That harsh, gagging sound your cat makes can mean anything from a simple hairball working its way up to a serious respiratory condition that needs veterinary attention. Most cat owners hear their pet hack at some point and assume it is just fur, but the sound cats produce when they cough, retch, or gag can look and sound remarkably similar across very different causes. A cat crouched low with its neck extended, producing rhythmic, raspy noises, could be dealing with swallowed hair, inflamed airways, an infection, or even parasites. Sorting out which one matters, because some of these causes resolve on their own while others get worse without treatment.
Hairballs Are Common but Not Always Harmless
Cats swallow loose fur every time they groom, and most of it passes through the digestive tract without incident. Occasionally, accumulated hair forms a mass in the stomach that the cat vomits up, producing a distinctive hacking and retching episode that ends with a tubular wad of fur on your floor. This is so common that many owners and veterinarians treat it as normal feline behavior. But frequent hairball vomiting, especially in shorthaired cats, often signals something else going on beneath the surface. In most shorthaired cats, frequent hairball elimination points to an underlying chronic condition causing increased fur ingestion or altered gut motility, with itchy skin disease, flea infestation, and dietary intolerance among the common culprits.1PubMed Central. Hair balls in cats: a normal nuisance or a sign that something is wrong?
Long-haired breeds naturally swallow more fur, so the occasional hairball is less surprising in a Persian or Maine Coon. Even so, hair does not always exit harmlessly. In some cats, swallowed hair forms dense masses called trichobezoars that migrate into the small intestine and cause partial or complete blockages. A case series of five cats found that these intestinal hairballs lodged between the upper small intestine and the lower ileum, with predisposing factors including long coats, flea allergy dermatitis, inflammatory bowel disease, and ingestion of plant material.2PubMed Central. Intestinal obstruction by trichobezoars in five cats An intestinal obstruction is a veterinary emergency, so a cat that keeps hacking and retching without producing anything, stops eating, or has a swollen belly needs prompt evaluation.
How to Tell a Cough from a Retch
One of the trickiest things about cat hacking is that coughing and vomiting look almost identical in cats. Dogs cough in a way most people recognize, but cats crouch, extend their necks, and open their mouths in the same posture whether they are trying to clear their airways or bring something up from the stomach. The difference matters a lot for diagnosis. A cough involves the respiratory system and usually produces nothing or a small amount of mucus. A retch or gag is a digestive event that typically ends with the cat producing a hairball, food, or bile.
If your cat’s hacking episodes end with vomited material, the problem is more likely gastrointestinal. If the episodes are dry and repetitive, sometimes happening in clusters over minutes, and the cat seems to swallow at the end rather than produce anything, that pattern is more consistent with a cough. Recording a video of the next episode on your phone is one of the most useful things you can do before a vet visit, because cats rarely perform on cue in the exam room, and the distinction between cough and retch changes the entire diagnostic workup.
Feline Asthma and Chronic Bronchitis
Asthma is one of the most common causes of chronic coughing in cats. It involves inflammation and narrowing of the airways, triggered by inhaled allergens like dust, pollen, cigarette smoke, or scented litter. During an asthma attack, the muscles around the airways constrict and the lining swells, making it hard for air to move in and out. The result is a characteristic dry, wheezy cough, sometimes accompanied by open-mouth breathing and visible effort to inhale. Some cats have mild, occasional episodes. Others experience acute attacks that look distressing, with the cat breathing rapidly, sides heaving, and sometimes turning slightly blue around the gums.
Chronic bronchitis in cats produces very similar symptoms and can be nearly impossible to distinguish from asthma based on outward signs alone. A study comparing cats with feline asthma and cats with chronic bronchitis found that the two conditions could not be reliably differentiated by physical signs, blood work, or chest X-rays alone. The distinction required sampling the fluid from the airways: asthma tends to show a specific type of inflammatory cell, while bronchitis shows a different type.3PubMed Central. Comparison of signalment, clinical, laboratory and radiographic parameters in cats with feline asthma and chronic bronchitis From a practical standpoint, this means your vet may need to perform more than a basic exam and X-ray to figure out exactly which condition your cat has, especially if initial treatment does not resolve the coughing.
Fortunately, both conditions respond to corticosteroids, which reduce airway inflammation. Research on experimentally induced feline asthma has shown that inhaled corticosteroids can substantially reduce the airway inflammation responsible for symptoms. One study found that inhaled fluticasone at varying doses reduced airway inflammation by roughly three-quarters or more, without suppressing the cat’s broader hormone system, which is a concern with long-term oral steroid use.4PubMed Central. Effects of fluticasone propionate dosage in an experimental model of feline asthma Cats receiving inhaled treatment use a specially designed feline spacer and face mask, which most cats can be trained to tolerate with patience and positive reinforcement. Oral corticosteroids also work and are sometimes used during acute flare-ups.5PubMed. Effect of short-term oral and inhaled corticosteroids on airway inflammation and responsiveness in a feline acute asthma model
Upper Respiratory Infections
If your cat’s hacking comes with sneezing, a runny nose, watery eyes, or a fever, an upper respiratory infection is a likely suspect. Two viruses dominate feline respiratory disease: feline herpesvirus and feline calicivirus. Together, they account for the vast majority of “cat colds.”6In Practice. Clinical update on feline respiratory pathogens The bacterium Bordetella bronchiseptica, related to the pathogen behind kennel cough in dogs, also plays a role in some cases.
Respiratory infections are especially common in multi-cat households and shelters. A large survey found that about 38% of cats in such environments showed signs of respiratory disease. Calicivirus was isolated from about a quarter of all cats sampled, and herpesvirus from roughly 5%. Younger cats between four and eleven months old and cats living with multiple other cats were at higher risk.7PubMed Central. A study of feline upper respiratory tract disease with reference to prevalence and risk factors for infection with feline calicivirus and feline herpesvirus Most mild infections clear up with supportive care: keeping the cat hydrated, clearing nasal discharge, and using steam to loosen congestion. Bacterial complications may require antibiotics. Vaccination reduces the severity of these infections but does not prevent them entirely, so even vaccinated cats can develop mild symptoms.
One thing to know about feline herpesvirus: once a cat is infected, the virus stays in the body for life. Most of the time it sits dormant, but stress, illness, or immune suppression can reactivate it, causing a new round of sneezing, coughing, and congestion. If your cat seems to come down with the same cold every few months, latent herpesvirus is a very common explanation.
Parasites That Cause Coughing
Worms are not just a gut problem. Several parasites can set up residence in a cat’s lungs or associated blood vessels and trigger coughing, wheezing, and respiratory distress.
Lungworms are probably the most straightforward of the respiratory parasites. Cats typically pick them up by eating infected snails, slugs, or small prey animals that serve as intermediate hosts. Once ingested, the larvae migrate to the lungs, where they mature and cause inflammation. Free-roaming and outdoor cats are at highest risk, but lungworm infections have been documented across a range of living situations. Kittens seem to be especially sensitive, developing more severe respiratory signs than adult cats.8PubMed Central. Respiratory distress associated with lungworm infection in a kitten The good news is that lungworm responds well to antiparasitic treatment once diagnosed.
Heartworm disease is the other parasitic cause worth knowing about. While dogs are the primary hosts for heartworm, cats in mosquito-endemic areas do get infected. The overall rate in cats runs between about 5% and 10% of the rate in dogs in any given area. What makes heartworm tricky in cats is the range of presentations: some cats show no symptoms at all, others develop chronic coughing and respiratory signs (sometimes with chronic vomiting), and some die suddenly without any warning.9PubMed Central. Feline heartworm disease: a clinical review Unlike in dogs, there is no approved treatment to kill adult heartworms in cats, so prevention with a monthly heartworm preventive is critical, especially for cats in areas where mosquitoes are common. Indoor cats are not exempt, because mosquitoes get inside.
Foreign Bodies in the Airways
Cats are generally more selective about what they put in their mouths than dogs, but foreign objects do occasionally end up lodged in the trachea or bronchial tubes. Grass blades are a classic offender. A cat might inhale a piece of grass while chewing on it, and the blade lodges in a bronchus, triggering intense coughing. A retrospective study of 12 cats with airway foreign bodies found that coughing was the main complaint in 75% of cases. The objects tended to settle in the trachea and bronchial tree, with a particular preference for the right side of the lower airways.10PubMed Central. Tracheobronchial foreign bodies in cats: a retrospective study of 12 cases
What makes airway foreign bodies especially tricky is that the cough they produce can be indistinguishable from the cough caused by asthma or bronchitis. If a cat that was previously healthy develops a sudden, persistent cough that does not respond to standard anti-inflammatory treatment, a foreign body is one of the things your vet should consider. Diagnosis usually requires a procedure called bronchoscopy, where a tiny camera is threaded into the airways under anesthesia, and the object is often removed during the same procedure.
Flat-Faced Breeds and Breathing Problems
If you own a Persian, Exotic Shorthair, Himalayan, or another flat-faced breed, your cat’s hacking and noisy breathing may partly be baked into its anatomy. Brachycephalic cats have shortened skulls that compress the nasal passages and can lead to elongated soft palates, narrowed nostrils, and displaced nasal structures that increase resistance to airflow.11PLoS ONE. Flat Feline Faces: Is Brachycephaly Associated with Respiratory Abnormalities in the Domestic Cat (Felis catus)? The result is snoring, snorting, and sometimes genuine breathing difficulty, especially during exertion or in warm environments.
A large survey comparing brachycephalic and non-brachycephalic cats quantified just how much more frequently these problems occur. Flat-faced cats were roughly seven times more likely to snore, about eight times more likely to have nasal discharge, and roughly five times more likely to experience labored breathing than cats with normal-length faces. They also showed about 1.75 times the rate of coughing.12PubMed. Influence of feline brachycephaly on respiratory, gastrointestinal, sleep, and activity abnormalities These are not small differences. If your flat-faced cat has always made noisy breathing sounds, that is likely structural. But a new or worsening cough on top of baseline noisy breathing still warrants investigation, because brachycephalic cats can develop asthma, infections, and other respiratory diseases just like any other cat, and the pre-existing airway compromise makes those conditions more dangerous.
Less Common but Serious Causes
While the conditions above account for the majority of hacking in cats, a few rarer causes deserve mention because they can be life-threatening and are sometimes caught late.
Mediastinal masses, particularly lymphoma, can develop in the chest cavity and compress the airways or heart. A case report described a young cat presenting with progressive lethargy, poor appetite, coughing, and sudden breathing difficulty over two weeks. Imaging showed what looked like an enlarged heart, but postmortem examination revealed a large mass that had overtaken the front of the chest, compressed a lung lobe, and invaded the tissue around the heart. It was identified as B-cell lymphoma.13ScienceDirect. B-cell lymphoma invading and compressing the heart base and pericardium in a cat Mediastinal lymphoma is one of the more common thoracic cancers in cats and can affect relatively young animals. Coughing alone would not be enough to suspect cancer, but coughing accompanied by weight loss, declining appetite, or visible breathing trouble that worsens over days to weeks warrants thorough imaging.
Pleural effusion, the accumulation of fluid around the lungs, is another possibility. It can result from heart disease, infection, or cancer. A cat with fluid in the chest typically shows rapid, shallow breathing and reluctance to lie down, sometimes combined with episodes of hacking or gagging. The fluid physically prevents the lungs from fully expanding, and the cat compensates by breathing faster and harder.
When to Worry and When to Wait
Not every hacking episode requires an emergency vet visit. A cat that retches, produces a hairball, and goes back to acting normal is almost certainly fine. An occasional cough in an otherwise healthy cat that resolves on its own within a day or two is usually not an emergency either. But certain patterns should prompt you to seek veterinary care sooner rather than later:
- Persistent cough: Coughing that continues for more than a few days, recurs regularly, or seems to be getting more frequent deserves investigation. Chronic coughs rarely resolve without identifying the underlying cause.
- Breathing difficulty: Open-mouth breathing, rapid or labored respiration, visible effort to breathe (belly pumping), or blue-tinged gums are emergencies. Cats are obligate nasal breathers under normal conditions, so any cat breathing through its mouth is in distress.
- Loss of appetite or weight loss: If hacking is accompanied by your cat eating less or losing weight, the cause is more likely to be something systemic rather than a simple hairball.
- Lethargy or hiding: Cats mask illness, so a cat that suddenly becomes withdrawn, stops playing, or spends much more time than usual sleeping in unusual spots is telling you something is off.
- Productive cough: If your cat coughs up blood or thick mucus, see a vet promptly.
- Failed hairball: Repeated retching without producing anything over several hours can indicate an obstruction. If the cat is also refusing food, this is especially urgent.
Simple Steps That Can Reduce Hacking at Home
For cats whose hacking is related to mild hairball issues, regular brushing reduces the amount of loose fur they swallow. This is especially worthwhile for long-haired breeds. Some owners find that hairball-formula diets or petroleum-based hairball pastes help move swallowed fur through the gut more efficiently, though the evidence behind these products is mostly anecdotal rather than rigorously studied.
If asthma or allergies are suspected, environmental changes can make a real difference. Switch to an unscented, low-dust litter. Avoid air fresheners, scented candles, and strong cleaning products near your cat’s living spaces. If you smoke, do it outdoors, as secondhand smoke is a known airway irritant for cats. Running an air purifier in the rooms where your cat spends the most time can also help reduce airborne allergens.
For cats in heartworm-endemic regions, monthly preventive medication is the single most effective protection available. Since there is no safe treatment for established heartworm infection in cats, prevention is the entire strategy. Talk to your vet about which preventive product makes sense for your cat’s lifestyle, even if your cat stays indoors.
Keeping up with regular veterinary checkups is the less glamorous but genuinely useful catch-all recommendation. Many of the conditions behind chronic hacking, including early-stage asthma, subclinical infections, and even intestinal disease driving excessive grooming, are easier and cheaper to manage when caught before they progress. A vet who knows your cat’s baseline health can pick up subtle changes that are invisible at home until they become severe.