Chronic cough is a persistent cough that lasts for at least eight weeks, and often much longer. Although cough is a common symptom of many lung diseases, chronic cough can always be linked to another disease or condition and it often doesn’t respond to treatment. If you have chronic cough it can feel like a burden on your daily life, with lack of sleep, mental and physical exhaustion and social stigma impacting your quality of life.
There are two types of chronic cough:
- “Symptomatic” chronic cough is caused by an underlying disease and can be treated once the disease is diagnosed.
- “Refractory” chronic cough is a cough that persists despite guideline based treatment.
Terms to Describe Chronic Cough
- Chronic: This means long term. When diagnosing cough, there are three lengths:
- “Acute cough” is one that lasts less than three weeks
- “Subacute cough” is one that lasts three to eight weeks
- “Chronic cough” lasts longer than eight weeks
- Refractory: This means the cough hasn’t been controlled after multiple testing and specific treatments as well as having tried various over-the-counter treatments from your healthcare provider.
What Causes Chronic Cough?
Common Causes
Up to 90% of cases are caused by a “pathogenic triad” of conditions:
- Postnasal Drip (UACS): Excess mucus from the nose or sinuses drips down the throat, triggering the cough reflex.
- Asthma: Often presents as a dry cough, which may be the only symptom in “cough-variant asthma”.
- Gastroesophageal Reflux Disease (GERD): Stomach acid flows back into the esophagus, irritating the airway nerves.
Other causes include:
- Infections: Lingering after-effects of pneumonia, flu, or whooping cough.
- Medications: ACE inhibitors used for high blood pressure often cause a dry, nagging cough.
- Smoking: Chronic bronchitis and COPD are common in current or former smokers.
- Cough Hypersensitivity Syndrome: Nerves in the airway become oversensitive, causing a cough in response to minor triggers like cold air or strong smells.
When to See a Specialist
Consult a healthcare provider at Cleveland Clinic or Mayo Clinic if your cough persists beyond 8 weeks. Seek immediate medical attention for “red flag” symptoms:
- Coughing up blood
- High fever or drenching night sweats
- Unexplained weight loss
- Significant shortness of breath or wheezing
Diagnosis & Treatment
Diagnosis typically involves a physical exam, Chest X-ray, and lung function tests like spirometry.
- Targeted Therapy: Treatment focuses on the underlying cause—such as antihistamines for postnasal drip, inhalers for asthma, or acid blockers for GERD.
- Refractory Cough: If no cause is found, doctors may prescribe neuromodulators (like gabapentin) or refer you for speech-language therapy to learn cough suppression techniques.
- Home Relief: Stay hydrated with warm liquids, use a humidifier, and avoid irritants like tobacco smoke.