Chronic Cough: Frequently Asked Questions
A cough is the most common reason people go to the doctor. Coughing clears our airways of irritants, pathogens, and mucus in a rush of air that travels at close to the speed of sound. A cough is considered chronic if it lasts more than eight weeks in adults or a month in children. Understanding chronic coughs can make it easier to learn how to handle them yourself, and when to seek medical advice.
There are many reasons for chronic coughs. Some of the most common are:
A form of asthma called cough-variant asthma
Acid reflux that irritates your throat or esophagus
Blood pressure medications called ACE inhibitors
An infection like a cold or pneumonia can leave you with a cough that lingers long after the infection is gone, and allergies also can cause chronic coughs. Smokers may develop chronic bronchitis or other respiratory diseases that cause coughs.
A cough is a reflex that can irritate your airways and lead to more coughing, which leads to more irritation. Coughing can also become a habit that can be hard to break. Until you or your doctor address the source, the cough may stay with you.
Generally, even a long-standing chronic cough doesn’t indicate a need for real concern. Your doctor can treat many of the underlying causes, whether it’s an infection, allergy, acid reflux, or due to medication. There are times, however, when a chronic cough can be a symptom of serious illness, especially if you use tobacco. Smokers are at higher risk for developing COPD (chronic obstructive pulmonary disease) or lung cancer, both of which cause chronic cough, though smoking is not the only reason you may develop these diseases. If you do use tobacco, talk with your doctor about getting help so you can quit.
If you feel a strong urge to cough when you talk, you may have laryngopharyngeal reflux (LPR), which is a kind of acid reflux. It’s similar to GERD (gastroesophageal reflux disease), which irritates your esophagus, but LPR irritates your voice box, or larynx. When you talk with an irritated larynx it can activate the cough reflex. You may also feel the urge to cough when you eat, drink or laugh and your voice may be hoarse or sound different than it usually does.
Treatment for LPR is the same as for GERD. You can try changing your diet by avoiding high-fat foods, caffeine, alcohol, and spicy foods, especially within several hours of going to bed. If that doesn’t work, consult your primary care provider.
If your cough is due to acid reflux, it may get worse at night because your reflux does. Stomach acid becomes more concentrated at night, and when you lie down to go to bed, gravity doesn’t help force it back into your stomach. Swallowing also pushes stomach acid back down, but swallowing occurs less often when sleeping.
Most specialists believe there is a direct link between GERD and asthma. Droplets of stomach acid that make it up into the throat can find their way down the airways and stimulate irritation, inflammation and bronchospasm. The combination can result in chronic cough, even if the individual has none of the familiar GERD symptoms.
If your cough is from postnasal drip, mucus can collect in the back of your throat while you sleep and kick off the cough reflex. Many people with allergies and asthma, two possible causes of chronic cough, have worsening symptoms at night.
Minimize nighttime coughing by not eating close to bedtime and sleeping with your head elevated. You can also sip warm liquid or a bit of honey before you go to bed, and cough drops or hard candy may soothe your throat. Over-the-counter cough medicine has not been proven to be more effective than home remedies in stopping coughs. If you have allergies or asthma, minimize your triggers at night and keep up on your treatment plan. Consider using a HEPA air filter in the bedroom. If you do these things and you still cough, you may need to change medication(s) for better prevention and symptom control.
How much you can control your chronic cough depends on the cause. If it’s allergy driven, try to avoid triggers. If it’s due to smoking, get help to stop. If it’s due to acid reflux, try changing your eating habits. If your cough is from asthma or an infection, or you don’t know what’s causing it, it’s time to call the doctor.
You may be able to stop the cough reflex using this technique: when you feel an urge to cough, hold your breath and count to five. Blow the air out as if you were blowing out birthday candles. Sip some water and swallow with your chin tucked, then take another sip of water. Sometimes sniffing and then blowing out through pursed lips will also help.
If your child has been coughing for more than four weeks, call your pediatrician. In the meantime, you can try some home remedies, paying careful attention to the dosages appropriate to your child’s age. If your child is under 6 years, do not give them over-the-counter cough medicine, which is not safe and can be life threatening. For babies 3 months to 1 year, you can give a few teaspoons of warm clear fluids four times per day. For children age 1 and up, give a half to a full teaspoon of honey as needed. For children older than 6, you can give cough drops or hard candy.
If you or your child can’t sleep because of the cough, or there are troublesome changes in your child’s behavior at school or home, call your pediatrician for guidance—even if it’s before the four-week mark.
Even though they can be worrisome, most chronic coughs are not due to serious illness. However, there are times when a cough warrants a prompt visit to the doctor. Call your provider if you have a high or persistent fever, cough up a lot of phlegm, cough up blood, or feel short of breath. You should also see your doctor if you notice unexplained weight loss, fatigue, chest pain, night sweats, or wheezing along with your cough. Most chronic coughs can be effectively treated, however, freeing you from bother and worry during the day and letting you get a good night’s sleep.