Whooping Cough in Adults: Symptoms, Causes, Test & Treatment
Whooping cough, medically known as pertussis, is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. Although it is often associated with children, adults can also develop pertussis.
In adults, the illness may be difficult to recognize because the classic "whoop" is often absent. Instead, the patient may develop a persistent, severe or repeated coughing attack that continues for weeks.
What Is Whooping Cough?
Whooping cough, or pertussis, is an infectious respiratory disease caused by Bordetella pertussis. The bacteria attach to the lining of the respiratory tract and produce toxins that contribute to airway irritation and the characteristic prolonged cough.
Pertussis spreads mainly from person to person through respiratory secretions. People can transmit the infection before the diagnosis is recognized, which is one reason why adult cases can be important sources of infection for infants and other vulnerable people.
The incubation period is commonly around 5-10 days, although symptoms can sometimes take up to about three weeks to appear after exposure.
Why Is Whooping Cough Important in Adults?
Adults may develop pertussis but often do not have the dramatic whooping sound traditionally associated with the disease. Previous vaccination or previous infection can make the illness less typical.
According to CDC clinical guidance, healthcare professionals can overlook pertussis in adolescents and adults because the classic "whoop" is less frequent in these age groups.
This means an adult with a cough lasting several weeks should not automatically assume that the problem is simply "allergy," "flu," "bronchitis" or a lingering viral infection.
Symptoms of Whooping Cough in Adults
The illness commonly progresses through stages. Early symptoms can look very similar to an ordinary cold.
Early symptoms
- Runny nose
- Nasal congestion
- Mild fever or no fever
- Mild occasional cough
- Fatigue
- Gradually increasing cough
The early stage commonly lasts about one to two weeks before more severe coughing develops.
Later symptoms: severe coughing attacks
- Repeated violent coughing fits
- Several coughs occurring rapidly one after another
- Difficulty catching the breath after a coughing attack
- A "whoop" while breathing in after coughing — but this may be absent in adults
- Vomiting after coughing
- Extreme tiredness after coughing attacks
- Difficulty sleeping because of cough
- Chest or abdominal muscle pain from repeated coughing
- Occasionally fainting or other complications
CDC notes that coughing paroxysms can continue for weeks and may sometimes last for many weeks, with gradual improvement during recovery.
The Classic "Whoop" May Be Missing in Adults
The name "whooping cough" can be misleading when evaluating adults. You do not have to produce a whooping sound to have pertussis.
Adults, especially those who have previously been vaccinated, may instead present with a prolonged irritating cough or repeated coughing attacks.
- Your cough is becoming increasingly severe.
- You have repeated coughing fits.
- You vomit after coughing.
- Your cough is continuing for weeks.
- You have been exposed to someone with confirmed or suspected pertussis.
- You have close contact with a newborn or young infant.
Stages of Whooping Cough
| Stage | Typical features |
|---|---|
| Catarrhal stage | Runny nose, mild cough, low-grade fever and symptoms resembling a common cold. |
| Paroxysmal stage | Repeated severe coughing attacks, sometimes followed by vomiting, difficulty catching the breath and occasionally a whoop. |
| Convalescent stage | The cough gradually becomes less frequent and less severe, but recovery can be slow. |
These stages are well recognized in pertussis, although individual patients do not always follow an identical pattern.
How Is Whooping Cough Diagnosed in Adults?
Diagnosis is based on the combination of the patient's symptoms, duration of cough, exposure history and appropriate laboratory testing.
1. Clinical assessment
A pulmonologist will usually ask about:
- How long the cough has been present
- Whether the cough occurs in attacks
- Vomiting after coughing
- Breathing difficulty
- Contact with someone with pertussis
- Previous vaccination
- Recent respiratory infection
- Smoking and environmental exposures
- Other symptoms such as wheezing, fever or chest pain
2. PCR testing
A nasopharyngeal PCR test can be useful for detecting pertussis, particularly during the earlier weeks of illness.
The timing of testing matters. CDC guidance indicates that PCR is generally useful during approximately the first three to four weeks after cough onset, while its sensitivity declines later as bacterial DNA decreases.
3. Culture
Culture is another diagnostic method, but it is most useful relatively early in the illness, particularly during the first two weeks after cough onset.
4. Serology
In selected situations, serologic testing may be considered later in the illness. The appropriate test depends on the timing of symptoms and local laboratory availability.
Whooping Cough vs Common Cough
| Feature | Whooping cough / Pertussis | Common viral cough |
|---|---|---|
| Beginning | May initially resemble a cold | Usually begins with viral respiratory symptoms |
| Cough | Can become severe and occur in repeated attacks | Usually gradually improves |
| Whoop | May occur but is often absent in adults | Not typical |
| Vomiting after coughing | Can occur | Less characteristic |
| Duration | Can persist for many weeks | Usually shorter, although post-viral cough can persist |
This table is a guide rather than a diagnostic test. Other respiratory conditions can produce very similar symptoms.
Treatment of Whooping Cough in Adults
Pertussis is generally treated with antibiotics. Early treatment is particularly important, because treatment during the first one to two weeks may reduce illness severity and can help reduce transmission.
Commonly recommended antibiotic classes include macrolides such as azithromycin, clarithromycin or erythromycin. Trimethoprim-sulfamethoxazole may be an alternative in appropriate patients. The exact antibiotic and duration should be decided by a healthcare professional based on the patient's age, medical history, drug interactions, pregnancy status, local resistance considerations and other factors.
A prolonged cough can have many causes. Antibiotic selection and timing should be based on a clinical assessment and, when appropriate, diagnostic testing.
Supportive care
Most adults without serious complications can be managed at home with appropriate medical guidance.
- Drink adequate fluids.
- Avoid cigarette smoke and second-hand smoke.
- Avoid dust, fumes and other cough triggers.
- Rest adequately.
- Eat smaller meals if coughing causes vomiting.
- Follow the prescribed antibiotic course exactly.
CDC advises avoiding smoke and other triggers that can provoke coughing and recommends adequate fluids and small meals when appropriate.
How Long Does Whooping Cough Last?
One of the most frustrating features of pertussis is the duration of the cough. The cough can continue for several weeks and sometimes longer even after the infection itself has resolved.
This prolonged recovery does not necessarily mean that the antibiotic has failed. After the infection, the airways can remain irritated and cough sensitivity may take time to settle.
Can Whooping Cough Cause Complications in Adults?
Adults usually have less severe disease than young infants, but complications can still occur.
- Pneumonia
- Dehydration
- Severe exhaustion
- Sleep disturbance
- Vomiting
- Fainting associated with severe coughing
- Rib or chest-wall injury from violent coughing
- Worsening of underlying respiratory disease
CDC notes that adolescents and adults can develop complications such as pneumonia, although serious complications are generally less common than in infants.
When Is Whooping Cough an Emergency?
Seek urgent medical care if severe cough is accompanied by:
- Significant difficulty breathing
- Blue or grey lips or face
- Fainting or altered consciousness
- Severe chest pain
- Coughing up significant amounts of blood
- Severe weakness or dehydration
- Rapid deterioration
Extra caution is needed when a person with suspected pertussis is living with or regularly around a newborn or young infant.
Whooping Cough and Babies: Why Adults Matter
Pertussis can be particularly dangerous for young infants. Adults with mild or unrecognized pertussis may unknowingly transmit the infection to babies.
For this reason, an adult with a prolonged severe cough should be particularly careful around newborns and young infants and should seek medical advice when pertussis is suspected.
Can Adults Get Whooping Cough After Vaccination?
Yes. Pertussis vaccination provides important protection, but protection decreases over time. Vaccinated people who become infected may have a milder illness, and the classic whoop may be absent.
This is one reason why vaccination history should not be used alone to rule out pertussis in an adult with a highly suggestive cough.
Tdap Vaccine for Adults
Tdap is a combination vaccine that protects against:
- T - Tetanus
- d - Diphtheria
- ap - Acellular pertussis
CDC recommends that adults who have never received Tdap should receive a dose. Vaccination recommendations can differ according to age, pregnancy and previous vaccination, so discuss your individual schedule with a qualified healthcare professional.
Who Should Be Particularly Careful About Pertussis?
- Adults who work closely with infants
- Parents and caregivers of newborn babies
- Pregnant women, who should discuss Tdap vaccination during pregnancy with their healthcare provider
- People with suspected exposure to confirmed pertussis
- People with prolonged unexplained coughing attacks
- People with underlying respiratory disease
Whooping Cough vs Asthma
A persistent cough does not automatically mean asthma or pertussis. Sometimes the two can also be confused clinically.
Asthma commonly causes variable cough, wheezing, chest tightness and breathlessness, while pertussis classically produces progressive coughing attacks. Objective lung-function testing can be useful when asthma is suspected.
Read our detailed guide: Asthma in Islamabad: Symptoms, Diagnosis & Treatment.
Persistent Cough: Other Causes to Consider
If an adult has a cough lasting several weeks, a pulmonologist may consider several possible causes, including:
- Pertussis
- Asthma
- Post-viral cough
- COVID-19 or other respiratory infections
- Allergic rhinitis and post-nasal drip
- Sinus disease
- Gastroesophageal reflux
- COPD
- Bronchiectasis
- Pneumonia
- Tuberculosis
- Medication-related cough
- Other lung or airway diseases
Can a Pulmonologist Help With a Persistent Cough?
Yes. A pulmonologist can evaluate the pattern of cough and determine whether investigations such as chest imaging, spirometry, blood tests, microbiological testing or pertussis PCR are appropriate.
At Islamabad Respiratory Clinic (IRC), G-11 Markaz, respiratory assessment may include specialist clinical evaluation and appropriate pulmonary function testing.
Useful IRC Respiratory Guides
When Should You See a Pulmonologist for Cough?
Consider specialist assessment if your cough:
- Persists for several weeks
- Is becoming progressively worse
- Occurs in violent repeated attacks
- Causes vomiting
- Disturbs sleep severely
- Causes breathlessness
- Is associated with wheezing
- Is associated with chest pain
- Occurs after known exposure to pertussis
- Occurs in someone who is frequently around infants
Whooping Cough & Persistent Cough Assessment in Islamabad
If you have a prolonged, severe or unexplained cough, a respiratory specialist can help determine whether pertussis or another lung condition may be responsible.
Islamabad Respiratory Clinic (IRC)
Inside Saeed International Hospital
G-11 Markaz, Islamabad
Consultant Pulmonologists:
Dr Muhammad Israr - Head of Pulmonology
Dr Jehangir Khan - Consultant Pulmonologist & Interventional Pulmonologist
Appointment: 0343-1510025
Email: ircchest@gmail.com
Frequently Asked Questions About Whooping Cough in Adults
Can adults get whooping cough?
Yes. Adults can develop pertussis. The classic whoop may be absent, making diagnosis more difficult.
What is the main symptom of whooping cough in adults?
The most characteristic feature is a prolonged cough that may occur in repeated, violent coughing attacks. Vomiting after coughing can also occur.
Does whooping cough always cause fever?
No. Early pertussis may cause only mild fever or no significant fever.
Can you have whooping cough without the whoop?
Yes. Adults frequently do not have the classic whooping sound, particularly if they have previous immunity from vaccination or previous infection.
How is pertussis tested?
Depending on the stage of illness, testing may include nasopharyngeal PCR, culture or selected serologic testing.
How long can whooping cough last?
The cough can continue for many weeks and may gradually improve rather than stopping suddenly. Coughing attacks can sometimes recur during subsequent respiratory infections.
Does azithromycin treat whooping cough?
Azithromycin is one of the antibiotics used for pertussis, but antibiotic treatment should be prescribed by a healthcare professional after considering the clinical situation, medication interactions and other factors.
Can vaccinated adults still get pertussis?
Yes. Protection decreases with time, and vaccinated people can still become infected. However, vaccination can reduce the severity of illness.
Where can I see a pulmonologist for persistent cough in Islamabad?
Islamabad Respiratory Clinic (IRC) provides specialist respiratory care inside Saeed International Hospital, G-11 Markaz, Islamabad. Appointments can be arranged at 0343-1510025.
Medical Disclaimer
This article is provided for general medical education and does not replace an individual medical consultation, examination or diagnostic testing. A prolonged cough can have many causes. Do not start, stop or change antibiotics or other prescription medicines without medical advice. If you have significant breathing difficulty, blue discoloration, severe chest pain, fainting, coughing blood or rapidly worsening symptoms, seek urgent medical attention.
Medical review: Dr Muhammad Israr & Dr Jehangir Khan, Islamabad Respiratory Clinic (IRC), G-11 Markaz, Islamabad.