscopy, respiratory infection and chronic cough alongside respiratory diseases, respiratory failure and chest pain. He privately practices at Cromwell Hospital, The Sloane Hospital and Shirley Oaks Hospital as well as London Bridge Hospital and Chelsea Outpatient Centre.  His NHS bases are Royal Brompton & Harefield, and the Chelsea and Westminster NHS Foundation Trusts, London.

Professor Singh, who is also professor of practice at Imperial College, London, is also an experienced specialist in sleep apnoea and other sleep disorders like insomnia, alongside acute respiratory infection including COVID-19 and post-ITU recovery. Furthermore, he also has consultant experience in cardiac and burns intensive care, and he is a member of the national, platinum-marked Royal Brompton ECMO-SARF service and lead of the SARF/ECMO follow-up clinic, most recently during the COVID-19 pandemic.

He has an BSc and MBBC from Guys & St. Thomas' Hospitals Medical School, and underwent further postgraduate training at Royal Brompton Hospital, King's College, Chelsea and Westminster and Hammersmith Hospitals in London. He undertook a PhD in the mechanism of microvascular dysfunction at the National Heart and Lung Institute, London.

Professor Singh, who is active researcher with interests in early diagnostic markers for ventilator pneumonia and Burns inhalation injury, bronchoscopy (EBUS and interventional) and respiratory infection alongside post intensive care syndrome and microcirculatory disorders, is a decorated clinical teacher. In 2013 he was awarded the Imperial NHS Teacher's award, while he has been the Distinguished Teacher nominee for the trust in 2014, 17 and 18.

He is also the lead for Year 5 Critical Care Medicine, examiner for the Royal College of Physicians MRCP and the European Society and Faculty of Intensive Care Medicine EDIC courses, as well as for international fellowship programmes. He has been tutor for the intensive care faculty FICM. He supervises PhD, MD and BSc fellows involved in critical care and respiratory medicine academic research and has held grants from the National Institute of Academic Anaesthesia and the Westminster Medical School Joint Research committee for MD studies. 

He is a fellow of the Higher Education Academy, frequently lectures nationally and internationally on Respiratory and sLDoee and examines internally and externally for MD and PhD awards.

Professor Singh is also chief and principal investigator for multicentre trials of early diagnostic markers in pulmonary infection and sepsis, weaning from ECMO and bronchoscopic sampling lung-volume reduction studies. He is also a respected academic who has published over 100 peer-reviewed articles, is the editor of the Oxford textbook Respiratory Critical Care and Respiratory Section editor and Editorial Board member of Medicine International. He is also an associate editor of Respiration, and reviewer for several international intensive care and respiratory journals.

Find out more about Professor Singh's work via his personal website, Respiratory Doctor.                       

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