Cough Treatment Online

What causes a cough?

Coughing is a normal protective reflex that clears the airway. A short-lived cough is most often the body responding to a viral upper respiratory infection — the common cold, influenza, RSV, or COVID-19 — and settles within a few weeks. A persistent cough, lasting longer than 3 weeks, has a broader list of possible causes that benefits from a structured GP assessment.

Doctors typically classify cough by duration: acute (less than 3 weeks), subacute (3 to 8 weeks), and chronic (more than 8 weeks). Each pattern points to different likely causes and a different work-up. Telehealth is well suited to the initial assessment because most of the diagnostic information comes from history rather than examination, and any referral for imaging or pathology can be issued during the consult.

Common causes of acute cough

• Viral upper respiratory infections — colds, influenza, RSV, COVID-19 — by far the most common cause
• Acute bronchitis (typically viral; antibiotics rarely indicated)
• Acute sinusitis with post-nasal drip
• Acute exacerbation of asthma — sometimes presenting with cough rather than wheeze (see asthma)
• Community-acquired pneumonia (suggested by high fever, productive cough, breathlessness, or chest pain)
• Whooping cough (pertussis), particularly with severe coughing fits, post-cough vomiting, or a ‘whoop’ on inhalation
• Inhaled foreign body in children (sudden onset, focal wheeze) — requires urgent in-person review

For most healthy adults with an uncomplicated acute cough, supportive care is the right answer and antibiotics are not. Your telehealth GP will look for the clinical features that point to a bacterial cause and prescribe only when warranted.

Common causes of chronic cough

A cough lasting longer than 8 weeks is classed as chronic. In Australian adults who do not smoke and are not taking an ACE inhibitor, around 90% of chronic cough is explained by one of three causes — often more than one at the same time:

• Asthma — including cough-variant asthma, which presents as a persistent dry cough without wheeze
• Gastro-oesophageal reflux disease (reflux) — often with no heartburn, only cough
• Upper airway cough syndrome (also called post-nasal drip), from chronic sinusitis or rhinitis

Other causes to consider include:

• ACE inhibitor blood pressure medication (perindopril, ramipril, enalapril, lisinopril)
• Smoking, vaping, and chronic exposure to dust or fumes
• Chronic obstructive pulmonary disease (COPD)
• Bronchiectasis
• Post-infectious cough (most common after pertussis, mycoplasma, viral pneumonia)
• Heart failure (cough with breathlessness on exertion or when lying flat)
• Less commonly: lung cancer, tuberculosis, interstitial lung disease, foreign body

Your GP will take a structured history, review your medications, and arrange the next appropriate test — most often a chest X-ray and spirometry, sometimes a CT scan or respiratory specialist referral if first-line testing is normal but symptoms continue.

When to see a GP, and when to go straight to an ED

Book a GP (in person or via bulk billed telehealth) if your cough has lasted longer than 3 weeks, has not improved despite a few days of supportive care, is associated with fever, breathlessness, or chest pain, or is accompanied by wheeze, weight loss, or night sweats. People with pre-existing asthma, COPD, bronchiectasis, immunocompromise, or heart failure should seek review earlier.

Attend an emergency department, or call 000, if you have any of the following red-flag features:

• Severe shortness of breath, or breathlessness at rest
• Chest pain, particularly with breathlessness
• Blueness around the lips, fingers, or face (cyanosis)
• Confusion or drowsiness
• Coughing up significant amounts of blood (more than streaks)
• Sudden onset of cough with choking (suggesting an inhaled foreign body, especially in a child)
• A child with stridor, severe wheeze, or who is working hard to breathe (sucking-in of the chest wall, nasal flaring, grunting)
• Collapse or fainting with cough

For these features, do not delay by booking telehealth — go straight to an emergency department.

How a telehealth GP can help with a cough

Most of the diagnostic information for cough comes from the history rather than a chest examination, which makes telehealth particularly well suited to the initial assessment. Your NewDoc GP will ask about the duration, character (dry or productive), and triggers of your cough, your other symptoms, any pre-existing respiratory or cardiac conditions, your medications, smoking history, and any features that would change management.

During the consult, your GP can:

• Send an eScript for an inhaled bronchodilator, inhaled corticosteroid, or an appropriate oral antibiotic where indicated per Australian Therapeutic Guidelines
• Issue an imaging referral for a chest X-ray to look for pneumonia, masses, or other findings
• Issue a pathology referral for pertussis PCR, FBC and CRP, sputum culture, or other tests as clinically indicated
• Issue a specialist referral (typically to a respiratory or general physician) for spirometry, lung function testing, or further investigation of chronic cough
• Issue a medical certificate for work, school, or carer's leave (covering the period from when your symptoms started, where clinically appropriate)

For eligible Medicare cardholders, the consultation, eScript, referral, and certificate are all bulk billed with no out-of-pocket cost. Medications themselves are usually subsidised under the PBS at your pharmacy.

Treatment options for cough

For the typical viral cough, treatment is supportive: rest, fluids, paracetamol or ibuprofen for any associated aches or fever, steam inhalation, and (for adults and children over 12 months) honey, which has reasonable evidence for reducing cough frequency at night. Over-the-counter cough mixtures have limited evidence in adults and are not recommended for children under 6.

Where asthma is suspected — particularly if your cough is worse at night, after exercise, in cold air, or with laughter — a trial of an inhaled bronchodilator and short-acting inhaled corticosteroid is reasonable, per current Australian asthma guidelines. Spirometry confirms the diagnosis. Bacterial chest infection is treated with a targeted antibiotic course per Therapeutic Guidelines, with choice and duration tailored to severity, patient factors, and any allergies.

Cough caused by reflux, post-nasal drip, or an ACE inhibitor side-effect is treated by addressing the underlying cause rather than by suppressing the cough itself. Smoking cessation, if relevant, is the single highest-yield intervention for chronic cough.

Whooping cough (pertussis)

Pertussis is a bacterial infection that can cause prolonged, severe coughing fits, often with vomiting and characteristic ‘whooping’ on inhalation. In Australia, pertussis cases have risen since 2024 and the disease is most dangerous in infants under 12 months. Adults and adolescents can have an atypical, less dramatic presentation that is nonetheless highly infectious to vulnerable contacts.

Your GP can request a PCR swab during the catarrhal or early paroxysmal phase, and prescribe a macrolide antibiotic — typically azithromycin — to reduce transmission to close contacts. If you have been around an infant, a pregnant woman, or an immunocompromised household member, tell your GP at the start of the consult so the right management can be arranged urgently.