Written by Sharon Orrange, MD, MHS | Reviewed by Karla Robinson, MD
Key takeaways:
– A persistent dry cough is common after having an upper respiratory infection like a cold or the flu. It will typically go away on its own.
– A dry cough that lingers may have an underlying cause that requires additional treatment by your healthcare provider.
– If you have a persistent cough that lasts longer than 8 weeks or is accompanied by fever, shortness of breath, or chest pain, you should contact your healthcare provider immediately.
Portrait of a man coughing into his fist.
Charday Penn/E+ via Getty Images
You may be wondering why you’re coughing so much if you don’t feel sick. Well, you’re not alone. In fact, persistent cough is one of the most common reasons that people visit a healthcare provider. But it shouldn’t always be a cause for concern. A cough is a natural reflex by the body to help clear the airway, and it can be protective. It usually goes away on its own, but sometimes a cough can last a few weeks after an infection like a cold or the flu.
It can be hard to know what to do about a lingering cough that won’t go away. Here, we’ll cover some possible causes for your cough, what you can do about it, and when it may be time to see a healthcare provider.
What is a persistent cough?
A persistent cough is one that has been around for more than 3 weeks. It’s common to have a persistent cough that lasts up to 3 weeks after an upper respiratory infection has resolved.
A persistent dry cough — meaning you aren’t coughing up much mucus — will sometimes go away on its own. If you have had an upper respiratory infection and now have a persistent productive cough — meaning you’re coughing up mucus — you need to notify your healthcare provider. This can sometimes be a sign of an infection (like pneumonia) that requires treatment.
What are the most common causes of a persistent cough?
There are many reasons for a lingering cough, most of which aren’t too serious. The good news is, with proper evaluation of your cough, your healthcare provider can usually treat it.
Here are the eight most common reasons you might have a persistent cough.
1. Reactive airways after an upper respiratory infection
Sometimes your airways can become inflamed after an upper respiratory infection. This can make your airways sensitive and hyperreactive, making you cough.
It’s not clear why this happens. It may be due to the nerves in your airways, or the airways themselves becoming more sensitive. Or it may be caused by the body’s increased mucus production.
In most cases in which reactive airways are the cause, all X-rays and tests will be normal. This type of persistent cough will usually resolve on its own. But taking medication to reduce cough, inflammation, and mucus may be helpful for relieving symptoms.
2. Postnasal drip
Postnasal drip, or upper airway cough syndrome, can occur anytime the nose or sinuses become irritated or inflamed. This leads to mucus draining down the throat and triggering a cough.
There are many causes of postnasal drip, including colds, sinus infections, and allergies, like hay fever. The result may be a dry cough or it may be associated with some mucus.
Signs that postnasal drip may be the cause of your persistent cough include:
– The sensation of liquid dripping down the back of your throat
– Always having to clear your throat
– Nighttime cough
– Hoarse voice
– Nasal discharge
Postnasal drip may improve on its own. Or your healthcare provider may recommend treatments like antihistamines, steroid nasal sprays, or other over-the-counter (OTC) nasal sprays. In some cases, prescription medication may be useful.
3. Asthma with cough
Asthma normally includes symptoms, such as wheezing, difficulty breathing, and chest pain. But sometimes the only symptom is coughing. In this case, the cough is typically worse at night.
An asthma cough won’t get better with OTC medication. It’s usually treated with prescription inhalers, which help control the cough. In cases in which this type of asthma goes untreated, up to 40% of adults go on to develop further symptoms of asthma.
Asthma-related coughing may follow an upper respiratory infection and worsen if you’re exposed to cold temperatures or certain allergens, like dust or fumes. It can also be triggered by laughing or exercise.
If you have a cough with no other symptoms, you may want to visit a healthcare provider and get checked for asthma.
4. Acid reflux and gastroesophageal reflux disease
Acid reflux and gastroesophageal reflux disease (GERD) are other potential causes of persistent dry cough.
It’s still unclear why GERD might make you cough, but experts think it’s related to aspiration. This is when food or acid from the stomach comes up to the throat and enters the airways. Coughing may be a reflex to help prevent the food and acid from entering your lungs. More research is needed to understand this relationship.
For some people, a cough from acid reflux will be accompanied by the typical symptoms of heartburn or a sour taste in the mouth. But up to 75% of people have no GERD symptoms at all.
Taking a proton pump inhibitor (PPI), a medication used to treat GERD, is often recommended in these cases. Your healthcare provider may recommend that you take a PPI, which helps to reduce the amount of acid in your stomach, for 2 to 8 weeks to see if your cough goes away.
Medications that are commonly recommended include:
– Lansoprazole (Prevacid)
– Pantoprazole (Protonix)
– Omeprazole (Prilosec)
– Esomeprazole (Nexium)
Other recommendations may include sleeping with your head elevated and not eating within 3 hours of bedtime.
5. Medication side effects
Sometimes medications can cause a persistent dry cough.
A classic example of this is with a class of medication called angiotensin-converting enzyme (ACE) inhibitors. These medications are commonly prescribed for people who have high blood pressure, heart disease, and diabetes. But ACE inhibitor-induced cough is reported in up to 20% of people who take them.
Popular ACE inhibitors include:
– Lisinopril
– Benazepril
– Captopril
– Enalapril
Other medications may also cause a persistent cough. The most common include:
– Sitagliptin (used to help control blood sugar in people with diabetes)
– Calcium channel blockers (used to manage high blood pressure)
– Nitrates (most often used to treat chest pain)
– Latanoprost (eye drops used to treat glaucoma)
If you think medication might be the reason for your cough, talk with your healthcare provider. They can help you determine whether you need to switch medications.
But it’s important that you continue taking your medications until your healthcare provider says you can safely stop. If medication is causing your cough, the cough will usually go away within a few weeks after you stop taking the medication.
6. Lower respiratory infection
Lower respiratory infections are a common cause of chronic cough. These include infections like:
– Pneumonia
– Bronchitis
– Bronchiolitis
These infections are typically caused by viruses but may be caused by bacteria as well.
Clues you may have a lower respiratory infection include symptoms like:
– Fever
– Shortness of breath
– Decreased appetite
If you have any of these symptoms with your cough, you need to let your healthcare provider know. You may need a chest X-ray to look for changes in the lung that require further treatment.
7. Smoking
Smoking tobacco or marijuana can cause a persistent cough. This is because the toxins released when smoking are irritants to the airways. These toxins can damage the lining of the lungs and cause symptoms of bronchitis, like cough and excess mucus.
The “smoker’s cough” is typically a cough with mucus that’s worse in the morning. But, it can improve once you stop smoking. You could notice a decrease in your coughing in the first month after you quit smoking.
8. Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a condition that’s commonly associated with chronic cough. In fact, cough is one of the most reported symptoms of COPD.
COPD is usually caused by repeated exposure to irritants of the lungs and airway. The most common reason for this is smoking.
Symptoms of COPD include:
– Productive cough
– Wheezing
– Shortness of breath
– Fatigue
If you have a history of smoking and a chronic cough, let your healthcare provider know. You may need further testing to figure out the cause of your symptoms.
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