What is chronic cough?
Chronic cough is usually defined as a cough that lasts more than eight weeks in adults and four weeks in children. Chronic cough is one of the most frequent reasons for visits to the doctor. Chronic cough isn't a disease itself. It's a health problem that results from other health conditions.
What causes coughing?
Your throat is a very sensitive part of the body. The lining of your throat can sense touch, temperature, taste and position. You can sense these things even while you are breathing and eating. Your throat is responsible for getting food and air into the right tubes, making sure you don’t choke. The main job of your throat is keeping your airway safe and clear so you can breathe. A cough can be either voluntary or automatic.
Coughing is one method our bodies use to keep us healthy, but a cough that lasts a long time can affect your life in many ways. Coughing can keep you up at night and make your days miserable from muscle pain and being tired. It’s important to find out why your cough won’t go away.
Who is most likely to experience chronic cough?
People who use tobacco, especially smokers, are at a high risk of developing chronic cough. There is even something called ‘smoker’s cough’ that lasts longer than three weeks. The cough begins when your body tries to clear itself of the irritants that enter when you smoke.
Other people at risk of developing chronic cough include those with certain conditions, including:
Symptoms and Causes
What causes chronic cough?
There are several medical conditions that are linked to chronic cough. These include respiratory conditions, such as:
- Asthma: This is the second most frequent cause of chronic cough. Shortness of breath and wheezing happen when you have asthma. These breathing difficulties can result in a chronic cough. There is also a form of asthma (cough-variant asthma) where chronic cough may be the only symptom.
- Bronchiectasis: This condition causes coughing because mucus builds up and lung tissue gets thicker.
- Bronchitis: This condition is a known cause of coughing due the swelling that happens in the bronchial tubes and the increase in mucus production. There are two types —chronic and acute.
- Chronic obstructive pulmonary disease (COPD): COPD is actually a term that refers to a group of respiratory issues that includes chronic bronchitis and emphysema.
- Upper respiratory conditions like flu, pneumonia and colds: These infections are generally caused by viruses. Coughing is one symptom that tends to last after the others are through. The viruses attack the nose, the throat and the sinuses.
Other reasons for chronic cough include sinusitis and allergies. Sinus problems and allergies, along with upper respiratory infections, produce post-nasal drip. This drip is sometimes feels like “a tickle in the back of the throat,” and drainage can lead to chronic cough. This “tickle” happens when the amount of draining mucus is larger than usual.
Many people might worry about cancer if they have a chronic cough. It's possible that coughing that won’t stop is a sign of cancer of the lung or upper airway, but that isn't the most likely cause.
Finally, chronic cough is a well-known side effect of angiotensin-converting enzyme (ACE) inhibitors, a specific group of drugs used to treat high blood pressure. These drugs may be used for other things, like preventing kidney damage if you have diabetes. Some common ACE inhibitors are:
- Benazepril (Lotensin®, Lotensin® Hct).
- Captopril (Capoten®).
- Enalapril (Vasotec®).
- Fosinopril (Monopril®).
- Lisinopril (Prinivil®, Zestril®).
- Moexipril (Univasc®)
- Quinapril (Accupril®).
- Peridopril (Aceon®).
- Ramiparil (Altace®).
- Tandolapril (Mavik®).
If you have a chronic cough and you take one of these medications, you shouldn’t just stop taking the medication on your own. Talk with your healthcare provider about what’s going on. They'll probably be able to recommend a different medication.
What other symptoms might you have if you have a chronic cough?
Some symptoms can be more common and less likely to be serious, such as:
- A runny or stuffy nose.
- Post-nasal drip (‘tickle' in the back of the throat).
- Wheezing or shortness of breath.
- Sore throat or frequent throat clearing.
- Fever (higher than 101°F).
Other symptoms might be more serious, such as:
- Weight loss without any effort.
- Coughing up phlegm or blood.
- A hoarse voice that does not go away.
- A drenching overnight sweat.
What are the complications of chronic cough that goes untreated?
Chronic coughing can affect your life in negative ways that disrupt your daily routine. The most obvious is that you can become extremely tired because you can't sleep (insomnia). Coughing nonstop can also make your muscles hurt and break your ribs.
You might also find that you have:
Diagnosis and Tests
What tests will be used to diagnose the cause of chronic cough?
Diagnosing the cause of chronic cough can be difficult. This may be because many patients have more than one thing causing their cough. Therefore, many types of tests are used to diagnose the causes. The other symptoms will help determine which tests are needed.
For both adults and children, but especially for children, the answers to questions your healthcare provider asks will provide clues about the cause. They'll ask questions such as when the coughing started, what seems to trigger the cough, and questions about the nature of the cough (like is it a dry cough or does it produce mucus). The answers will suggest what kind of testing is needed.
Lab tests help determine if bacteria are present (a sign of an infection) and are causing the cough. The most common of these involve blood tests. Others might test mucus that you cough up.
Lung function tests are tests that tell your healthcare provider how well your lungs are working. They are also called pulmonary function tests. These measure your breathing patterns — from inhaling to exhaling. Spirometry is one type of lung function testing, while others are lung volume testing, gas diffusion studies and the six-minute walk test.
Imaging tests include X-rays, CT and MRI scans, ultrasound and nuclear testing. X-rays reveal the more common reasons for chronic cough, such as a build-up of fluids in the areas that help breathing, as well as lung diseases and lung cancer. All of the other imaging tests provide more detailed views of areas of the body that affect breathing.
Scoping studies are tests that use a scope. This is an instrument that combines a camera and a long tube. To find the reason for a chronic cough, a scope is passed into certain areas of the body that might reveal a problem. For example, a scope can be passed:
- Up through the nostrils to look for signs of infection or blockages in the nasal passages.
- Through the nose into the voice box area to look for signs of acid reflux, post-nasal drip and abnormalities in the upper airway.
- Down the esophagus and into the stomach to measure the level of acid, which would help determine if acid reflux is the cause of chronic cough.
- Down the windpipe and into the bronchial tubes to look for blockages and signs of infections in the lung.
In terms of diagnosis, there’s one last thing you might hear. Sometimes, the cause of chronic cough cannot be found, so the cough is said to be idiopathic. (This is the medical term used when a cause is unknown and stays that way.) The cough that can’t be stopped might also be called unexplained chronic cough or chronic refractory cough.
Management and Treatment
How is chronic cough treated?
Your healthcare provider will discuss a treatment plan that will be based on your needs and the cause of the cough.
Possible treatments include new or different medications. If you are having chronic cough due to ACE inhibitors, your doctor might prescribe a different type of medication for your high blood pressure. It’s important to note that you shouldn’t just stop taking a medication without discussing it with your healthcare provider or pharmacist.
Drug treatments for asthma include inhaled bronchodilators and/or steroids. These drugs help reduce airway inflammation and wheezing.
For infections such as bacterial pneumonia or bronchitis, your provider might prescribe antibiotics, such as azithromycin (Azithrocin®, Zithromycin®), cefuroxime (Ceftin®) or cefprozil (Cefzil®), are prescribed.
For some conditions, like GERD, your provider might suggest a combination of non-drug treatments and prescription medications. Non-drug treatments include:
- Using pillows to prop up your head when you're lying down.
- Avoiding foods that cause acid reflux (such as chocolates, colas, red wines).
- Not eating right before bedtime.
Prescription medicines that treat GERD by reducing stomach acids include:
- Cimetidine (Tagamet®).
- Famotidine (Pepcid®).
- Ranitidine (Zantac®).
- Esomeprazole (Nexium®).
- Lansoprazole (Prevacid®).
- Omeprazole (Prilosec®).
If the cause is post-nasal drip, over-the-counter decongestants, such as diphenhydramine or pseudoephedrine, may help relieve symptoms. Antibiotics may be prescribed if the cause of the chronic cough is sinusitis. Nasal spray, such as ipratopium (Atrovent®) can relieve a runny nose, sneezing and post-nasal drip. A nasal glucocorticoid, such as fluticasone (Flonase®), can also reduce post-nasal drip.
In the case of unexplained chronic cough (UCC), your healthcare provider might suggest that you see a speech/voice pathologist. Voice therapy for coughing is called behavioral cough suppression therapy (BCST).
The therapy will start with education and by explaining cough hypersensitivity reflex — that some people just cough more easily because their body is more sensitive to things that make people cough. Many people with UCC have triggers that make them cough like talking or laughing, environmental stimuli like sprays or aerosols, and even smaller changes in air temperature or the position of the body (laying down or bending over) bother these more sensitive people. BCST teaches you how to control the urge to cough through various behavioral techniques.
In therapy, you will learn how to do other things with the muscles you use for coughing. Those are the muscles that bring your vocal cords together, along with the muscles in your throat used for swallowing and breathing.
There are other next-level treatments for UCC such as oral medications:
- Neuromodulators (amitriptyline, gabapentin) or tramadol, a pain reliever.
- A superior laryngeal nerve block with steroids.
- Laryngeal onabotulinumtoxinA (Botox®) injections.
Sometimes more holistic treatment such as acupuncture can also be helpful. If other treatments have failed and the chronic cough is severe, a cough suppressant such as codeine may be prescribed.
What can I do to prevent or relieve the symptoms of chronic cough?
To prevent chronic cough:
- Quit smoking, or don't start smoking, since this is the most common reason for chronic cough.
- Avoid contact with anyone you know who may have bronchitis or pneumonia.
- Eat fruit and foods that contain fiber. Research suggests that a combination of fiber and flavonoids found in fruit may prevent chronic cough.
To relieve the symptoms of chronic cough:
- Drink plenty of water (at least eight 8-ounce glasses a day).
- Gargle with warm saltwater to help remove any mucus.
- Inhale steam.
- Avoid inhaling dust, smoke or other pollutants as much as possible.
- Use extra pillows at night to prop up your head and upper body.
- Try cough lozenges.
- Try over-the-counter cough medicines that contain guaifenesin and/or dextromethorphan.
When should I call my doctor about a chronic cough?
Call your doctor if you are:
- Coughing up blood or phlegm.
- Running a fever (temperature greater than 101°F).
- Losing weight without trying.
- Having a drenching sweat overnight.
A note from Cleveland Clinic
Chronic cough is one that lasts longer than eight weeks in an adult and four weeks in a child. If coughing is having a negative impact on your life, contact your healthcare provider to find a cause. Finding a cause will let you find a treatment, so you can go back to sleeping, eating, moving and feeling well.