Cough (Chronic Cough)

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: George Schiffman, MD, FCCP
    George Schiffman, MD, FCCP

    George Schiffman, MD, FCCP

    Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Alt TextChronic coughing can be a sign of a cold or a more serious disease making it a symptom you shouldn't ignore.

Chronic cough facts

  • Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition.
  • Causes of chronic cough include:
    • smoking,
    • asthma,
    • hay fever (allergic rhinitis),
    • sinus problems and post-nasal drip,
    • GERD,
    • cystic fibrosis,
    • whooping cough (pertussis)
    • infections, and
    • medications.
  • Treatment for chronic cough is based on addressing the underlying cause.
    • Home remedies to ease symptoms of chronic cough include:
    • staying hydrated,
    • gargling with warm saltwater,
    • cough drops,
    • honey, and
    • ginger.
  • Chronic cough may be prevented by not smoking, and managing medical problems such as asthma, postnasal drip, GERD, and getting vaccinated against whooping cough.

What is chronic cough?

Chronic cough is a cough that persists over time. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits.

Quick GuideTips to Calm Your Cough in Pictures

Tips to Calm Your Cough in Pictures
OTC Cough Medications

Making Sense of OTC Cold Medications

Unsure about the hundreds of cold and flu preparations on the drugstore shelves? You're not alone. Deciding among the OTC (over-the-counter) remedies for cold, flu, or allergy symptoms can be intimidating, and a basic understanding of the types of drugs included in these medications can help you make an informed choice.

Coughing is a symptom of asthma, a disease that should be monitored by a doctor.

What are causes of chronic cough?

Some common causes of chronic cough include asthma, allergic rhinitis, sinus problems (for example sinus infection),esophageal reflux of stomach contents, medications such as ACE inhibitors, and whooping cough. In rare cases, chronic cough may be the result of inhaling foreign objects into the lungs (usually in children). It is important to see a doctor who may order a chest X-ray if a chronic cough is present. The following are common causes of chronic coughing.

  • Cigarette smoking is the most common cause of a constant, chronic cough.
  • Asthma is a disease of the airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests. Some asthma sufferers have chronic cough as their only symptom. They may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthma symptoms can be aggravated by cold air, exposure to air pollutants, pollen, smoke, or perfumes.
  • Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be chronic cough.
  • Sinus problems and postnasal drip also are causes of chronic cough with mucus. This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a "tickle in their throat" and frequent throat clearing.
Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough.

What are causes of chronic cough? (Continued)

  • Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungus. Viral infections do not respond to antibiotics. Cold and the flu often produce a dry cough. Viral upper respiratory infections often result in a prolonged cough even after the infection has cleared in people with asthma. Bronchitis is one of the most common causes of coughing up blood (hemoptysis).
    • A particular strain of bacterial pneumonia, called Mycoplasma, may cause a chronic cough with fatigue, weakness, shortness of breath, and sputum production. This infection is sometimes referred to as "walking pneumonia," and commonly affects young and healthy people.
    • Whooping cough (pertussis) is an acute, highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It can cause violent, rapid, constant coughing and it can be fatal in young children. Whooping cough commonly affects infants and young children, but can be prevented by immunization with pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.
  • Chronic cough in children is uncommon. Foreign material obstructing the airways of the lungs, asthma, and allergies need to be evaluated by a pediatrician.
  • Certain medications, notably ACE inhibitors (enalapril [Vasotec], captopril [Capoten] etc.) used in treating high blood pressure, can cause chronic cough.
  • Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, or other lung diseases such as chronic obstructive disease (COPD) or emphysema. Lung diseases also can cause coughing up blood.

If chronic cough persists it is important to be evaluated by a doctor. The health-care professional will consider the possibility of asthma, postnasal drip, esophageal reflux, drug side effects, interstitial lung disease, lung cancer, or other unusual infections.

View the Finding Relief for Your Cough Slideshow
Whooping cough can last for 10 weeks, and a vaccination can prevent whooping cough.

What are the different types of chronic coughs?

There are several different types of chronic (or persistent) cough.

  • A persistent dry cough is a cough that does not produce any mucus, is irritating to the lungs and throat, and may be a sign of a viral infection or sinus problems.
  • A chronic wet cough is a cough that produces mucus (sputum), and depending on the color, may indicate a bacterial infection or fluid in the lungs (congestive heart failure).
  • A stress cough is a reflexive spasm of the airways caused when you are under stress. It usually produces no mucus and is not generally related to infections.
  • A 'barking' cough is usually found in children, and may be associated with croup or other viral illness. The harsh, barking sound of a croup cough is caused by a swollen windpipe (trachea).
  • A cough that causes a 'whooping' sound after the cough may be indicative of a serious infection and should be evaluated by a doctor. Whooping cough (pertussis) is a highly contagious respiratory disease that can be deadly for babies under 1 year of age.

What kinds of doctors treat chronic coughs?

A primary care provider (PCP) such as a family practitioner or internist may initially diagnose and treat a persistent cough. If cough is severe a person may be seen in a hospital's emergency department by an emergency medicine specialist.

People suffering from constant cough may be referred to different specialists depending on the underlying cause. A pulmonologist is a lung specialist who treats diseases of the airways. An allergist is an allergy specialist who may treat chronic cough due to allergies. Gastroenterologists specialize in diseases of the digestive tract and can treat chronic cough due to conditions such as gastroesophageal reflux disorder (GERD). Cardiologists specialize in diseases of the heart and circulatory system and may treat persistent cough that can be a secondary symptom of heart disease.

Cough syrup may help soothe and calm both chronic and acute coughs.

How is chronic cough treated?

The treatment of chronic cough is directed at the cause. Patients may get symptomatic relief from:

  • over-the-counter (OTC) cough medicines containingguaifenesin and/or dextromethorphan (these can be found as cough syrups in tablet form),
  • drinking lots of water,
  • inhaling steam, and
  • using cough lozenges.

In severe cases of chronic cough a health-care professional may prescribe codeine or other similar narcotic medications, which are effective as cough suppressants.

The following are treatments for chronic cough caused by medications, conditions, or diseases.

  • Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways, and reduce wheezing. In some cases, short-term oral steroids are prescribed to relieve chronic cough.
  • Gastroesophageal reflux disease (GERD): Treatment for chronic cough of GERD includes avoiding foods that increase reflux, avoiding meals before lying down, elevating the head while sleeping, and taking medication such as famotidine (Pepcid), cimetidine (Tagamet),ranitidine (Zantac) omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24-Hour), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium) to decrease stomach acidity.
  • Sinus problems and postnasal drip: Use of decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) may improve symptoms of post nasal drip, which can lead to a persistent, nagging, cough. Inhaled nasal steroids are very effective in treating allergic rhinitis (hay fever), a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide (Atrovent) can relieve post nasal drip. Antibiotics may be prescribed if the cause is determined to be sinusitis.
A doctor should examine any patient with persistent coughing.

How is chronic cough treated? (Continued)

  • Infections: Bacterial pneumonia and bronchitis are typically treated with antibiotics such as cephalosporins, azithromycin (Zithromax), and other antibiotics. If the pneumonia is close to the chest wall inflammation of the surface of the lung can cause pain, known aspleurisy and pain relievers (analgesics) can be helpful. Cough suppressants are used with caution in these situations because clearing the lung of the infected mucus by coughing helps clear the infection. Most bronchitis in adults is caused by viral infections. Therefore, treatment is much the same as that of the common cold including rest, fluids, pain relievers, and humidification. Some people find expectorant cough medicines containing guaifenesin helpful in alleviating their discomfort. Sometimes it is hard to differentiate a viral bronchitis from a bacterial bronchitis, and antibiotics are prescribed. In some cases, asthmatics can produce green mucus that looks infected. Your doctor can have the mucus examined to determine if an infection is present.
  • Medications: Patients with chronic cough who are taking blood pressure medicines called ACE inhibitors (angiotensin converting enzyme), for example, enalapril (Vasotec), captopril (Capoten),lisinopril (Zestril, Prinivil), etc. should talk to their doctor about switching medications. Patients should not stop taking medicine on their own because a marked elevation in blood pressure can result from discontinuation. A newer generation of ACE inhibitor like medicines called ARBs (angiotensin receptor blockers, for example, valsartan [Diovan], losartan [Cozaar], etc.) can be alternatives that have less potential to cause chronic coughing. There are a host of other medicines available to manage blood pressure.
Ginger tea with lemon is one of many home remedies to relieve and soothe chronic cough symptoms.

Are there home remedies for chronic cough?

Chronic cough in adults can sometimes be treated with home remedies. Consult your doctor for the home remedies that might be best for you, and talk to your doctor before taking any herbal supplements or natural remedies for chronic cough as some may interact with medications you take.

  • Stay hydrated. Fluids can help thin secretions.
  • Gargle with warm saltwater to help cleanse the throat and rid it of mucus.
  • Elevate your head with extra pillows at night to ease a chronic dry cough.
  • Inhale steam in a shower, or use a humidifier to relieve dry cough.
  • Cough drops may soothe an irritated throat.
  • Do not smoke or usetobacco products.
  • Avoid inhaled irritants such as smoke, dust, or other pollutants.
  • Honey often can be an effective treatment for a persistent cough. Add honey to hot tea, or even grape juice.
  • Ginger, prepared as a tea, is often used to help reduce symptoms of chronic cough and clear the nasal passages.
  • Other herbs such as eucalyptus or mint are often used to relieve cough symptoms.

Can chronic cough be prevented?

  • Don't smoke, as smoking is the most common cause of chronic cough.
  • Talk to your physician about managing your asthma, postnasal drip, or GERD to avoid chronic cough symptoms.
  • Stay away from others known to be sick with bronchitis or pneumonia.
  • Eat fruit. Research suggests that diets high in fruit fiber and flavonoids may prevent chronic productive cough.
  • Make sure you and your child gets the whooping cough (pertussis) vaccine.

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Reviewed on 5/17/2016
References
REFERENCES:

Medscape.com. Diet High in Fruit Fiber and Flavonoids May Prevent Chronic Productive Cough.

National Lung Health Education Program. Chronic Cough.

The Centers for Medicare & Medicaid Services. Proton Pump Inhibitors: Use in Adults. August 2013. 16 June 2015 <http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-factsheet.pdf>

UpToDate. Patient information: Chronic cough in adults.

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