Paroxysmal coughing is frequent and violent coughing that can make it hard for a person to breathe.

Coughing is an automatic reflex that helps your body get rid of extra mucus, bacteria, and other foreign substances. With an infection like pertussis, your cough may persist for long periods of time, making it hard to get enough oxygen or catch your breath. This can cause you to inhale sharply and gasp loudly for air, which is why pertussis is also known as whooping cough.

In 2012, a peak year for whooping cough, the Centers for Disease Control and Prevention reported nearly 50,000 cases of pertussis. Many of these cases, especially in young children, involve paroxysmal coughing fits.

Read on to learn what causes paroxysmal coughing, how it’s treated, ways you can prevent it, and when you should see your doctor.

Paroxysmal coughing is most commonly caused by Bordetella pertussis bacteria. Pertussis bacteria infects your respiratory tract (your nose, throat, and windpipe) and causes whooping cough. This infection is extremely contagious.

Paroxysmal coughing is the second stage of whooping cough. This stage comes about two weeks into the infection. A typical case of paroxysmal coughing lasts from one to six weeks before it lets up. In severe cases, fits of paroxysmal coughing can become so intense that you vomit, and your lips or skin can turn blue from a lack of oxygen in the blood. Seek emergency medical care if you experience these symptoms.

Other possible causes of paroxysmal coughing include:

  • asthma, a respiratory condition in which your airways become swollen and filled with excess mucus
  • bronchiectasis, a condition in which tubes in your lungs are permanently widened or damaged, causing a build-up of bacteria or mucus
  • bronchitis, an inflammation in the lungs
  • gastroesophageal reflux disease (GERD), a condition in which acid from your stomach comes back up your esophagus and into your throat
  • lung injury from trauma, smoke inhalation, or drug use
  • pneumonia, a type of lung infection
  • tuberculosis (TB), a bacterial infection of the lungs that can spread to other organs if left untreated

If you see your doctor about a coughing fit, they may order one or more of the following tests to diagnose the cause:

  • nasal or throat swab to test for the presence of infectious bacteria
  • blood test to check for white blood cell count, which can indicate an infection
  • X-ray or CT scan of the chest or sinuses to look for symptoms of respiratory infections, damage, or abnormalities
  • spirometry or lung function tests to assess how your body takes in air, to diagnose asthma
  • bronchoscopy with a thin, lighted tube that can show real-time images of the inside of your lungs
  • rhinoscopy to see real-time images of the inside of your nose and nasal passages
  • endoscopy of your digestive tract to check for acid reflux or GERD

Once your doctor diagnoses a cause, they may prescribe a variety of treatments depending on the cause. This may include:

  • antibiotics, including azithromycin (Z-Pak), to help your immune system fight infectious bacteria
  • decongestants, such as pseudoephedrine (Sudafed) or guaifenesin (Mucinex), to reduce mucus buildup, coughing, and other symptoms
  • antihistamines, such as cetirizine (Zyrtec), to reduce allergy symptoms that may worsen coughing, such as congestion, sneezing, and itching
  • an inhaler or bronchodilator to help open airways during coughing fits or asthma attacks
  • antacids for symptoms of acid reflux or GERD
  • acid-blocking medications, including proton pump inhibitors like omeprazole (Prilosec), to help your esophagus heal from acid reflux or GERD
  • breathing exercises or therapies for conditions like bronchitis

Try the following at home to reduce coughing fits:

  • Drink at least 64 ounces of water a day to keep yourself hydrated.
  • Bathe regularly to keep your body clean and limit bacterial spread.
  • Wash your hands often to keep bacteria from building up and spreading.
  • Use a humidifier to keep your airways moist, which can help loosen mucus and make it easier to cough up. Don’t overuse your humidifier, as this can make it easier for bacteria to reproduce.
  • If vomiting, eat small portions at meals to reduce the volume of vomit.
  • Reduce or eliminate your exposure to smoke from tobacco products or fumes from cooking and fireplaces.
  • Stay isolated from others as much as possible to keep the bacteria from spreading. This includes five days of isolation while you’re taking antibiotics. Wear a mask if you plan to be around others.
  • Don’t use scented products like air freshener sprays, candles, cologne, or perfume that can irritate your airways.

Paroxysmal coughing from whooping cough is common in young children. Get your child vaccinated with the tetanus-diphtheria-pertussis (Tdap) vaccine to prevent them from being susceptible to infection by pertussis bacteria.

If someone close to you has whooping cough, avoid touching or being near them until they’ve taken antibiotics for five days.

Here are some other ways to help prevent paroxysmal coughing:

  • Avoid smoking tobacco products or other inhaled drugs.
  • Sleep with your head elevated to keep mucus or stomach acid from moving up your airways or throat.
  • Exercise often to make it easier to breathe and prevent weight gain that can contribute to acid reflux and GERD.
  • Eat at a slow pace and chew at least 20 times per bite for easier digestion.
  • Use an essential oil diffuser to help open your airways.
  • Try relaxation techniques, such as yoga or meditation, to gain control of your breathing, strengthen your immune system, and prevent acid reflux.

See your doctor as soon as possible if paroxysmal coughing fits last longer than a week and become increasingly frequent or violent.

Some accompanying symptoms may mean you have a serious infection or underlying condition causing your coughing fits. Seek emergency medical help if you experience any of the following:

Paroxysmal coughing can have a variety of causes, but it’s most commonly a result of a pertussis infection. In some cases, it’ll go away on its own, but some causes, such as asthma and TB, require immediate treatment or long-term management.

See your doctor if you have a persistent cough that’s disrupting your life or regularly making it difficult for you to breathe. Many causes can be treated without the risk of complications if they’re diagnosed early.