The present disclosure is directed to the detection of coughs and coughing episodes using acoustic signals. In various examples, an implantable medical device processes an acoustic signal obtained from an acoustic sensor to determine whether a patient has coughed. In some examples, the implantable medical device also performs a cough severity assessment. In some examples, the cough severity assessment may include a determination of the depth of the cough, the duration of the coughing episode, or whether the cough was wet or dry.