This winter, know the difference!

While a cough can be a symptom of both a common cold and flu, the difference between a wet and dry cough is definitely a difference worth knowing1.

In fact, a dry cough and a wet cough are two different types of cough. Their names are derived from the presence (or not) of phlegm or mucus when you cough2, 3. Yet many people have trouble differentiating between these two types of coughs and end up buying and using the incorrect cough mixtures, which means that their cough remains untreated for longer than necessary1.

This winter, know the difference and know how best to treat each type of cough for you and your family.

A dry (non-productive) cough produces no phlegm (mucus) and is usually tickling and irritating 2, 4, whereas a wet cough produces mucus or phlegm 3. A wet cough tends to be chesty and loose, and may lead to chest pains 2, 4, 5.

There are many things that can cause a cough. A dry cough is typically caused by viral infections, a smoky or dry environment, air pollution, allergies, asthma, acid reflux, acute bronchitis, croup and certain medications. Medicines that are associated with a dry cough include some blood pressure medication and nonsteroidal anti-inflammatory medication2. Typical causes of a wet cough include chronic bronchitis, upper and lower respiratory tract infections, postnasal drip and smoking2.

“A Wet/ Chesty (productive) cough is termed this because when you cough, mucus or phlegm is produced6. This type of cough usually accompanies feelings of congestion, is often feels worse on waking6. It can be described as having a “rattly” cough. A dry cough produces very little or no sputum or phlegm and is described as an ‘irritating, persistent or tickly’ cough,” says Dr Sarahan Brophy, who runs a family medicine practice in Sea Point, Cape Town.

Due to the differing natures of dry coughs and wet coughs, medications used to treat these coughs differ1, 4

Since a dry cough does not produce phlegm or mucus and usually serves no physiological purpose as they lungs do not have to cough up mucus, it can be suppressed, especially if it is disturbing your sleep4. If a dry cough is left untreated, some complications may arise7.

In some cases, lungs can become hypersensitive following an infection, and create a vicious cycle in which the cough perpetuates more coughing. A persistent cough may lead to complications such as fatigue, sleep deprivation, hoarseness, musculoskeletal pain and urinary incontinence7.

The opposite is true of a wet cough. A wet cough should not be suppressed and the coughing action should be encouraged to prevent secretions from pooling in the lungs and impairing breathing or causing infection4.

So, how should we manage these different types of coughs?

Cough suppressants are used for the short-term relief of a dry cough2. Cough suppressants that work on the cough centre in the brain to suppress a cough include codeine, pholcodine and dextromethorphan2. Sedating antihistamines are also used to suppress a cough and dry up nasal secretions2. These can be useful when a cough and cold occur together and their sedative effect is beneficial if cough is disturbing sleep4.

Cough mixtures for wet coughs either contain a single ingredient, or a combination of ingredients to promote coughing and make it easier to cough up mucus or phlegm 2, 3, 8. Remember, a wet cough should not be suppressed, as the phlegm or mucus may cause breathing problems or may cause infection4. Mucolytics are useful when mucus or phlegm is thick and sticky, as it decreases mucus viscosity (makes it less thick), making it easier to cough up mucus4. Expectorants are used for wet coughs to help cough up secretions or mucus2. Bronchodilators relieve a tight chest by relaxing the muscles around the airways, allowing for easier breathing 8. They also reduce the volume of mucus secretion11. A combination of a mucolytic and a bronchodilator works well for a wet cough3,8.

Some cough mixtures contain combinations of cough suppressants and expectorants. These are not advisable, as the active ingredients actually oppose each other. The cough suppressant is working hard to suppress the cough, whilst the expectorant is trying its best to cough up the mucus11.

With so many different active ingredients and types of cough mixtures, it can be confusing to know which cough mixture is suitable for your type of cough. Your doctor or pharmacist will be able to assist you in choosing the correct cough mixture for you and your family.

Go to www.knowyourcough.co.za for more information or speak to your doctor or pharmacist if you need clarity on your symptoms and what treatment is required.

DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. This editorial has content that includes independent comments and opinions from independent healthcare providers and are the opinions and experiences of that particular healthcare provider which are not necessarily that of iNova Pharmaceuticals.

Name and business address of applicant: iNova Pharmaceuticals (Pty) Limited. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. For further information, speak to your healthcare professional.


  1. Differentiating Dry Cough and Wet Cough Based on Causes, Symptoms, Treatment – ePainAssist (https://www.epainassist.com/chest-pain/lungs/differentiating-dry-cough-and-wet-cough) Website accessed on 11 March 2018
  2. Truter I. Cough. Evidence Based Pharmacy Practice. SA Pharm J 2007;74(4):20-27.
  3. Cough treatment. Specialist Forum 2017;17(6): 28-30
  4. Van Schoor J. An approach to recommending cough mixtures in pharmacy. S Afr Pharm J 2012;79(6):30-33.
  5. Productive Coughs – Topic Overview [online] [cited 2 March 2018]; Available from URL: https://www.webmd.com/cold-and-flu/tc/productive-coughs-topic-overview
  6. Q&A with Dr Sarahan Brophy 28 February 2018
  7. De Blasio F, Virchow JC, Polverino M, et al. Cough management: a practical approach. Cough 2011;7(1):7.
  8. Data on file. Available on request.
  9. Data on file. Available on request.
  10. Data on file. Available on request.
  11. Hanson C. Cough mixtures – an overview. S Afr Pharm J 2016;83(5):14-17.