Understanding Chronic Cough

For many people, a cough is an annoying symptom that starts with an upper respiratory tract infection. The cough may last for weeks and then slowly fade. However, some people experience a cough that continues long after an illness. This is called chronic cough.

A man in a blue and white checkered shirt is coughing into his hand. He appears to be standing against a dark background, looking downward.

A chronic cough is one that lasts eight weeks or more in adults and four weeks or more in children. It can cause headaches, disrupt sleep and daily activities, and lead to lung damage.

Many conditions can cause chronic cough. In addition to respiratory viruses, these conditions may include asthma, postnasal drip and gastroesophageal reflux disease (GERD). Some people develop symptoms after getting COVID-19. Smoking or being around secondhand smoke raises the risk of developing a chronic cough. Environmental factors, like dust exposure at work, can also play a role.

How common is chronic cough? It affects about 12 million adults, or about 5% of the adult population, in the United States. It is more common in older adults and women. The typical person with chronic cough is a woman in her 50s. Many people may have a lingering cough and not realize that it is part of a chronic medical condition.

Important note on chronic cough

A chronic cough is nothing to shrug off. It could be a symptom of a manageable condition like asthma, allergies or GERD. Or it may be an indication of a severe lung disease such as IPF. What is consistent across research is that people with a chronic lung disease and chronic cough have worse outcomes. If you have a cough lasting more than 8 weeks, it is imperative that you see a healthcare provider. Find out the underlying cause for your cough. This will guide appropriate treatment.

Chronic cough can be triggered by many things, including allergens, dust, secondhand smoke, strong smells, cold air, and even laughing and singing. People with this condition typically cough in “bouts” they cannot control. They usually feel a strong urge to cough or a tickle in their throat before a coughing bout starts.

Remember, a chronic cough can be a symptom of an underlying condition. It is important to consult a healthcare provider to review potential causes and treatment options.

Chronic cough symptoms

The primary symptom of a chronic cough is a daily cough that lasts a long time. For it to be classified as chronic, adults must have a cough for at least eight weeks. In children, the cough must last four weeks or more to be considered chronic.

People who have a chronic cough often experience related symptoms. These may include:

  • a runny or stuffy nose
  • fluid draining down the throat (called postnasal drip)
  • hoarse voice or need to clear the throat frequently
  • sore throat

With a chronic cough, some people may wheeze or feel shortness of breath easily. Some may also have frequent episodes of acid reflux causing heartburn (or GERD). Very severe chronic coughs may also cause vomiting or even blood tinged mucus.

How is chronic cough diagnosed?

If you have a cough that lasts for eight weeks or longer (four weeks or longer in children), it’s important to work with a healthcare provider to confirm a diagnosis that is the cause of the chronic cough.

Diagnosis starts with a detailed health history and a physical exam. Then your doctor may do one or more of the following:

  • Lung function tests. Your doctor may perform tests like spirometry, peak expiratory flow tests, methacholine challenge tests, or FeNO tests.
  • Imaging. X-rays and CT scans of the chest, lungs, or sinuses will check for infections. It can also help to rule out something like lung cancer.
  • Blood or lab tests. Blood tests can indicate infections. Testing the mucus from your cough can identify bacterial infections or fungi.
  • Bronchoscopy or rhinoscopy. These procedures let your doctor examine your lungs or sinuses with a camera and collect tissue samples for testing.
A doctor uses a stethoscope to listen to a patient's back during a medical examination. The patient is seated and holding their chest. The room is brightly lit with blinds partially closed on the window.

Respiratory conditions linked to chronic cough

What causes chronic cough? It can occur as a symptom of different medical conditions, including respiratory or lung diseases.

Chronic cough from asthma

Cough is a common symptom of asthma. Many people with asthma have chronic cough symptoms. If you visit a doctor with a chronic cough, you may get screened for asthma.

Research indicates that people with asthma who also have chronic cough tend to have worse asthma control. They may report more asthma flare-ups, use their quick-relief inhaler more frequently, and require oral corticosteroids (OCS) for treatment.

If you or your child has chronic cough, see a healthcare provider who can perform lung function tests. Find out if you have an asthma-related cough so you can get the right treatment plan. If you already are diagnosed with asthma, then a chronic cough might mean your current treatment plan is not working well.

Upper airway cough syndrome and chronic cough

Upper airway cough syndrome (UACS) used to be known as postnasal drip syndrome. It is one of the most common reasons for chronic cough. Along with asthma and GERD, UACS accounts for 90% of chronic cough cases.

People with UACS often have postnasal drip in their throat. They may have irritation or inflammation of the cough receptors.

There is no clear way to specifically diagnose UACS, leading to debate about whether it is a distinct medical condition.

COPD and chronic cough

Chronic obstructive pulmonary disease (COPD) blocks airflow in the lungs. This blockage comes from long-term inflammation and lung damage due to inhaling harmful substances, such as tobacco smoke.

Many people with COPD have chronic bronchitis along with a chronic cough. They may ignore the cough, believing it is just from smoking. Some may not see it as a sign of COPD. That’s why it’s vital that people with chronic cough symptoms see a healthcare provider to get an accurate diagnosis.

Chronic rhinosinusitis (CRS) and CRS with nasal polyps

Chronic rhinosinusitis is a long-lasting sinus infection. It lasts twelve weeks or more. Some people with CRS also have nasal polyps. These are noncancerous growths in the nasal and sinus passages.

Both CRS and CRS with nasal polyps can cause a chronic cough. This happens because both conditions often lead to sinus congestion, a runny nose, and postnasal drip.

Chronic cough and allergy symptoms

People with environmental or seasonal allergies may develop allergic rhinitis. This condition causes a stuffy or runny nose, drainage in the throat, and an itchy or scratchy throat. If left untreated, allergies can lead to chronic cough.

Interstitial lung diseases

Interstitial Lung Diseases (ILD) are a group of more than 300 lung diseases affecting 650,000+ people in the United States. These diseases are characterized by inflammation and scarring of lung tissue. This can alter lung function, sometimes permanently. One of the first signs of an ILD is often a dry cough.

Many ILDs are “idiopathic,” meaning they have no apparent cause. Others are caused by connective lung tissue disorders or occupational exposures due to air pollution, bacteria or tobacco smoke.

Pulmonary fibrosis with dry chronic cough

Pulmonary fibrosis (PF) involves damaged and scarred lung tissue. It can make breathing hard. The damage can come from smoking tobacco, exposure to toxins or taking cancer treatments. Often the cause is unknown (idiopathic). About one-third of all interstitial lung diseases are idiopathic pulmonary fibrosis (IPF).

Pulmonary fibrosis is serious and cannot be reversed. A dry, persistent cough is often one of the first signs. More than half of those with PF report having this cough.

A lung specialist such as a pulmonologist can evaluate you for PF. If you’re diagnosed with the condition, your doctor will discuss treatment to slow the disease. However, worsening cough and disease progression are common. It’s also important to monitor activity tolerance, shortness of breath, and oxygen needs.

Sarcoidosis

Sarcoidosis occurs when groups of immune cells form lumps on various organs in the body. The lumps are called granulomas. They usually occur in the lungs and lymph nodes in the chest. While it is unknown what causes the condition, it’s believed that inflammation and an overactive immune system may play a role.

Sarcoidosis symptoms include breathing problems that mimic asthma (cough, wheeze, shortness of breath and chest pain) and reduced lung function. Symptoms can lead to permanent lung damage (including scarring).

The disease can affect anyone, but people over 20 years of age and women are more likely to develop it. Black Americans are at higher risk for sarcoidosis and may experience more severe symptoms.

Connective tissue disease

Connective tissue diseases (CTDs) autoimmune diseases. They are often linked to interstitial lung disease (ILD). Types of CTDs include scleroderma, rheumatoid arthritis, Sjogren’s syndrome and systemic lupus erythematosus.

Some people with a CTD later develop a cough, shortness of breath and other lung symptoms. This can lead to an ILD diagnosis. In others, lung symptoms are the first issue. These symptoms are later found to be caused by a CTD.

GERD with chronic cough

Chronic cough is often linked to gastroesophageal reflux disease (GERD). GERD symptoms can trigger coughing, just as it triggers coughing that causes asthma symptoms. GERD symptoms include frequent heartburn, acid reflux, belching or gas. Some people may also have a sore or hoarse throat.

If you have chronic cough, it’s important to see a healthcare provider to determine the cause. GERD may be contributing to it if your cough gets worse when you lie down and improves when you sit or stand. This type of cough typically does not cause shortness of breath.

Bronchiectasis with chronic cough

Bronchiectasis is a disease in which the walls of the airways become thick and enlarged due to scarring from inflammation and repeat infections. The damage makes it hard to clear mucus. When mucus builds up, bacteria can grow, leading to repeat infections.

There is no cure for bronchiectasis. Treatment often focuses on reducing inflammation and addressing infections, such as with antibiotics. Some people may need oxygen therapy to improve breathing or surgery to clear blockages.

Bronchiectasis occurs mostly in people age 75 or older – but it can develop at any age. It is more common in women than men.

A person wearing a scarf sits at a desk, coughing into their hand. There is a computer, tissue box, and medicine bottle on the desk. The setting appears to be an office.

Cystic fibrosis and chronic cough

Cystic fibrosis (CF) is a genetic disease that affects cells responsible for making fluids such as mucus, causing them to become thick and sticky. This thick mucus can build up in the lungs, making CF a condition that commonly affects breathing. Chronic coughing is a common symptom of CF and may worsen as the disease progresses.

All 50 states began newborn screening for cystic fibrosis by 2010, and most people who were not screened at birth are diagnosed by age 2. In adults, CF testing may be considered for recurrent lung or sinus infections, bronchiectasis, inflammation of the pancreas, or male infertility.

In the 1950s, many people with CF did not survive into childhood. Advances in treatment have improved outcomes. Today, the average life expectancy for people with CF is approaching 50 years, with children born in the past decade expected to live even longer.

Chronic cough from an infection or virus

Pneumonia, the flu, COVID-19 and colds can cause coughing symptoms for weeks. Coughs can last even after the infection symptoms fade away. If your cough lingers, consult a doctor. Some rare causes of chronic cough are whooping cough (pertussis), certain fungal infections and tuberculosis.

Chronic cough from environmental factors

Every breath you take brings in particles from your environment. For people with chronic cough, it is important to monitor for environmental exposures.

Do you smoke or are you around smokers? Are there allergens and irritants in your home, such as mold or chemicals from cleaning products? Are you around chemicals at work? Is there wildfire smoke nearby? Each of these can trigger the cough reflex and worsen chronic cough.

In addition to treatment, it’s important for patients to identify and then find ways to avoid triggers.

Chronic cough and obstructive sleep apnea

Obstructive sleep apnea (OSA) is a medical condition that occurs when muscles in the throat relax during sleep. Soft tissue in the back of the throat collapses and blocks the upper airway. This can result in a reduction of airflow and oxygen to the lungs. It causes coughing, gasping, gagging and choking.

Many people with OSA report chronic cough, but the cause of the link is unclear. OSA is more common in men, older adults and people with a high body mass index (BMI). Many people improve OSA and chronic cough after using a CPAP (continuous positive airway pressure) machine, the primary treatment for OSA.

Chronic cough treatment

Treatment for a chronic cough depends on the underlying cause. Your healthcare provider may begin with initial treatments based on your symptoms and medical history. This approach can help relieve your cough and provide useful clues about what may be triggering it, often before more invasive or complex testing is needed.

If your cough improves, it can help to confirm the diagnosis. If symptoms continue, your doctor may recommend additional tests or adjust your treatment plan to better address the cause.

A young man wearing a gray T-shirt is coughing and touching his chest. He is at a medical consultation with a doctor, who is observing him and holding a stethoscope.

Medications to treat chronic cough and other lung diseases

Medications that treat associated conditions – like asthma drugs – can help with chronic cough symptoms:

  • Antihistamines. These pills can help treat allergies that trigger coughing. Many are available over the counter.
  • Decongestants. These pills help relieve sinus congestion and nasal drip, which can lead to coughing.
  • Short-acting and long-acting inhalers. Short-acting inhalers help with sudden asthma symptoms. Long-acting inhalers are taken daily to control inflammation and coughing.
  • Inhaled corticosteroids. These are used to treat inflammation and control cough for asthma.
  • Antibiotics. These pills may be prescribed if your doctor thinks an infection is causing the cough.
  • Acid reflux medications. These can help reduce GERD symptoms. They include antacids and proton pump inhibitors.
  • Cough suppressants. Over-the-counter or prescription cough suppressants (or cough medicines) can help manage symptoms for a short time until the cause is identified or diagnosed.
  • Anti-fibrotic and cytotoxic medications. These help treat lung scarring, particularly in cases of ILD.
  • Immunosuppressants. These are used for conditions where the immune system is overreacting, such as sarcoidosis.
  • Biologics. These are injectable medications taken every 2-4 weeks. Biologics can treat moderate to severe asthma, chronic rhinosinusitis with nasal polyps, and certain autoimmune diseases.

Additional treatments for chronic cough

Your doctor might recommend extra treatments in addition to taking medications:

  • Pulmonary rehabilitation. This is a program for people with chronic lung diseases. It includes supervised education and exercise. Patients collaborate with respiratory therapists and physical therapists, in addition to doctors and nurses. The focus is on reducing respiratory issues and improving physical fitness. This program connects you with others who may be experiencing similar respiratory issues.
  • Oxygen therapy. If your lung disease prevents you from getting enough oxygen, your doctor will prescribe oxygen therapy.
  • Lung transplant. This is only considered for very severe cases of COPD, cystic fibrosis and certain interstitial lung diseases (idiopathic pulmonary fibrosis and sarcoidosis). Doctors may decide that a lung transplant is the only way to improve breathing and quality of life. This decision carries significant risks and is not made lightly, but it can be a viable option for some severe cases.

Lifestyle adjustments for chronic cough relief

Avoiding triggers is an important part of managing a chronic cough, especially at home where you may spend most of your time. Making a few simple changes can help reduce irritation and ease chronic cough symptoms, including:

  • Quit smoking and don’t allow smoking in your home.
  • Focus on indoor air quality interventions to limit environmental triggers.
  • Drink plenty of water to help thin mucus.
  • Suck on a hard candy or throat lozenge, or put honey in some tea to help soothe a cough.
  • Adjust the way you sleep – you may find that sleeping slightly propped up helps you breathe better and reduces mucous build up.

Questions & answers (Q&A) on chronic cough

Do you have questions about chronic cough? Here’s a Q&A with some common questions we’re asked about this condition. If there’s a question you would like to see addressed here, email our editor.

Coughs are often worse at night because mucus collects in the back of the throat when lying down. This leads to more coughing. For those with GERD, lying flat can make acid reflux worse and lead to coughing. Try lying semi-reclined to help calm your cough.

At night, indoor allergens such as dust mites or pet dander may cause respiratory problems. Talk to an allergist to find the source.

A cough is a normal way of getting something out of your airways that is irritating or harmful. But a chronic cough could lead to lung damage if it causes small tears in the lungs from the force of the cough. Remember that a chronic cough could also be a symptom of underlying lung disease..

Only coughs caused by infectious illnesses, such as a cold, the flu, COVID-19 or pneumonia, are contagious. A cough caused by asthma or GERD is not contagious.

Treatment for a chronic cough is not one size fits all. Your doctor may start with treating the cause of your cough. For example, your doctor might prescribe short-acting and long-acting inhalers to treat asthma or proton pump inhibitors to treat GERD. Or your doctor might start you with allergy medications to help reduce chronic cough symptoms.

When treatments don’t work, further testing may be needed. Unfortunately, some lung diseases that can cause chronic cough cannot be reversed. That is why it is important to see a doctor about your symptoms and follow up to see if the treatment is effective.

There isn’t a single cure for chronic cough, but treating the condition that’s causing it can often bring relief. For example, when asthma is well controlled with the right medications, a long-lasting cough may improve or even go away. Identifying and managing the underlying cause is the key to reducing chronic cough symptoms.

Coughing is often linked to illnesses, like a bad cold or the flu. These viruses usually cause short-term coughing that may last a few weeks. However, if you cough daily for 4-8 weeks or more, it may indicate a chronic condition. Several chronic conditions can lead to coughing, irritate the airways and damage the lungs, even when you aren’t sick with a virus.

If your cough won’t go away, it may be because the underlying cause hasn’t been fully identified or treated yet. Chronic cough can be triggered by several conditions, such as asthma or acid reflux. More than one cause may be involved at the same time.

Some treatments take time to work, while others may not help if they don’t match the true cause of your cough. That’s why ongoing symptoms should be evaluated by a healthcare provider, who can reassess triggers, adjust treatments, or recommend further testing to get to the root of the problem.

A habitual cough is a type of chronic cough. It is a functional disorder, mostly in children, when coughing becomes a learned behavior. Stopping a habitual cough requires treating the underlying cause of the cough. If the cough becomes habitual, it’s important to see a healthcare provider.

With effective treatment of the underlying cause of your cough, symptoms may gradually improve within a few weeks of starting medication. It will depend on the treatment. If symptoms do not improve, check in with your healthcare provider to revise your treatment plan.

Phlegm is another word for mucus, which is an important part of your immune system. It helps trap irritants before they get into your lungs. But different colors of phlegm can mean different things. For example, people who smoke often have a chronic cough with brown phlegm. People with allergies and asthma often have a chronic cough with clear or white phlegm.

Your doctor may ask you about the color of the phlegm you cough up. In some cases, your doctor may collect a sample for further testing.

Reviewed by:
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as a media spokesperson and Chair of the Medical Advisory Council for Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).