Chronic Cough

Symptoms, Doctors, Treatments, Advances & More

Chronic cough is a cough that lasts for several weeks or months. While a non-chronic cough from an acute (short-term) illness, such as the common cold, flu, acute bronchitis, and pneumonia, will usually subside within one to two weeks without any treatment, a chronic cough may last indefinitely and requires medical attention.

Chronic cough may also be referred to as persistent cough, lingering cough, nagging cough, habit cough, or Upper Airway Cough Syndrome (UACS).

Chronic cough is caused by several conditions, including postnasal drip, allergies, asthma, bacterial and viral upper respiratory infections (URIs), chronic sinusitis, chronic bronchitis (a form of COPD), chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), congestive heart failure (CHF), exposure to airway irritants, such as chemicals, pollution, and perfumes, certain medications for high blood pressure (ACE inhibitors), and smoking. Chronic lung infections, such as tuberculosis (TB), as well as lung cancer or cancer that has spread from other organs to the lungs, also cause chronic cough. Chronic cough can additionally be caused by a condition known as Cough Hypersensitivity Syndrome (CHS), or habit cough. Postnasal drip is a common condition where extra mucus is produced in response to allergens or upper respiratory infections (URIs) that irritate the throat and produce cough. This type of common chronic cough is also known as Upper Airway Cough Syndrome (UACS). Allergic reactions to pollens (trees, grass, ragweed), dust, and pet dander may trigger chronic cough. Asthma may cause chronic cough. Symptoms of asthma include wheezing, shortness of breath, and excessive mucus production. However, some types of asthma that are triggered by exercise or cold air may cause a persistent dry cough. Upper respiratory infections (URIs), such as the common cold, flu, or pneumonia may cause a persistent cough that lasts for a few weeks (one-to-three), even after the infection has subsided. Chronic sinusitis involves inflammation of the nasal and facial sinuses for three months or longer and can cause chronic cough due to infected postnasal drainage. Chronic sinusitis has several causes, such as allergies, nasal polyps, immune-related conditions, and respiratory tract infections and requires medical treatment.   Chronic obstructive pulmonary disease (COPD) is an inflammation of lungs that has two common types: 1) chronic bronchitis, and 2) emphysema, both of which cause chronic cough, shortness of breath, and wheezing. Chronic bronchitis causes swelling of the bronchial tubes in the lungs with a build-up of mucus, difficulty breathing, and frequent coughing. Emphysema damages the air sacs (alveoli) in the lungs and reduces oxygen saturation to the blood. Many individuals with COPD have both chronic bronchitis and emphysema. COPD is most often caused by long-term exposure to cigarette smoke or other lung irritants. People with COPD have an increased risk of heart disease and lung cancer as well as other conditions. COPD is a progressive disease that requires medical treatment. Gastroesophageal reflux disease (GERD), where stomach acid backs up into the lower esophagus causing heartburn, can cause chronic cough. This stomach acid reflux irritates nerves in the lower esophagus, triggering coughing. ACE inhibitors, which are medications for high blood pressure (lisinopril, captopril, enalapril and ramipril), can cause a chronic dry cough. Smokers often develop chronic cough, known as “smoker’s cough,” in addition to other conditions, such as chronic sinusitis, bronchitis, pneumonia, and lung cancer. Tuberculosis is a highly contagious lung infection that causes fever, night sweats, and severe cough with bloody phlegm. Lung cancer, in addition to other symptoms such as chest pain, fatigue, and shortness of breath, is also characterized by a chronic, productive cough that increasingly worsens and may include bloody phlegm. Congestive heart failure (CHF) is when a weakened heart cannot adequately pump blood, usually due to coronary artery disease and/or high blood pressure, which leave the heart too weak or stiff to fill and pump properly. Symptoms of CHF include persistent cough, shortness of breath, fatigue, irregular heartbeat, swelling in the lower legs, and chest pain. Cough Hypersensitivity Syndrome, or habit cough, is currently believed to be caused by neurological abnormalities.

In addition to a persistent cough that lasts several weeks, chronic cough is often associated with other symptoms, such as nasal congestion, postnasal drainage, sore throat, hoarse voice, shortness of breath, and wheezing. In the case of gastroesophageal reflux disease (GERD), individuals may also experience heartburn or indigestion.

Treatment for chronic cough depends on the underlying cause of the cough. While over-the-counter (OTC) cough medications can be used to manage symptoms of chronic cough, these are generally not effective for treating an underlying condition. However, a doctor may prescribe cough suppressants while determining the underlying cause of chronic cough. Decongestants can be useful for treating postnasal drip. If the chronic cough is caused by allergies, antihistamines and corticosteroids may be prescribed. Allergy shot treatment (immunology) can reduce allergic reactions. Treatment for asthma requires the use of inhalers (corticosteroids and bronchodilators) that help both to control inflammation and ease breathing during an acute asthma attack. Upper respiratory infections (URIs), chronic sinusitis, and bronchitis are treated according to their cause (bacterial or viral) and can include the use of aspirin or acetaminophen, decongestants, corticosteroids, and/or antibacterial and antibiotic medications. Chronic sinusitis may further require surgery. Chronic obstructive pulmonary disease (COPD): Treatment for the two main causes of COPD, 1) chronic bronchitis, and 2) emphysema, involves lifestyle changes such as quitting smoking, avoiding secondhand smoke and other lung irritants, physical activity, pulmonary rehabilitation, and nutritional therapy. Medications for chronic bronchitis and emphysema include bronchodilators, antibiotics, and oxygen therapy, while lung transplant may be considered for severe cases. Gastroesophageal reflux disease (GERD) can be treated with changes in diet, medications that decrease stomach acid production (antacids, H-2 receptor blockers, proton pump inhibitors), Baclofen, a medication which slows relaxation of the lower esophageal opening, and surgery. Smoking cessation can be achieved through interventions such as behavioral support and medications, including nicotine replacement therapy (patch, gum, lozenge, inhaler, and nasal spray), bupropion, and varenicline. Tuberculosis treatment is based on antituberculosis medications, typically isoniazid (INH), which is sometimes used in combination with three other drugs—rifampin, pyrazinamide, and ethambutol. Lung cancer is treated with chemotherapy, radiation, surgery, immunology, and/or a combination thereof. Congestive heart failure (CHF) treatment includes medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers, diuretics, aldosterone antagonists, inotropes, and digoxin , and surgery (coronary artery bypass grafting, heart valve repair or replacement, or pacemaker implantation). Cough Hypersensitivity Syndrome (CHS), or habit cough, can be treated with medications and speech therapy. Home remedies and lifestyle changes, such as drinking warm liquids, using cough drops, a tablespoon of honey, a cool-mist humidifier, or a warm shower, and avoiding tobacco smoke can help to ease the symptoms of chronic cough while also following medical treatment.

Numerous online, local, national, and international support groups are available that focus on the underlying conditions for chronic cough, including: American Lung Association COPD Support Groups - https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/finding-support Asthma and Allergy Foundation of American Support Groups - https://www.aafa.org/aafa-affiliated-asthma-allergy-support-groups/

Chronic cough is a common condition that requires working with your doctor to discover the underlying cause and is generally manageable with proper treatment.

Chronic cough can impact a person’s quality of life. Persistent cough can lead to a sore throat, hoarse voice, fatigue, sleeplessness, difficulty concentrating, and headaches. Some individuals with chronic cough may further experience urinary incontinence. Severe, chronic cough can even cause hernia and/or bruised or broken ribs.

For a cough that lasts longer than three-to-eight weeks, and/or is accompanied by any acute symptoms such as chest pain, shortness of breath, coughing up blood, or fever contact a medical professional immediately.

Ways to prevent chronic cough include stopping smoking, reducing second-hand smoke exposure, avoiding other potential lung irritants, controlling allergies, and seeking medical treatment for increasingly severe or lingering cough following colds and flu, or any continuing cough for more than three-to-eight weeks. Always practice good handwashing, use disposable tissues for nasal discharge, and avoid touching the face or eyes to prevent infection.