Chronic cough: 10 causes and treatments - Insider
- Chronic cough is any cough that lasts for at least 4 weeks in children and 8 weeks in adults.
- If you can't stop coughing it could be due to asthma, post-COVID-19, GERD, COPD, and more.
- Once the underlying condition is treated, your chronic cough should go away.
About 4% to 10% of the adult population experiences chronic cough — a cough lasting eight weeks or more, or at least four weeks for children.
A chronic cough doesn't call for immediate medical attention unless you experience it with other symptoms like fever, shortness of breath, chest pain, or coughing up blood, which may indicate a serious underlying medical condition.
Chronic cough generally goes away once the underlying problem(s) has been addressed. So, to help you with that, here are 10 potential causes of chronic cough and how you can treat each.
1. Asthma
Asthma is a chronic condition where the airways become inflamed and narrow and start producing extra mucus. This causes symptoms like wheezing, shortness of breath, chest tightness, and coughing.
However, there is a form of asthma called "cough-variant asthma" wherein the only symptom is a chronic cough. This tends to be more common among children.
"Cough-variant asthma is actually a relatively rare diagnosis in my experience," says Megan Conroy, MD, a pulmonologist at The Ohio State University Wexner Medical Center. "Cough as a symptom of the asthma may mean that your asthma is under-treated or poorly controlled."
How to treat it: Cough-variant asthma cannot be treated with over-the-counter cough medications. You would need prescription asthma medication like bronchodilators, a group of drugs that relieve asthma symptoms.
More data is needed to ascertain the dose or duration of treatment for cough-variant asthma, but the coughing may improve within a week of taking bronchodilators.
If not treated, cough-variant asthma can progress to classic asthma where patients experience more symptoms other than a cough, which might require long-term control medications or biologic therapies.
2. Post-COVID-19
A cough is a common symptom of COVID-19, and in some cases, it will linger post-COVID and become chronic.
In fact, chronic cough is common in post-COVID syndrome (aka long COVID), a range of symptoms that lasts for weeks or months after the initial SARS-CoV-2 infection.
Other symptoms of post-COVID-19 include:
- Headache
- Fever
- Muscle aches
- Loss or change in taste or smell
- Sleep issues
- Lightheadedness
- Diarrhea
How to treat it: We are still learning more about post-COVID syndrome and its treatment, says Rob Rohatsch, MD, emergency medicine physician and chief medical officer at Solv Health.
For now, the management of COVID-19-associated cough is still unclear. To find relief, try drinking hot beverages that might warm your airways and break up any mucus in your throat. Drinking water throughout the day will also keep your throat moist, which can make you feel more comfortable.
"Any cough lasting more than six to eight weeks after a viral infection warrants further discussion with your doctor, COVID included," says Conroy.
3. Upper airway cough syndrome (UACS)
Upper airway cough syndrome (UACS), previously called post-nasal drip syndrome, is one of the most common causes of chronic cough.
"If you have uncontrolled sinus and nasal congestion, it's likely that some of that mucus is dripping back behind your nose [and] down your throat to trigger cough receptors, and also landing mucus in your lungs that you need to cough up," says Conroy.
How to treat it: Treating the cough requires managing the sinus congestion, she adds. The use of a nasal steroid spray with over-the-counter fluticasone or triamcinolone may reduce swelling, inflammation, and mucus in the sinuses. If congestion persists, prescription nasal sprays like ipratropium or azelastine may be needed.
If allergies contribute to your sinus congestion, reduce your exposure to allergens like pollen or pet dander.
"It often takes a few weeks from complete control of post nasal drip to see improvement in the cough from upper airway cough syndrome, often four to six weeks after treatment regimen has been started," says Conroy.
4. Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases, including emphysema and chronic bronchitis, where the airflow from the lungs is obstructed, making it harder to breathe.
It also causes the lungs to produce excess mucus, which may lead to frequent coughing, in addition to other symptoms like chest tightness and wheezing.
How to treat it: "Treatment of the cough is really treatment of the underlying COPD and centers around the use of the right inhalers for the patient. This may not completely get rid of the cough, but is likely to provide some control," says Conroy.
The treatment for COPD depends on the severity of the disease. If you have a mild case, you may be asked to quit smoking or take medications like bronchodilators or corticosteroids. Severe cases might require oxygen therapy or surgery. However, more studies are needed to identify how well cough responds to the treatment for COPD.
Guaifenesin, an over-the-counter medication that relieves chest congestion, may help minimize the coughing caused by chronic mucus production, says Conroy.
5. Medications
Drug-induced chronic cough is rare and may be connected with bronchial hyperreactivity, or when your airways become more sensitive to a variety of factors that may narrow the airways.
Drugs that are commonly used to treat high blood pressure and heart failure — such as angiotensin-converting enzyme inhibitors (ACEI) — may cause chronic cough. About 20% of people taking ACEIs experience a persistent cough.
How to treat it: The only way to eliminate drug-induced cough is by switching to another type of medication that does not cause coughing.
If the cough was induced by the drug, it should go away within one to four weeks.
6. Gastroesophageal reflux disease (GERD)
GERD is a more severe form of acid reflux where stomach acid travels up the esophagus, which may irritate the esophageal lining and trigger chronic cough.
"If the cough is due to GERD, treating the GERD will typically improve the cough substantially, if not resolve it altogether," says Carolyn L. Rochester, MD, professor of medicine at the Yale School of Medicine and director of the Yale COPD Program.
How to treat it: Lifestyle modifications are often the first line of treatment for GERD. Avoid eating fatty foods, chocolate, and peppermint, which may trigger acid reflux. Also, make sure to elevate your head while sleeping so your stomach's contents don't flow backward.
If lifestyle modifications don't work, antacids that neutralize stomach acid or proton pump inhibitors that reduce the amount of stomach acid may significantly minimize — if not fully resolve — the coughing, says Rochester.
7. Chronic and eosinophilic bronchitis
Chronic bronchitis is a type of COPD that specifically refers to the inflammation and irritation of the airways, which may be caused by inhaled irritants like air pollution or tobacco smoke. It is diagnosed when someone produces excess mucus regularly for at least three continuous months out of the year for two or more years in a row, says Rochester.
The inflammation of the airways may lead to a chronic cough. Other symptoms of chronic bronchitis include chest tightness and wheezing.
Eosinophilic bronchitis is a common cause of chronic cough. It occurs when there is an increased presence of eosinophils — a type of white blood cell — in the mucus produced by the lungs.
How to treat it: Chronic bronchitis is incurable, but its symptoms can be minimized by quitting smoking, avoiding irritants, and taking inhaled bronchodilators or other medications that reduce airway inflammation.
Chronic cough caused by eosinophilic bronchitis can be treated with the use of inhaled corticosteroids like budesonide. It may improve the inflammation in about two months.
8. Bronchiectasis
Bronchiectasis is a chronic lung condition where the airways dilate and lose the ability to clear mucus out. The inflammation and accumulated mucus in the airways can lead to a chronic cough, says Rochester
Bronchiectasis is most common in people over 75. Other symptoms include wheezing, chest tightness, coughing up mucus and/or blood, and weight loss.
How to treat it: Potential treatments include mucolytic agents such as guaifenesin, which helps thin the mucus in the airways, says Rochester.
Taking albuterol or plain saline solution via nebulizer machine, followed by the use of positive expiratory pressure (PEP) devices, may also treat bronchiectasis-associated cough by helping expel mucus, she adds.
9. Other infections
"Both viral and bacterial infections such as bronchitis and pneumonia are common causes of cough. When bacterial infections are adequately treated, the cough associated with them typically resolves," says Rochester.
How to treat it: Antibiotics may be prescribed if chronic cough was caused by a bacterial infection.
"Cough related to viral infections such as the common cold, or influenza often typically resolves as the infection is cleared from the body," says Rochester. It often goes away spontaneously after a few days.
Post-infectious cough — cough that persists more than three weeks after recovering from a viral infection — may occur if the cough receptors in the body have increased sensitivity and the airways are temporarily hyper-responsive. It is self-limited, which means it typically resolves on its own over time.
10. Cancer
Lung cancers and other forms of cancer that spread to the lungs can cause coughing if they irritate cough receptors in the body, says Rochester.
Other cancers that may spread to the lungs and cause persistent cough include the following, she adds:
- Breast cancer
- Gastrointestinal cancers
- Kidney cancer
- Prostate cancer
- Thyroid cancer
- Head and neck cancers
- Malignant melanoma
"In some cases, it is possible to achieve excellent relief from the cough related to cancer. In other cases, the cough can be troublesome and persistent," says Rochester.
How to treat it: The treatment of cough related to cancers depends on the underlying cancer, but cough suppressants and airway clearance techniques may provide some relief, she adds.
Insider's takeaway
If you find yourself constantly coughing for more than eight weeks straight, you should get in touch with your primary care provider to figure out and address any possible underlying cause(s).
Persistent coughing is not necessarily a matter of concern unless you experience chest pain, fever, or shortness of breath, which might require immediate medical attention.
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