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Chronic Cough Return to Patient Education

Chronic Cough

Chronic cough is usually defined as a cough that lasts for 6 to 8 weeks or longer. Most of the time, chronic cough has an underlying cause and needs to be evaluated.

Upper Airway Cough

In general, it is not life-threatening and is more of a quality of life issue. It is typically a dry cough that is most common in elder individuals. This type of cough interferes with sleep, social activities and bladder control (particularly with females). Causes of upper airway cough include: Gastroesophageal Reflux (GERD) or Laryngopharyngeal Reflux (LPR), Postnasal Drip Syndrome from Rhinitis and/or Sinusitis, ACE Inhibitors and Vocal Cord Dysfunction.

Acid Reflux – Gastroesophageal reflux (also known as acid reflux) occurs when acid from the stomach flows back (refluxes) into the esophagus, which is the tube connecting the stomach and the throat. Many people with a cough due to reflux have heartburn or a sour taste in the mouth, however, some patients with GERD have a cough as their only symptom. Substances that increase reflux include high fat foods, chocolate, soft drinks, red wine, acidic juices and excessive alcohol. Avoid eating for two to three hours before lying down. Elevate the head of the bed at least six to eight inches. Lose weight if you are overweight. Quitting smoking may also help reduce acid reflux.

Postnasal Drip Syndrome – Postnasal drip occurs when secretions from the nose drip or flow into the back of the throat from the nose. These secretions can irritate the throat and trigger a cough. Postnasal drip can develop in people with allergies, colds, vasomotor rhinitis and sinusitis. Some people have so-called “silent” postnasal drip, which causes no symptoms other than a cough.

Use of ACE inhibitors – Medications known as angiotensin converting enzyme (ACE) inhibitors, which are commonly used to treat high blood pressure, cause a chronic cough in up to 20% of patients. The cough is usually dry and hacking. Switching to another medication often improves the cough over the course of one to two weeks.

Vocal Cord Dysfunction – This is an abnormal opening and closing of the vocal cords when inhaling and exhaling. Vocal Cord Dysfunction is typically secondary to postnasal drip, mouth breathing or acid reflux. Breathing in through your nose and out through your mouth can help reduce the spasm.

Lower Airway Cough This type of cough is most common in children. Most common causes include: Cough Variant Asthma and Bronchitis. To help manage a lower airway cough, identify the cause through testing which may involve chest x-rays and CT’s of the chest and neck. Treatment includes short term cough suppressants.

Asthma/Cough variant asthma – Asthma is the second most frequent cause of chronic cough in adults and is the leading cause in children. In addition to coughing, you may also wheeze or feel short of breath. However, some people have a condition known as cough variant asthma in which cough is the only symptom of asthma. Asthma-related cough may be seasonal, may follow an upper respiratory injection or may get worse with exposure to cold, dry air or certain fumes/fragrances.

Respiratory tract infections/Bronchitis – An upper respiratory infection such as a cold can cause a cough that lasts one to two weeks. This may be due to postnasal drip (as described above) or to irritability in the airways that have developed as a result of the infection. In almost all cases of bacterial tracheobronchitis, patients will have a cough that procures sputum. Sputum can range in color from light yellow to dark green or even brown. If such colored sputum or postnasal drip remains unimproved for more than 10 to 14 days, then antibiotics may be required in order to treat the infection.

Chronic Bronchitis – Chronic bronchitis is a condition in which the airways are irritated causing a cough and sometimes phlegm. Most people with chronic bronchitis are current or past smokers.

Lung Cancer – Although lung cancer can cause coughing, very few people with a chronic cough have lung cancer. Cancer is possible (especially if you are a smoker) when a cough changes suddenly and/or coughing up blood occurs. Cancer is also possible if the cough persists for more than one month after quitting smoking.

Postinfectious Cough – Patients who complain of a persistent cough lasting more than 3 weeks after experiencing acute symptoms of an upper respiratory tract infection may have a postinfectious cough. Such patients are considered to have a subacute cough if the condition lasts for more than 8 weeks. In most patients, a specific etiologic agent will not be identified.

Cough suppression – If the cause of a cough cannot be determined after a thorough evaluation, a medication that suppresses your cough may be recommended.

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