All of us have coughed when we have swallowed a tiny amount of food or liquid “the wrong way.” A cough is a reflex to remove debris from the lungs and airways.
In the dog, there are cough receptors from the back of the throat all the way down to the lower airways to help accomplish this goal.
A cough can become counterproductive, though, when a dog coughs too often or when there is no debris actually there.
The act of coughing can be tiring. Frequent coughing can make muscles sore and keep you and your dog from sleeping.
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When Is Coughing an Emergency?
Here are the signs in addition to coughing that should merit an immediate veterinary visit day or night versus waiting for your vet to open the next business day.
Coughing Symptoms that Indicate An Immediate Veterinary Visit Is Necessary
- Your dog’s gums are white, blue, purple, or cherry red in color.
- Your dog is breathing more than 40 breaths per minute AT REST.
- Your dog is sitting up with their neck extended forward, or your dog is reluctant to lay down.
- Your dog brings up blood or yellow/green phlegm after coughing.
- Your dog doesn’t want to get up or has trouble standing or walking.
- Your dog coughs so much that you and/or your dog are not getting much rest.
- Your dog is eating or drinking less than 50% of their usual amount.
Coughing Symptoms Where a Veterinary Is Necessary Within 1–2 Days
- Your dog is slowing down on walks.
- Your dog coughs occasionally during the day, at night, or during activity.
- Your dog is eating and drinking normally, or almost the normal amount.
- Your dog is acting like their usual self despite the occasional cough.
- Your dog does not seem bothered by the cough.
If your dog’s symptoms lie between these two groups, a veterinary visit within 24 hours is needed.
Canine Infectious Respiratory Disease Complex (CIRDC) Outbreaks 2023
In 2023, outbreaks of CIRDC have been reported across the US, both in dogs living in homes and in dogs living in shelters. Dogs living at home typically have been exposed to other dogs through daycare, grooming, boarding, dog parks, and sharing water/food bowls with other dogs. Some outbreaks have been caused by canine influenza based on PCR testing (North Carolina, Virginia, Maryland, Georgia, Minnesota, Texas, Pennsylvania, New Jersey, California, and Arkansas).
There have also been outbreaks of CIRDC of unknown origin, i.e., the virus or bacteria that causes it has not yet been identified. One outbreak occurred in New Hampshire and Vermont at the beginning of 2023. In late 2023, an outbreak is occurring in the western states, with the most serious in Oregon.
PCR testing is very sensitive if the DNA for a known infection is present. However, the testing must be done when the infectious particles are being shed, which is often early in the disease, not necessarily when the dog has severe symptoms. This may be one reason why traditional PCR testing is not diagnosing dogs in these outbreaks.
In the meantime, given the number of influenza outbreaks across the country, if your dog boards or goes to daycare, dog parks, or a groomer, ask your vet about Bivalent Canine Influenza and Bordetella vaccinations in addition to their core vaccines. Please keep your dog home if they show signs of cough, lethargy, or runny eyes.
What You Can Do to Help Your Dog's Cough
If your dog feels well despite the occasional cough, you can manage your dog at home:
- Run a clean humidifier in the room where your dog spends most of their time.
- If you don’t have a humidifier, let your dog stay in the bathroom while you shower daily. Remove your dog from the bathroom if your dog shows signs of getting too warm (panting, tongue hanging low).
- To relieve an episode of coughing, you may give your dog a mixture of ½ honey and ½ warm water.
- Small dogs may have 1–2 teaspoons (5–10 ml)
- Large dogs may have 1 tablespoon (15 ml)
- This may be repeated as needed
- See below why you shouldn't give over-the-counter medicine for coughs
- Let your dog rest until they recover. No vigorous play, long hikes, or walks.
If your dog is lethargic, is coughing up phlegm, has a reduced appetite, or has any of the emergency signs listed above, a vet visit is needed ASAP for diagnosis and treatment.
Record Your Dog Coughing
Take a video of your dog’s cough or any unusual symptoms at home. Often, the signs your dog has at home are different from what will happen in the vet clinic. These videos can be very helpful in making a diagnosis.
Take notes for your veterinarian about the following:
1) When does your dog have coughing episodes?
- Day, night, at rest, during/after activity, during/after eating
2) Has your dog been exposed to other dogs recently? Do you know if any of those dogs have been sick or coughing?
- daycare, dog park, playdates, grooming, veterinary clinic, boarding
3) When did the coughing start? Did the coughing start slowly and get worse, or has it been steady since it started?
4) Has your dog had any other signs such as a reduced appetite, lethargy, slowing down on walks, noisy breathing, clicks when breathing, less playful, less energetic?
5) Has your dog been swallowing frequently, even when not eating or drinking?
Why You Should Not Give Over-the-Counter Cough Medicine to Dogs
Some human cough medications may contain the artificial sweetener xylitol, which is toxic to dogs, so they are not recommended for use in dogs.
Acetaminophen in some tablet and liquid cough medications is only safe to use in dogs in small amounts before becoming toxic (such as Robitussin® Daytime Severe Cough Flu and Sore Throat or Theraflu Multisymptom Severe Cold Relief).
Safer options are available through your veterinarian or see above for a honey mixture you can safely give your dog.
Causes of Coughing in Dogs
Gastroesophageal Reflux (GERD, Acid Reflux, Heartburn)
Because the cough receptors start at the top of the throat, some dogs with acid reflux may cough. The cough happens when the acid reaches the top of the throat and tickles the cough receptors.
If your vet finds no respiratory issues and your dog has had frequent swallowing between meals, reduced appetite, or any regurgitation, ask your vet about the possibility of acid reflux. Treatment with a proton pump inhibitor such as Omeprazole is often very helpful.
Pharyngeal & Laryngeal Disease
The pharynx and larynx are parts of the throat. Disorders here can affect how a dog swallows and breathes. There are cough receptors in the larynx.
If the throat cannot move normally, or there is a blockage here, the dog is at significant risk of inhaling food or water, causing aspiration pneumonia. Aspiration pneumonia can cause coughing, lethargy, and fever and can be life-threatening. Disorders in this region include nerve dysfunction, skull fractures, jaw dislocation, and a mass or abscess (pocket of pus).
Two other examples of pharyngeal and laryngeal disease include:
Cricopharyngeal Achalasia
In Cricopharyngeal Achalasia, the muscle sphincter at the top of the esophagus will not relax, making it difficult for the dog to swallow food. The dog stretches their neck and puts great effort into swallowing food. They may cough as they try to eat or drink. Some food or water inevitably falls into the airway, causing aspiration pneumonia and coughing.
See Golden Retriever Cormac's story of how his parents discovered this condition and how he got the corrective surgery he needed.
Laryngeal Paralysis
At the back of the throat are two gates called the arytenoids, which open when the dog is breathing and close when the dog is swallowing. The arytenoids prevent the dog from choking or getting food or water into the normally sterile airways. In dogs affected by laryngeal paralysis, one or both of the arytenoids are paralyzed, remaining partially closed at all times. This gives affected dogs a noisy sound to their breathing. Because the arytenoid(s) lie partially closed, food and water can drop through the open space while they eat and drink, making them susceptible to aspiration pneumonia.
Foreign Object in Airway
Inhaled objects are uncommon but can be life-threatening when they block a larger airway or if they cause pneumonia. An object in the airway leads to a persistent cough as the dog tries to push it out. If you suspect your pet is choking or has inhaled a foreign object, immediate veterinary care is needed.
Airway Inflammation
Dogs do not get asthma like cats and humans do. Still, they get similar types of inflammation — Chronic Bronchitis and Eosinophilic Bronchitis, both of which can cause chronic coughing and can progress to serious respiratory distress. These diseases respond best if treatment is started early. Treatment is anti-inflammatory steroids, either oral or inhaled, cough suppressants, and reducing environmental air irritants.
Tracheal Collapse
Middle-aged to older small-breed dogs are prone to collapsing trachea, in which the tracheal rings weaken over time. These dogs have a cough commonly described as a “goose honk” sound, although not all dog owners agree with this interpretation of the noise.
Initially, these dogs cough when they are excited or stressed. As the disease progresses, some dogs can cough throughout the day. There is no cure for collapsing trachea. Treatment is anti-anxiety medication as needed, cough suppressants, bronchodilators, and anti-inflammatory doses of steroids as needed. For severely affected dogs, placing a stent to keep the trachea from collapsing is a potential option.
Heart Disease
Pulmonary Edema (lung congestion) Due to Left-sided Heart Failure
In dogs with heart disease, a heart murmur, or even no known heart disease, a cough due to pulmonary edema may occur quite suddenly. When they think back, some pet parents may remember that their dog has slowed down on walks or has perhaps not been as energetic in the past few weeks before the cough started.
If your dog has known heart disease, but the cough is new, this cough is a reason to see the vet right away. Congestion in the lungs can worsen quickly, so do not wait days to see a veterinarian! Treatment with diuretics and managing your dog’s heart disease by your veterinarian can be lifesaving.
Diuretics are medications that help the body remove extra fluid to ease the load on the heart. Common diuretics used in veterinary medicine are Furosemide (also called Lasix or Salix) and Spironolactone.
Symptoms Associated with Heart Failure
- Coughing
- Coughing up foam or clear liquid dripping from the nose
- Increased effort to breathing
- Reluctance to go on walks or play — just wants to rest
- Swollen belly
- Blue gums, pale gums
Enlarged Left Atrium Pressing on the Bronchi
Dogs who have heart disease can cough without having heart failure. This may be due to an enlarged left atrium (one of the four heart chambers is larger than normal) pressing on the mainstem bronchi ("windpipe"), which have cough receptors. Your vet will take x-rays to determine whether this needs treatment with diuretics (for heart failure) and cough suppressants (for the enlarged left atrium).
See how Murphy, a 14-year-old Cavalier King Charles Spaniel, is doing with managing his cough and heart condition.
Non-Cardiogenic Pulmonary Edema (Lung Congestion not due to Heart Disease)
Cough due to this type of lung congestion is less common and is more difficult to treat because it does not respond well to diuretic therapy. Treating the underlying cause and supportive care are essential. It can occur in a wide variety of scenarios, such as:
- Electrocution or biting an electric cord
- Severe seizures
- Smoke inhalation in a house fire
- Near drowning (when a dog is saved from almost drowning)
- Brachycephalic obstructive airway syndrome
Infection
Canine Infectious Respiratory Disease Complex (a.k.a. Kennel Cough)
Canine Infectious Respiratory Disease, otherwise known as Kennel Cough, is a spectrum of contagious bacterial and viral diseases that cause respiratory illnesses in dogs.
Dogs who meet other dogs at boarding, daycare, grooming, vet clinics, parks, and playdates may develop a cough, runny eyes, runny nose, lethargy, or a reduced appetite within days to two weeks after exposure to an infected dog. Most dogs recover well with supportive care at home in 7–10 days. The most common causes of Kennel Cough can be prevented through vaccination, keeping well dogs apart from dogs who have been sick, and preventing your dog from sharing toys, food, and water bowls with other dogs. While some Kennel Cough infections have no vaccines, these infections occur less frequently.
Infectious Respiratory Diseases and Vaccine Availability
Canine adenovirus
Vaccine Available: Core
Vaccine Name: Part of the DA2PP vaccine
Canine distemper virus
Vaccine Available: Core
Vaccine Name: Part of the DA2PP vaccine
Canine parainfluenza virus
Vaccine Available: Core
Vaccine Name: Part of the DA2PP vaccine
Bordetella bronchiseptica
Vaccine Available: Non-core*
Vaccine Name: Bordetella
Canine influenza virus
Vaccine Available: Non-core*
Vaccine Name: H3N8 and H3N2 vaccines
Canine respiratory coronavirus
Vaccine Available: None
Mycoplasma cynos
Vaccine Available: None
Streptococcus equi
Vaccine Available: None
*Non-core means these vaccines are not part of routine vaccinations. Ask your veterinarian if these vaccines are available in addition to the core vaccines your dog has received.
Read more information on puppy vaccines.
Pneumonia
Pneumonia causes a rattly cough. The dog may cough up phlegm that is white initially and turns yellow to yellow/green as the disease progresses. Bacterial pneumonia is most commonly seen in immune-suppressed dogs, elderly dogs, puppies, or in dogs with severe cases of Canine Infectious Respiratory Disease Complex.
Dogs most susceptible to aspiration pneumonia are those who regurgitate food or stomach contents, such as those with swallowing disorders, laryngeal disorders, or those recovering from sedation, anesthesia, or a seizure.
Fungal pneumonia causes a long-lasting cough, lethargy, and weight loss. Fungal infections vary by region, so veterinarians tend to become experts in treating fungal infections in their region of the world. X-rays for fungal pneumonia can look similar to cancer, but fungal blood, urine, and tissue testing can help confirm a diagnosis of fungal pneumonia.
- Aspergillosis
- Blastomycosis
- Cryptococcus
- Coccidioidomycosis
- Histoplasmosis
Lungworms
Lungworms can cause a persistent cough that does not respond to antibiotics or other treatments. Finding lungworms in a typical stool sample is, unfortunately, difficult, so to properly diagnose lungworms, a transtracheal wash, bronchoscopy, or a Baermann fecal examination technique (usually multiple of them) needs to be done. Treatment with the appropriate anti-parasitic drug is typically very successful.
Heartworms
Heartworms cause a soft, dry cough as one of the first signs of Heartworm infection in dogs, even if your dog feels well in every other way. The cough will worsen, along with a gradual appearance of lethargy, weight loss, belly swelling, and labored breathing.
Heartworms can be prevented with monthly oral preventatives or injections at the vet every 6 or 12 months. To diagnose heartworms, your vet will perform a blood test looking for the heartworm antigen and x-rays looking for heart and lung changes consistent with heartworm disease. There are treatments available for heartworm disease, but prevention is much simpler and easier on you and your dog.
Cancer
Primary or metastatic (cancer that began elsewhere) cancer in the lungs, in the airways (trachea, bronchi), or in the throat (pharynx, larynx) can cause coughing. A mass not in the respiratory tract but pressing on the airways can also cause a cough. For example, enlarged lymph nodes or a thyroid mass can cause a cough as they put pressure on the trachea. A mass in the throat can cause difficulty swallowing and lead to aspiration pneumonia, which will cause coughing and lethargy.
Pulmonary Thromboembolism (PTE, blood clot)
Heartworm disease, Cushing’s disease, trauma, recent surgery, cancer, immune-mediated hemolytic anemia, sepsis, or any disease that causes low albumin levels can make a dog more susceptible to forming blood clots.
If a clot travels to the lungs, the dog may have a sudden cough, fast breathing (greater than 40 breaths per minute at rest), labored breathing, pale or blue gums, and fast heart rate. Some dogs may cough blood. Immediate veterinary care is needed if you suspect your dog might have a blood clot in their lung.
Mouse/Rat Bait
Anti-coagulant mouse rat and mouse baits prevent blood from clotting, leading to internal bleeding. When this occurs in the lungs, it causes coughing, including possibly coughing up blood. These baits are no longer manufactured in the US but may still be used.
If your dog is coughing blood and has had access to mouse or rat bait or has eaten part of a mouse or rat who could have been poisoned, an immediate vet visit is needed. Dogs with anticoagulant mouse/rat bait poisoning are treated with Vitamin K1 (a prescription medication) and potentially fresh frozen plasma and oxygen therapy.
Canine Idiopathic Pulmonary Fibrosis (Westie Lung)
This is a progressive disease affecting some geriatric West Highland White Terriers in which the lungs develop fibrosis or scar tissue. As a result, the lungs can no longer expand as they should, making it more difficult for the dog to take deep breaths.
Dogs with Idiopathic Pulmonary Fibrosis tire easily, cough, and may breathe faster or with more effort. While there are ongoing studies to help dogs with this disease, no cure has been found. Veterinarians treat dogs with steroids, other immune suppressants, and bronchodilators to ease the symptoms. However, the long-term prognosis is poor.
Irritants & Allergens
Any dog can develop a cough or difficulty breathing in an area with heavy pollution or wildfire smoke. A dog with any heart or respiratory disease is going to be more prone to coughing and breathing issues from environmental pollutants and allergens.
Keeping the windows closed and running an air purifier and/or an air conditioner with a good quality, clean air filter is essential. If it is hot outside and your home does not have air conditioning, consider staying with a friend or family member who does have air conditioning. Minimize time outdoors to bathroom breaks only. The honey mixture above may help for mildly affected dogs. If your dog is struggling to breathe or coughing frequently, it is time to head to the veterinary clinic. Your vet can provide medication to ease your dog's cough to make them more comfortable. Will proving the honey mixture in these circumstances help a bit?
Coughing After Anesthesia (e.g., after dental cleaning)
If a dog has had general anesthesia, most likely, the veterinarian placed a tube to protect the dog’s airway during the procedure. It is also placed so that the anesthetist always has control over the amount of oxygen and anesthetic gas available to the dog during the procedure. The anesthetist can breathe for the dog or use a ventilator if needed.
During any anesthetic procedure, the dog becomes very relaxed, and stomach contents could slide up their esophagus toward their mouth. The tube is also in place to prevent regurgitation of stomach contents into the airway. If the procedure is a dental, oral, or nasal procedure, the endotracheal tube is especially important, as we do not want any liquid from the procedure to be inhaled.
When a dog wakes up, the tube is gently removed. The dog is monitored in the clinic until they are more awake before going home. An occasional soft cough is expected for the first 24 hours after anesthesia because of the endotracheal tube placement. Giving diluted honey as needed can be helpful to soothe the throat as the dog recovers.
If a dog is coughing persistently (once every 2 hours or more), has noisy breathing, or is showing any of the emergency signs above, then a call to your veterinarian or an emergency veterinary visit is needed.
How Veterinarians Diagnose Causes of Coughing
When you bring your dog to the veterinary clinic, especially in an emergency situation, it can be stressful, not knowing what is going to happen next. These are the steps that most veterinarians will take for a dog who is coughing to determine the underlying cause.
Physical Examination
- Heart rate, respiratory rate, gum color, capillary refill time (this is an assessment of the body’s peripheral blood flow)
- Is the dog working hard to breathe?
- Is there a heart murmur?
- Are there increased airway sounds?
- Is there any evidence of a mass or disease in the mouth, back of the throat, or neck?
Chest X-rays (Radiographs)
The vet will look for changes in:
- Heart size and shape
- Size and shape of the lung vessels
- Airway structure and look for signs of blockage
- Look for signs of fluid in the chest
- Look at the chest wall and bone structure
- Look at lung patterns to help with diagnosis (alveolar, interstitial, bronchial, vascular, mixed)
Lab Tests
- Plasma ProBNP – elevated results make heart disease more likely
- Heartworm antigen test – to diagnose heartworm disease
- Fecal examination – to look for lungworms (these are hard to find)
- Fungal blood and urine tests – to diagnose fungal pneumonia
- Coagulation profile – if rat/mouse poison is suspected
Diagnostic Procedures
- Sedated examination of the throat/larynx to look for a mass, foreign object, or laryngeal paralysis.
- Fluoroscopic examination (live x-ray) to check for tracheal collapse, bronchial collapse, cricopharyngeal achalasia, cricopharyngeal dyssynchrony, and foreign bodies. See Cormac's story below and the video of his fluoroscopic exam.
- Bronchoscopy under anesthesia to remove a foreign body or to obtain cellular samples for biopsy, bronchoalveolar lavage (BAL) of the lower airway. This is helpful in diagnosing chronic cough, pneumonia, and canine idiopathic pulmonary fibrosis. This is a very quick procedure.
- Transtracheal wash is performed under sedation and can obtain a wash sample of the airway. This does not sample as deep in the lung as a bronchoalveolar lavage (BAL), so it is not always as helpful.
- An echocardiogram is an ultrasound of the heart, which is very helpful in determining the cause of heart disease and the best course of treatment.
- A mass is typically diagnosed with either a fine needle aspirate or biopsy.
- If a pulmonary thromboembolism is suspected, it can be confirmed with a lung perfusion scan.
Two Very Different Coughing Dogs
Cricopharyngeal Achalasia
Cormac is an almost 1-year-old Golden Retriever. He was having difficulty swallowing food and water due to a genetic condition, Cricopharyngeal Achalasia.
Sometimes, Cormac would cough when eating and drinking. Because food would not go down easily, he developed aspiration pneumonia and started coughing even when not eating.
After a barium swallow fluoroscopy test, his diagnosis was confirmed.
Coughing While Drinking
Although Cormac is drinking water from a raised bench in this video, once he has consumed a moderate amount, he cannot swallow the entire volume. Some water goes down his airway instead of his esophagus, causing a cough.
Barium Swallow Test
To diagnose the cause of Cormac’s coughing, he had a barium swallow test using fluoroscopy – a live-action x-ray – seen in the video below. The shading in fluoroscopy is the opposite of usual x-rays, so barium and bones appear black, while the air in his throat and trachea appear white.
In this video, we only see Cormac’s throat and the upper part of his neck. His nose is out of the screen, pointing to the left, while the rest of his body is to the right. The windpipe appears as a white tube and is at the lower part of the screen.
At the beginning of the video, you see Cormac swallowing some food mixed with barium, which appears black. A normal dog would quickly move this food into the esophagus, which is the tube above the windpipe (which appears white). No food with barium should remain in the throat or get into the windpipe.
However, when Cormac swallows, while some black barium/food successfully moves into the esophagus, you see some of the black barium/food balling up at the top of the throat, as well as a line of black appearing in the trachea (the white tube in the lower part of the neck). This retention of barium in the throat is classic for Cricopharyngeal Achalasia. The movement of food, water, or barium into the airway causes aspiration pneumonia, which can be very serious, needing antibiotic therapy, and sometimes a hospital stay.
With it being such a rare condition, there was only one surgeon his parents could find to do the surgery. They flew with Cormac from Seattle to a specialist in Michigan. He had surgery to release the affected muscles in his throat.
He now swallows normally and has a good long-term prognosis. However, recovering fully from the surgery and the pneumonia will take a month or so.
Heart Disease
Murphy is a 14-year-old Cavalier King Charles Spaniel. This breed is prone to heart disease (degenerative valvular disease of the mitral valve), which can significantly shorten their life span.
When Murphy was 7 years old, he developed a heart murmur. A cardiologist diagnosed early mitral valve disease. He was placed on Vetmedin (Pimobendan), which he has been on continuously since that time. He goes to the cardiologist for rechecks faithfully every 6 months. His parents know to check for any signs of breathing faster, coughing, or slowing down (more so than just being an older dog).
Recently, Murphy developed a cough 5–10 times a day. X-rays revealed no signs of lung congestion or heart failure, but his heart and left atrium are enlarged. The vet interpreted that the enlarged atrium is pressing on his airway where there are cough receptors, making him cough intermittently.
Murphy is taking hydrocodone as needed for his cough, which helps him rest better and not cough throughout the day. If his parents notice a significant increase in his cough, they need to have him rechecked by his veterinarian. He's lived a long time with this condition and continues to do well.
