Coughing Too Much? Could It Be COVID, Flu, RSV, or Allergies?

Coughing, a natural reflex to rid the airways of unwanted germs and debris, occurs for various reasons, from allergies to asthma to heart disease. GI ailments, smoking, weather conditions, and medication side effects also contribute. However, coughing is commonly associated with infectious diseases, such as COVID-19, flu, RSV, or the common cold. Regardless of the cause, coughing may be beneficial, ridding our airways of unwanted bugs. It can also indicate that something is amiss and that action is needed. You can determine if you cough too much by learning what causes it, how to interpret it, and when to seek medical attention.

Cough — a protective reflex or something different?

Identifying when coughing is a problem that requires medical attention and when it is something to wait out and let resolve on its own isn’t always black and white. Understanding why we cough and locating possible clues to viral infections may make the difference between a healthy recovery, getting the right medication (if any are needed), and hospitalization, or worse.

Why we cough

Coughing, an involuntary act most of the time, occurs for many reasons. We cough due to infectious diseases, allergies/asthma, heart disease, gastroesophageal reflux (GERD), and high blood pressure in the lungs (pulmonary hypertension). We even voluntarily cough to excuse ourselves or get people’s attention.

How to distinguish a cough

Some coughs may be dry, wet, or a combination thereof. Dry, meaning you do not bring anything up, vs. wet, meaning phlegm, discharge, sputum, or debris comes up on coughing. Sometimes, depending on the cause, you may also have wheezing, a whistling or rattling-like sound commonly associated with asthma/chronic obstructive pulmonary disease (COPD), or your lungs may even sound wet or raspy (congestive heart failure [CHF] or pulmonary edema).

Distinguishing what is causing your cough can be difficult. A cough occurs with so many underlying conditions that just a cough has no context. We need to evaluate our cough, among other symptoms. For example, determining if it is allergies vs. something infectious will include the presence or absence of things, like fatigue, fever, weakness, lethargy (sluggishness), achiness (joint/muscle pain), sinus congestion, and other signs.

Additionally, the duration of the cough matters. Suppose you have had a dry cough for weeks with no other symptoms. In that case, allergies may be all that ails you. Maybe you also have some itchy eyes and intermittent sneezing with the cough. However, if you or a loved one has a dry cough that suddenly becomes wet or a cough with other symptoms, infectious causes must be considered. Further, suppose you develop a fever > 100.4ºF (38ºC). In that case, this is not a sign of allergies and suggests paying attention to other symptoms to determine what may ail you.

Viral coughs: COVID-19 vs. RSV vs. flu

Viruses, like respiratory syncytial virus (RSV), COVID-19, and the flu, can be hard to distinguish by symptoms alone. Like most viral colds, they cause similar signs, like headaches, coughing, sneezing, and congestion or runny noses. Varying degrees of aches and pains and fevers also occur. Subtle variations exist between the viruses from age groups that are most vulnerable to the severity of clinical manifestations, and underlying conditions also affect how a disease manifests in individuals.

SymptomsCOVID-19FluAllergies (Seasonal)
Fever (≥100.4)TypicallyTypicallyNo
CoughTypicallyTypicallyUncommonly to sometimes
Sore throatTypicallyTypicallyNo
Shortness of breath/trouble breathingTypicallyTypicallyNo
Nausea/vomitingSometimesSometimesNo
DiarrheaSometimesSometimesNo
Loss of smell/tasteCommonlyRarelySometimes
Runny/stuffy noseTypicallyTypicallyTypically
HeadacheTypicallyTypicallySometimes
TirednessTypicallyTypicallySometimes
Muscle/body aches/chillsTypicallyTypicallyNo
Rash/hivesUncommonlyNoSometimes
Itchy eyes, skin, nose, ears, mouth NoNoTypically
Watery eyesSometimesSometimesSometimes
SneezingRarelyRarelyTypically

Suppose you are coughing and suspect that one of these is the culprit. In that case, testing may help narrow it down and help with peace of mind, recommendations to improve health outcomes, and any precautions necessary to protect yourself from complications and others from getting sick.

Is the cough viral?

Many may ask, "Can a test tell me what kind of virus I have?" The answer is sometimes. There are various bedside and laboratory tests for viral diseases from COVID-19 (SARS-CoV-2, a coronavirus) to RSV to influenza A or B (flu). However, when these routine tests are negative, that doesn’t rule out a virus as the underlying cause. Numerous other viruses, with less severe concerns or consequences, occur regularly. We are constantly exposed to various bugs, and being able to identify them all isn’t always necessary.

Risk factors for viral coughs

Various risk factors for viral diseases include exposure to those who are sick, duration of time exposed, underlying health conditions, such as diabetes or heart disease, age, and genetic factors.

Many wonder, “Does having allergies increase my risk of contracting COVID or other viral diseases?” To date (2023), research does not suggest an increased risk of COVID due to seasonal allergies. However, allergies (rhinitis) or asthma could increase a person’s risk for developing long-COVID — chronic problems secondary to COVID-19 infection. Current evidence is of low certainty. Thus, additional studies are needed to more conclusively determine what roles allergies and other risk factors play in one’s ability to fight COVID infection.

COVID vs. allergic cough

Coughing itself is simply a symptom. It tells us that something is caught in the throat (we just swallowed wrong or are choking) or that we may have allergies or something contagious. Differentiating infectious vs. non-infectious causes can be challenging.

If you are a chronic allergy sufferer and suddenly have new symptoms or worsening signs, then perhaps it isn’t allergies. Consider getting tested for COVID, RSV, or flu.

How serious is COVID cough?

Any cough associated with an infectious disease can become a concern when it becomes wet and doesn’t resolve. This may indicate the development of pneumonia or other more complicated lung diseases and warrants full medical attention and medications. The severity of the cough will vary from individual to individual, depending on the overall health of the person’s immune system and any underlying conditions that negatively affect the body’s ability to fight and clear the infection.

Is a COVID cough the same as an allergy cough?

Generally, environmental allergies do not lead to shortness of breath or trouble breathing. However, for those with asthma or other underlying respiratory ailments, attacks may be triggered by allergens, such as pollens, smoke, chemicals, and more. Further, while a cough can occur with allergy, it isn’t always present. Allergy sufferers often have itchy eyes, nose, and potentially inside the ears or mouth, but this isn’t a finding seen with COVID-19.

On the other hand, COVID usually involves coughing as one of the main symptoms, generally dry unless complications arise. Furthermore, even in those without asthma, shortness of breath or trouble breathing commonly occurs with COVID, but not allergies. Additional signs are seen with COVID, like muscle aches, sleepiness, and headaches, which rarely or never occur with allergies.

Coughing: when is it too much?

There is no specific parameter, such as coughing for so many hours per day or so many days in a row, that suggests you are coughing too much. Instead, whether you are coughing enough to seek professional assistance depends on your tolerance level and other symptoms, such as a fever, weakness, shortness of breath, and more.

If you have been coughing for several days with no sleep, cannot perform tasks of daily living, feel run down or worn out, or want to know the cause so that if it is infectious, you can protect others around you, seek medical care. It is better to be told it is nothing to worry about than to wait until you require hospitalization. We cough for a reason, but sometimes, coughing can become excessive and no longer protective. Seeking help sooner rather than later is of the utmost importance.

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