Cough, Blocked Nose and Sore Throat in Delhi's Winter Air

The short answer

Delhi's air genuinely does this to people. From late October, cooler air, still winds and a lower atmospheric boundary layer trap pollutants near ground level, and stubble burning adds to it. Fine particulate matter irritates the lining of the nose, sinuses and airway. Blocked nose, throat irritation and a nagging dry cough become common, and existing asthma and allergic rhinitis get worse.

But "it's just the pollution" is the most dangerous sentence of the Delhi winter. It is the reason people sit on a cough for three months without ever finding out what is causing it.

Use the clock. Under three weeks is usually an ordinary infection. Three to eight weeks is most often a post-infectious cough that will settle. Beyond eight weeks, something is driving it and it needs a diagnosis, not another bottle of syrup.

And in India there is a shorter rule that overrides all of this: a cough lasting more than two weeks needs to be assessed for tuberculosis. That is the national screening threshold, not a scare tactic.

This guide is written by two doctors who see this every winter in Vasant Kunj — an ENT specialist and a general physician — because the answer usually sits between the two.

Consultations at All Is Well Medical Centre, Vasant Kunj — Monday to Saturday, 10 AM to 7 PM. Call 8800844793 or book an appointment.

What Delhi's winter air actually does to your nose and airway

Your nose is a filter. The lining is coated in mucus and lined with microscopic hairs that sweep trapped particles backwards to be swallowed — a process called mucociliary clearance. It handles ordinary dust perfectly well.

Fine particulate matter is a different problem. PM2.5 particles are small enough to get past that defence and reach deep into the airway. Research shows they disturb the nasal lining, weaken the barrier between the surface cells, and slow the clearance system down. Long-term exposure studies have linked higher particulate levels with a greater risk of developing chronic rhinosinusitis.

That is the mechanism behind what half of Vasant Kunj describes to us every winter:

• A nose that is blocked on waking and clears by mid-morning

• A dry, tickly cough that is worse at night and after being outdoors

• A scratchy or hoarse throat with no fever

• Sinus pressure across the cheeks and forehead

• Eyes that itch and water

• Asthma that was quiet all summer and is suddenly not

The important nuance: pollution rarely creates a brand-new disease overnight. What it mostly does is unmask and worsen what was already there — mild allergic rhinitis, borderline asthma, a sinus that was already narrow. That is exactly why a winter cough is worth diagnosing rather than enduring. The underlying condition is usually treatable, and treating it makes the winter tolerable.

The three-week rule: how doctors classify a cough

Cough is grouped by duration, because duration narrows the cause faster than anything else.

DurationCalledUsually meansUnder 3 weeksAcuteViral infection — cold, flu, throat infection. Occasionally bacterial.3 to 8 weeksSubacuteMost often a post-infectious cough. Also post-nasal drip, asthma flare, bronchitis.Over 8 weeksChronicNeeds a cause identified. Post-nasal drip, asthma, reflux, medication side effect, smoking-related disease, and less commonly TB or something more serious.

Post-infectious cough is the one that catches people out. After a viral infection the airway stays irritable and the cough carries on for weeks after everything else has recovered. It can persist for six to eight weeks and it does not respond to antibiotics, because there is no longer an infection to treat. Knowing this saves people a great deal of unnecessary medication.

Chronic cough is not a diagnosis. It is a symptom waiting for one. In Delhi it is routinely blamed on air quality and left there — and that is where treatable asthma, treatable reflux and treatable sinus disease go unaddressed for years.

⚠️ The two-week rule in India

This section matters more than the rest of the page.

Under India's National TB Elimination Programme, anyone with a cough lasting more than two weeks should be assessed as a possible TB case and have a sputum test. Not eight weeks. Two.

That threshold exists because India carries a very large share of the world's tuberculosis, and because TB is entirely treatable when caught — and much harder when it isn't. The other features that raise concern:

• Fever for more than two weeks, particularly evening fever

• Weight loss — losing more than about 5% of your body weight over three months

• Night sweats

• Coughing blood, in any amount

• Known contact with someone who has had TB

A cough over two weeks plus any one of those needs testing, not reassurance. Sputum testing under the national programme is free at designated centres, and we can arrange it.

This is not an argument against pollution being real. Both things are true at once — and the only way to tell them apart is to look.

It isn't always the pollution: what else causes a winter cough

Post-nasal drip (upper airway cough syndrome). Mucus running down the back of the throat from the nose or sinuses. The most common cause of a chronic cough overall. Typically worse lying down, with throat-clearing and a sensation of something dripping.

Allergic rhinitis. Sneezing, itchy nose and eyes, clear runny nose, blocked nose. Delhi's winter combines pollution with dust mite exposure indoors as windows stay shut. Very treatable — and badly under-treated, because people assume it is a permanent cold.

Asthma, including cough-variant asthma. Some people with asthma never wheeze. Their only symptom is a dry cough, worse at night, in cold air or after exertion. It gets missed for years and it responds well to treatment once recognised.

Sinusitis. Facial pressure, thick discoloured discharge, reduced sense of smell, headache worse on bending forward. Most sinusitis is viral and settles without antibiotics. It is worth seeing an ENT specialist when it keeps returning, lasts beyond ten days without improving, or worsens after appearing to get better.

Acid reflux. Reflux causes cough without necessarily causing heartburn. Suspect it if the cough is worse after meals, lying flat, or on waking, often with a sour taste or hoarseness.

A blood pressure tablet. ACE inhibitors — drug names ending in -pril, such as ramipril or enalapril — cause a persistent dry cough in a well-recognised minority of people who take them. It can begin weeks or months after starting the medicine, which is why nobody connects the two. Never stop a blood pressure medicine yourself. Bring the strip to the consultation; if this is the cause, there are alternatives.

Smoking, including passive smoking. The single most modifiable cause on this list.

Tuberculosis. As above.

Red flags — see a doctor now, not next week

Go to a hospital emergency department if there is:

• Difficulty breathing, or breathlessness at rest

• Chest pain with breathlessness or sweating

• Blue lips or fingertips

• Confusion or unusual drowsiness with a chest illness

• In a child: fast or laboured breathing, the ribs drawing in with each breath, grunting, inability to feed or drink

Book an appointment promptly if there is:

• Cough lasting more than two weeks

• Coughing blood

• Unexplained weight loss or night sweats

• Fever for more than five days, or fever that settles and then returns

• A hoarse voice lasting more than three weeks

• Wheezing, or a cough that regularly wakes you at night

• Swelling in the neck

• Any cough in someone with diabetes, on steroids, or with reduced immunity — the usual rules are less reliable

What actually helps, and what doesn't

Worth doing

A well-fitted N95. Fit is the whole game. Studies of real-world use found N95-type respirators reduced particle exposure by around 60% on average, while cloth and surgical masks managed roughly 25% — and much of that gap is leakage around the edges rather than the filter itself. A well-sealed mask performs far better than a loose one of the same rating. If air passes around your cheeks or fogs your glasses, it is not sealing.

A HEPA air purifier in the bedroom. This is where the evidence is strongest, because it is where you spend eight uninterrupted hours. Trials consistently show indoor PM2.5 falling by around half with a properly sized HEPA unit running, and randomised studies in asthma and allergic rhinitis have shown improved symptom scores and reduced medication need. Size it to the room, run it with the door and windows closed, and change the filter on schedule — a clogged filter is an expensive fan.

Saline nasal irrigation. Cochrane evidence supports daily large-volume saline irrigation for chronic sinus symptoms; small nebulised sprays performed less well. It is cheap, well tolerated, and it physically washes deposited particles off the nasal lining. Use sterile, distilled or previously boiled and cooled water — never water straight from the tap.

Keep windows shut on high-AQI days, and check before you exercise outdoors. A morning run on a severe-AQI day undoes a great deal.

Take existing asthma medication properly. Preventer inhalers are the ones people quietly stop in summer and then need in November. Restart before the season, not during the flare.

Not worth doing

Antibiotics for a viral cough. They do not shorten it, they cause side effects, and antibiotic resistance in India is already a serious problem. A cough alone, without specific findings, is usually not a reason for antibiotics.

Cough syrups, especially for children. In October 2025 India's health authorities advised that cough and cold medicines should not be given to children under two, and are generally not recommended under five; above that age they should be used only after clinical assessment, with careful dosing and avoiding multi-drug combinations. Most children's coughs settle on their own with fluids and rest. For adults, the evidence for over-the-counter cough syrups is weak at best.

Steam inhalation over a bowl, for children. Scald injuries from upturned bowls of boiling water are a genuine and regular paediatric emergency. A warm, humid bathroom is safer and about as effective.

A "sinus antibiotic course" every winter. Recurrent sinusitis needs the cause investigated — allergy, a deviated septum, polyps — not the same course repeated annually.

ENT or general physician — which one?

Both see patients at our Vasant Kunj clinic, so it matters less than it sounds. But roughly:

Start with a general physician when the cough is the main problem, when there is fever, when it involves the chest, when you have diabetes or asthma or take regular medication, or when you simply aren't sure. A GP can assess the whole picture, arrange a chest X-ray or sputum test, and refer onward with a specific question.

Start with an ENT specialist when the problem is clearly above the neck — repeated sinusitis, persistent blocked nose, loss of smell, hoarseness lasting more than three weeks, recurring sore throat or tonsillitis, or an ear that keeps blocking.

See both — commonly the right answer for someone with post-nasal drip driving a chest cough, where the nose is the cause and the chest is the symptom.

Children and older adults

Children. Recurrent winter cough in a child is worth taking seriously rather than medicating repeatedly. Common causes are viral infections in sequence, allergic rhinitis, enlarged adenoids and asthma. Watch for snoring with mouth-breathing at night, poor sleep, daytime tiredness, or a cough that always follows exercise — those point to specific, treatable causes. Our paediatrician and ENT specialist see children at the same clinic.

Older adults. The usual signals are less reliable. Pneumonia in an elderly patient can present with confusion or a fall rather than fever, and breathlessness can be put down to age when it is heart failure or COPD. Lower the threshold for getting someone over seventy assessed.

What we do at the clinic

Assessment — history, examination, and where needed nasal endoscopy to look directly at the sinuses and post-nasal space rather than guessing.

Tests when they change the answer — chest X-ray, blood counts, sputum testing for TB, allergy assessment. Not a panel of tests as a substitute for examining you.

Treatment of the actual cause — nasal steroid sprays and antihistamines for allergic rhinitis, inhaled treatment for asthma, sinus treatment where indicated, reflux management, and a medication review where a drug is the culprit.

Both specialists under one roof. ENT and general medicine at the same address means one visit rather than two, and a shared record.

Fees: ENT consultation ₹1,000. General physician consultation ₹1,200. Charges for any investigation are confirmed before it is done.

Monday to Saturday, 10 AM to 7 PM. Opposite Vasant Square Mall, Masoodpur, Vasant Kunj. Call 8800844793 or book online.

Frequently asked questions

How long should a cough last after a cold? Up to three weeks is ordinary. A post-infectious cough can carry on for six to eight weeks after everything else has cleared, because the airway stays irritable. Beyond that, it needs a cause found.

Is my cough because of Delhi pollution? Pollution is a genuine cause and a very common aggravator, but it is a diagnosis of exclusion, not a first assumption. It far more often worsens an underlying condition — allergic rhinitis, asthma, sinus disease — than causes a cough on its own. Those are treatable, which is the reason to check.

When does a cough need a TB test in India? More than two weeks. That is the national screening threshold. It becomes more urgent with fever over two weeks, weight loss, night sweats, blood in the sputum, or contact with someone who has had TB.

Do air purifiers actually work? For particulate matter indoors, yes — trials show indoor PM2.5 roughly halving with a correctly sized HEPA unit, and symptom improvements in asthma and allergic rhinitis. They do nothing about outdoor exposure, and they need the right room size, closed windows and filter changes on schedule.

Which mask should I use for Delhi's air? A well-fitting N95. Cloth and surgical masks offer limited protection against PM2.5. Fit matters as much as the rating — if air leaks around the edges or your glasses fog, it isn't sealing.

Can I give my child cough syrup? Indian health authorities advised in October 2025 that cough and cold medicines should not be given to children under two, and are generally not recommended under five. Most children's coughs settle with fluids, rest and time. Please ask a doctor before giving any cough preparation to a young child.

Should I see an ENT specialist or a general physician? Chest symptoms, fever, or an unclear picture — general physician. Nose, sinus, throat or voice symptoms — ENT. Both are available at our Vasant Kunj clinic, and we refer internally without you starting again.

Is steam inhalation helpful? It can ease a blocked nose temporarily. It does not treat the underlying cause. For children, use a warm humid bathroom rather than a bowl of boiling water — scald injuries from overturned bowls are common and severe.

Contact

Call 8800844793. Home visits 6 am to midnight.

Phone

8800844793

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Shop no. 1, Central Market, Sector B Rd, opposite Vasant Square Mall, Masoodpur, Sector B, Vasant Kunj, New Delhi, Delhi 110070

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All is well medical centre

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