Violent coughing fits, or paroxysmal coughing, is usually caused by bacteria, although there are other causes.

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

Coughing is an automatic reflex that helps your body to 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, the last peak year for whooping cough, the Centers for Disease Control and Prevention (CDC) reported nearly 50,000 cases of pertussis.

More recently, in 2019, the CDC reported nearly 19,000 cases. Many of these cases, especially in young children, involve paroxysmal coughing fits.

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

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

Paroxysmal coughing is the second stage of whooping cough. According to the CDC, this stage comes about 2 weeks into the infection. A typical case of paroxysmal coughing lasts from 1 to 6 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 with thickened walls due to inflammation, causing a buildup of bacteria or mucus
  • bronchitis, an inflammation in the bronchi of the lungs
  • gastroesophageal reflux disease (GERD), a condition in which acid from your stomach comes back up your esophagus and into your throat and sometimes into your airways
  • 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 your cough is caused by a respiratory infection in your chest, such as pneumonia or bronchitis, you may have the following symptoms:

A chest infection may last about 7 to 10 days before going away on its own. The wet coughing can last up to 3 weeks.

A cough due to pneumonia may be louder than other types of coughs, according to a 2021 study.

Researchers collected cough sounds from 30 adults and then used an artificial intelligence (AI)-based algorithm to diagnose those with pneumonia, with about 85% accuracy.

The pneumonia cough sounds were louder, especially at the end of the cough.

If you see a 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 a high 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 other lung function tests to assess how your body takes in and expels air, to diagnose asthma
  • bronchoscopy with a thin, lighted tube and camera 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
  • upper gastrointestinal endoscopy of your digestive tract to check for GERD

Once a doctor diagnoses a cause, they may prescribe a variety of treatments. These may include:

  • antibiotics, including azithromycin (Z-Pack), to help your immune system fight infectious bacteria
  • decongestants, such as pseudoephedrine (Sudafed), or the cough expectorant 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 nebulized bronchodilator treatment to help open airways during coughing fits or asthma attacks
  • antacids for symptoms of GERD
  • proton pump inhibitors like omeprazole (Prilosec), which reduce stomach acid production, to help your esophagus heal from GERD
  • breathing exercises 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 you are 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 bacterial infection from spreading. This includes 5 days of isolation while you’re taking antibiotics. Wear a mask if you plan to be around others.
  • Don’t use heavily 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 diphtheria-tetanus-pertussis (DTaP) or 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 at least 5 days.

Here are 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 to 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. Certain oils can be more potent than others, so be careful if you try this for relief. If this worsens your coughing, avoid using them.
  • Try relaxation techniques, such as yoga or meditation, to gain control of your breathing, strengthen your immune system, and prevent acid reflux.

See a doctor as soon as possible if paroxysmal coughing fits last longer than a week and becomes 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:

  • coughing up blood
  • vomiting
  • not being able to breathe or breathing quickly
  • lips, tongue, face, or other skin turning blue
  • losing consciousness
  • fever
  • chills

Paroxysmal coughing can have a variety of causes, but it’s commonly a result of a pertussis infection.

In some cases and depending on the cause, it will go away on its own, but some causes, such as asthma, pertussis, and TB, require immediate treatment or long-term management.

See a 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.