A strong cough in the middle of the night may be caused by the following reasons: 1. The vagus nerve is more excited at night, and the bronchial smooth muscle contracts more strongly, which increases respiratory secretions and causes a cough reflex, so the cough is more severe at night. 2. Wind and cold: Because the temperature is lower at night and the air is dry, it is easy to invade the respiratory tract and cause mucosal irritation and bronchospasm, which results in a more pronounced cough. 3, Heart disease: Especially for patients with nocturnal paroxysmal dyspnea, hypertension, diabetes, coronary heart disease and other diseases, the possibility of acute heart failure should be ruled out.4. Cough variant asthma: A bronchial excitation test can be improved to clarify the diagnosis.5. When suffering from reflux esophagitis, gastric acid reflux to the throat occurs at night when lying down, so a severe cough at night can occur. If the cough is more pronounced at night and shortness of breath and airway spasm are evident, it is still recommended to visit the emergency department of the hospital to identify the cause before using medication.