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What are the complications of whooping cough?

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In babies under 4 months there are always complications likely.
Occasionally whooping cough can lead to pneumonia in older children and adults.
It does not cause long term lung damage.
Bruising in the skin and cracked rib can happen.

The number that get complications is small. About 1% of clinically diagnosed cases in my experience . Of course, if you only count hospital cases or laboratory proven cases, (which are going to be the more severe cases,) then the proportion of those with complications is greater. But you can only get a true perspective if ALL cases that occur are counted.

This is where many published figures are misleading and  may lead you to believe that whooping cough has a high rate of complications. Because whooping cough goes unrecognised much of the time official figures tend to exaggerate the severity and underestimate the incidence (the number of cases).

In my published study of 500 consecutive cases in an English village over 20 years, only 1 in 100 developed significant complications (always pneumonia).

The worst complication is death. This is rare except in young babies for whom it is a more exhausting illness than some can stand. In babies it can lead to respiratory failure, convulsions and coma from encephalopathy.  It is thought that some very young babies who get it, do not cough at all, but simply get the 'stopping breathing' bit that usually comes after a bout of coughing, with possibly very serious consequences. In the United Kingdom one child in 100 who gets it under the age of six months dies from it. In older children death is very rare; 1 in 20,000 cases. In the underdeveloped world, the mortality is vastly greater.

There are minor complications that are often described but usually occur only in the most severe. These are; bleeding over the white of the eye (subconjunctival haemorrhage), blood spots in the skin (petechiae), tearing of the ligament at the base of the tongue and umbilical hernia. All these are caused by congestion of blood or the strain of coughing, retching and vomiting. 

All these things are described in textbooks and reading them gives the impression they are very common.

I have to tell you that although I know these things do occur. None of my patients (in my family practice) has yet, to my knowledge, developed any of these congestion caused complications.

Some people faint with paroxysms and may make involuntary jerking movements resembling a fit. They may have no recollection of the faint, but unlike a true fit, they will usually remember the events leading up to it.

Other ill effects
It is suspected that undiagnosed whooping cough could be the cause some pneumonia cases in children and even possibly some  cases of sudden infant death syndrome.

Voice changes
A few people with whooping cough become hoarse or notice their voice changes. Singers may find they cannot sing as before. This usually resolves itself as the cough goes but occasionally it seems that the voice does not fully recover. Genny DiStasio found a letter in an old journal (Dr. Dan McKenzie, August 1932, Journal of Laryngology and Otology, Volume 47, Issue 8, p. 546) that seems to suggest it was common knowledge in the days before immunisation.

Long term complications
Whooping cough does not cause long term lung damage. (Young babies may be an exception).

It used to be thought that whooping cough led to bronchiectasis, a condition in which the main air passages in the lungs become enlarged and distorted, allowing sputum to accumulate and fester, causing the sufferer to have a chronic productive cough and susceptibility to more severe lung infections and general debility, if severe. Most cases of bronchiectasis have probably not been caused by whooping cough, but by previous pneumonia. I do not know of any evidence that uncomplicated whooping cough causes bronchiectasis.

More people who have whooping cough have asthma than those who have not had whooping cough. Whooping cough does not cause asthma.  It just so happens that people with asthma are more susceptible to it.