A chronic cough is one of the most common reasons for a doctor visit. Smoking can cause it. So can an allergy or infection, or a more serious condition.
A lasting cough may be a sign of many things. HereтАЩs why it may not be getting better and when to see a doctor to find out the cause and the treatment.
Postnasal Drip
тАЬYour nose is one of the first touch points between your body and the environment. Every infection and allergen, like dust mites and pollen, comes into it,тАЭ says Panagis Galiatsatos, MD, a pulmonary and critical care medicine doctor at the Johns Hopkins School of Medicine.
Also called upper airway cough syndrome, postnasal drip is a common cause of a persistent cough. When a virus, allergies, dust, chemicals, or inflammation irritate your nasal membranes, they make runny mucus that drips out of your nose and down your throat. This makes you cough, especially at night when you lie down.
тАЬThe most abundant cough receptors in your body are in the airways and around your vocal cords,тАЭ Galiatsatos says. тАЬIf anything gets in there, your bodyтАЩs first response is to cough to get it out.тАЭ
Asthma
Asthma is another common cause for chronic cough — and not only in kids.
When you have asthma, the muscles around your airways tighten, the lining of your airways swells, and the cells in your airways produce thick mucus. The asthma cough is your bodyтАЩs way of trying to get air into those restricted areas. ItтАЩs triggered by infections, weather, allergies, tobacco smoke, medications, and even exercise and emotions.
Infections
Even after your cold, flu, COVID-19 infection, or pneumonia is gone, the cough may not be. No one likes to hear this, but sometimes it just takes longer to run its course.
тАЬDuring that time, the lungs heal and new cough receptors are made,тАЭ Galiatsatos says. He likens it to building a house. тАЬYou have to clear out the old stuff to put new stuff in. ThatтАЩs what coughs do.тАЭ
Pertussis, or whooping cough, is a respiratory tract infection and an under-the-radar cause of chronic cough. Childhood immunizations usually cover it, but your resistance may wear down as you age. The CDC recommends that all adults age 19 and over should get a pertussis booster as a Tdap shot. Your doctor can measure your immunity with a blood test.
Gastroesophageal Reflux Disease
How can a stomach condition be the source of your lingering cough? When you have gastroesophageal reflux disease, or GERD, a weak band of muscle around the lower part of your esophagus lets stomach acid return to your esophagus instead of sending it to your stomach.
тАЬIt doesnтАЩt have to be a massive reflux in the back of your throat; itтАЩs actually the acidic fumes in your stomach — theyтАЩre really potent,тАЭ Galiatsatos says. тАЬThose fumes constantly come out of your stomach and, when you breathe them in, they irritate your lungs.тАЭ
Heartburn and chest pain are common symptoms of GERD, though you may not have any symptoms besides the cough.
Blood Pressure Drugs
тАЬACE inhibitors for blood pressure often cause a chronic dry cough,тАЭ says David Hill, MD, clinical research director at Waterbury Pulmonary Associates in Waterbury, CT, and a volunteer medical spokesperson for the American Lung Association.
When Hill sees a patient who has a persistent cough and takes an ACE inhibitor, тАЬitтАЩs sort of an easy win,тАЭ he says. тАЬWith a slight change in medication, the cough almost always goes away.тАЭ
COVID-19
COVID-19 is the illness caused by SARS-CoV-2, the coronavirus thatтАЩs at the heart of the pandemic that started in 2020. When the virus makes people sick, it can cause lung inflammation and a dry cough, among many other symptoms that can range from mild to life-threatening.
тАЬThe prolonged cough from COVID-19 is no different than any other virus that affects your lungs,тАЭ Galiatsatos says. тАЬThe injured parts of your lungs are trying to clear out the infection and heal.тАЭ
Smoking
Smoking damages your lungs (and the rest of your body). You may also have heard of the тАЬsmokerтАЩs cough,тАЭ which happens because chemicals and particles in tobacco smoke irritate the lungs. The body makes mucus to try to get rid of it through coughing.
тАЬMany smokers will not think of their daily productive cough as a chronic cough at all because they just assume it is normal to cough up phlegm,тАЭ Hill says in an email.
But тАЬsmokerтАЩs coughтАЭ can be among the first signs of a much bigger problem, such as chronic obstructive pulmonary disease (COPD).
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a group of diseases including emphysema and chronic bronchitis that make it hard to get air in and out of your lungs.
In most cases, your body makes too much mucus and coughs to try to clear it out. Other symptoms include shortness of breath. Over time, COPD can worsen and become life-threatening.
Most people who have COPD are smokers or used to be. But itтАЩs possible to have COPD and to never have smoked.
Lung Cancer
Chronic cough can be a sign of lung cancer, but there are many other things that could be causing your cough. тАЬIf youтАЩre a nonsmoker, and donтАЩt have a family history of lung cancer, itтАЩs not the likely diagnosis,тАЭ Hill says.
Smoking, by far, is the top cause of lung cancer. But many people who never smoked have had lung cancer. So although this shouldnтАЩt be at the top of your list of possible causes, itтАЩs important to get it checked out.
If it is lung cancer, the location of the tumor may affect whether thereтАЩs a chronic cough. Your lungs include three parts: tissue, airways, and circulation. Only the airways have cough receptors, so if thereтАЩs a growth in other parts of the lungs, it may not trigger a cough.
When to Call Your Doctor
тАЬI donтАЩt call anything a chronic cough until itтАЩs been there 3 months,тАЭ Hill says. тАЬAn allergy cough can last months, as can a cough from a common cold. EveryoneтАЩs had a cold at some point where they just kept coughing. A lot of it just has to run its course.тАЭ
But donтАЩt wait that long to tell your doctor whatтАЩs going on. Do that around 3-4 weeks if your cough hasnтАЩt gone away. Call sooner if you have other symptoms such as shortness of breath, fever, or if youтАЩre coughing up blood.
