Pollution cough: what's normal and when to see a doctor

Every winter, as the AQI climbs in north India, a lot of people start coughing. Often it is a dry, tickly cough and a scratchy throat that get worse outdoors and ease on cleaner days. Sometimes it is something else that only looks like a pollution cough. Here is how to tell the difference, what helps at home, and when to stop waiting and see a doctor.

Why polluted air makes you cough

Coughing is how your airways clear out things that irritate them. Fine particles (PM2.5), larger dust (PM10) and gases such as nitrogen dioxide from traffic all irritate the nose, throat and airways. The WHO notes that short-term exposure to air pollution can irritate the airways and worsen symptoms in people with asthma and other lung conditions. The official CPCB health statements say the same in plain terms: at Poor (201–300) air can cause breathing discomfort for most people on long exposure, and at Very Poor (301–400) it can cause respiratory illness.

What a typical pollution cough looks like

• A dry cough, throat irritation or a mild, clear phlegm.
• Worse after time outdoors, in traffic or near smoke, and better indoors or when the AQI falls.
• No high fever, and you otherwise feel well.

If that matches, the most useful thing you can do is cut how much polluted air you breathe. That is not a diagnosis, though: colds, flu, asthma, allergies and TB can all start the same way.

What helps at home

• Check the AQI before you go out. Look up your city on our air check or a city page such as Delhi, and plan errands and exercise for the cleaner part of the day.
• Move exercise indoors on bad days. The Ministry of Health and Family Welfare's air pollution advisories ask people to avoid outdoor exercise and morning walks on high-pollution days, and to stay away from busy roads.
• Wear a well-fitted N95 outdoors. A cloth or loose surgical mask does little against fine particles. See N95, surgical or cloth mask.
• Clean the air where you sleep. A purifier sized for the bedroom, with doors and windows shut, lowers the particles you breathe all night. See do you need an air purifier?
• Do not add smoke indoors. Avoid smoking, burning wood or waste, and cooking on open fires where you can.
• Soothe your throat. The NHS suggests rest, plenty of fluids and a warm drink of lemon and honey for a cough. Do not give honey to babies under one year old.

When to see a doctor

Get medical advice if any of these apply:

• A cough lasting two weeks or more. India's National TB Elimination Programme says anyone with a cough of two weeks or more should be tested for TB. The test is free at government health centres.
• Coughing up blood, chest pain, or breathlessness at rest or with light activity.
• Fever that does not settle, night sweats or weight loss without trying.
• Wheezing, or a cough that keeps you awake, especially if you have asthma or COPD and your usual inhaler is not helping.

Go to a doctor or emergency department straight away for sudden or severe breathlessness, coughing up a lot of blood, or blue or grey lips.

Children and older people

The WHO points out that children breathe faster than adults, so they take in more polluted air for their size, and older people are more likely to have heart or lung conditions that pollution makes worse. In a child, fast breathing or the lower chest pulling in with each breath are WHO warning signs of pneumonia: see a doctor the same day. The NHS advises against giving cough and cold medicines to children under six.

Where LungsPure fits

Cleaner air, a good mask and your doctor's advice come first, and a cough that matches any of the warning signs above needs a doctor, not a supplement. LungsPure, an Ayurvedic avaleha, is made to support your lungs through the smog season alongside these steps, never instead of them. See what's in it →

Read next: poor air day checklist · breathing exercises and yoga for city lungs · Delhi's winter smog, month by month

Sources: WHO, "Ambient (outdoor) air pollution" fact sheet and WHO Global Air Quality Guidelines (2021); Central Pollution Control Board, National Air Quality Index health statements; Ministry of Health and Family Welfare, National Programme on Climate Change and Human Health, air pollution health advisories; NHS, "Cough"; Ministry of Health and Family Welfare, National TB Elimination Programme (cough of two weeks or more as a reason to get tested); WHO, Integrated Management of Childhood Illness (fast breathing and chest indrawing as pneumonia signs); WHO, "Air pollution and child health: prescribing clean air" (2018).