Chronic Cough

What is Chronic Cough?

A cough is considered chronic when it lasts longer than eight weeks in adults (or four weeks in children). Chronic cough can be caused by a wide range of conditions — most commonly asthma, gastroesophageal reflux disease (GERD), and postnasal drip, also known as upper airway cough syndrome. Even when not linked to a serious illness, a chronic cough can be exhausting, disruptive and socially isolating. If your cough persists or is accompanied by alarming symptoms, you should contact a doctor.

In the United States, an estimated 5 % of adults (approximately 12 million people) report having a cough lasting 8 weeks or more in the past year, according to research published by the Journal of Clinical Allergy and Clinical Immunology: In Practice. The prevalence tends to increase with age and is higher in people who smoke or have comorbid respiratory conditions.

Types of Chronic Cough

When evaluating a persistent cough, doctors consider how long it has lasted:

• Acute cough: Lasts less than three weeks and is often caused by a cold or respiratory infection.
• Subacute cough: Persists for three to eight weeks, sometimes lingering after an illness.
• Chronic cough: Lasts longer than eight weeks and may signal an underlying condition that needs further evaluation.
• Refractory cough: A type of chronic cough that continues despite thorough testing and treatment — including prescription and over-the-counter therapies. In these cases, specialized evaluation may be needed to identify less common causes or explore new treatment options.

Causes

Underlying conditions typically cause chronic cough. 

• ACE inhibitor–related cough: A possible side effect of certain blood pressure medications.
• Asthma and cough-variant asthma: Airway inflammation or narrowing that causes a dry, persistent cough.
• Bronchiectasis: Damage and widening of the airways that trap mucus.
• Cough hypersensitivity syndrome (unexplained chronic cough): A cough that persists despite normal imaging and lung tests.
• Chronic obstructive pulmonary disease (COPD) or chronic bronchitis: Long-term airway irritation, often from smoking.
• Gastroesophageal reflux disease (GERD): Stomach acid backing up into the throat, which irritates airways.
• Nonasthmatic eosinophilic bronchitis: Airway inflammation without asthma symptoms.
• Upper airway cough syndrome (postnasal drip): Mucus drainage from the nose or sinuses, which triggers coughing.

In rare cases, a chronic cough may indicate conditions such as lung cancer or heart failure.

Signs and Symptoms

A cough that lasts more than eight weeks may signal an underlying medical issue. Chronic coughs are often dry (nonproductive), but can also produce mucus. Other related symptoms can include throat clearing, hoarseness and disrupted sleep.

Seek prompt medical attention if you experience:

• Coughing up blood (hemoptysis)
• Chest pain or shortness of breath
• Difficulty swallowing or persistent heartburn
• Fever or night sweats
• Hoarseness lasting more than three weeks
• Unexplained weight loss

Diagnosis

A complete medical history is essential for diagnosis. In many cases, a chronic cough is caused by an underlying condition such as asthma or GERD. To determine the root cause, your doctor will conduct a complete physical exam and ask you questions about your lifestyle, including your family history, your job, your habits, your hobbies, your current medications and your symptoms. Your doctor also may order a variety of diagnostic tests. 

Breathing and Exercise Tests

Bronchial provocation test: The bronchial provocation test evaluates how sensitive the airways in your lungs are. A spirometry breathing test is done before and after you inhale a spray such as methacholine. The spirometry results are compared before and after you inhale the spray to see what changes there are in your breathing.

Chest X-Ray: A chest X-ray is often one of the first tests used to evaluate chronic cough. It can help identify lung infections, inflammation, fluid buildup, masses, or structural changes that may explain ongoing cough symptoms or signal the need for further testing.

CT Scan of the Chest: A CT scan provides more detailed images of the lungs and airways than an X-ray. It can reveal conditions that may not appear on a standard X-ray, such as bronchiectasis, small lung nodules, airway thickening, or scarring that can contribute to chronic cough.

Exercise-induced bronchoconstriction test: Exercise induced bronchoconstriction or EIB, is a combined breathing and exercise test. The test can help identify what type of breathing trouble you have, if any, when you exercise. 

Exhaled nitric oxide Test: Exhaled nitric oxide is a simple test to measure airway inflammation. The results from this test make it easier for you and your doctor to monitor signs of asthma and find the best treatment plan for you.

Spirometry: A spirometry test measures airflow in and out of the lungs. This indicates whether or not there is airway narrowing that obstructs the flow of air in and out of the lungs. Spirometry test results are useful in making the diagnosis of asthma and other lung disorders. Even more important, yearly spirometry measurements help to detect lung disease at an early stage when lifestyle changes and treatment may help forestall future problems.

Imaging Tests

Barium Swallow (Esophagram): A barium swallow test, also called an esophagram (or esophagography) involves an X-ray examination of your esophagus. This type of X-ray exam uses live video so that gastroenterologists can watch the actions of your esophagus in real time as you swallow and diagnose reflux issues. 

X-rays: X-rays can show irregularities or damage in the lungs and airways caused by asthma. You doctor may verify a diagnosis, or evaluate what other diseases or conditions may be present with other tests.

Diagnostic Procedures

Endoscopy (EGD): An endoscopy or esophagogastroduodenoscopy (EGD) allows the doctor to look inside the esophagus, stomach and a portion of the small intestine. An endoscope is a thin, flexible tube inserted through the mouth into the esophagus, stomach and duodenum. A light and camera attached to the tube allow a specialist to view the lining of these organs and diagnose GERD. 

pH Impedance Probe: An impedance and pH study measures the amount of acid and non-acid gastroesophageal reflux you have. Using a thin catheter with sensors, specialists are able to see how daily activities and exercise affect your reflux levels. An impedance and pH study will help identify if you have increased amounts of reflux and if it is causing a chronic cough or other symptoms.

Treatment

The treatment for chronic cough will depend on the cause. In most cases, a chronic cough is caused by underlying conditions. 

Medications

• For asthma or eosinophilic bronchitis: Inhaled corticosteroids and bronchodilators.
• For GERD: Acid-suppressing medications (PPIs or H2 blockers) and lifestyle changes such as elevating the head of the bed or avoiding late meals.
• For postnasal drip: Antihistamines, nasal corticosteroids and allergy medications, along with a sinus rinse. 
• For ACE inhibitor–related cough: Substituting a different medication class to see if symptoms persist.
• For chronic bronchitis or bronchiectasis: Airway clearance, smoking cessation and pulmonary rehabilitation.
• For unexplained chronic cough: May respond to speech therapy–based cough suppression training or neuromodulator medications. Additionally, specialized cough suppression therapy performed at National Jewish Health can often benefit patients with unexplained symptoms. 

Lifestyle Management

Lifestyle changes also can help control symptoms. You can reduce your risk of chronic cough by:

• Avoiding tobacco smoke and secondhand smoke.
• Getting vaccinated against flu, COVID-19, and pneumonia.
• Managing allergies and sinus congestion.
• Monitoring air quality and avoiding outdoor activity on high-pollution days.
• Soothing your throat with things like hard candies, cough drops or warm liquids can ease throat irritation. 
• Using a humidifier to keep airways moist.

When to See a Specialist

It’s important to be evaluated by a pulmonologist if you or a loved one: 

• Has a chronic cough
• Would like to improve your current chronic cough treatment

At National Jewish Health in Denver, Colorado, we help thousands of patients every year with common and rare breathing issues like chronic cough. Learn more about our Respiratory Program, or use the button below to make an appointment.

FAQs

What qualifies as a chronic cough? 

A cough is considered chronic when it lasts eight weeks or longer in adults. Shorter coughs are usually caused by temporary infections, while chronic cough often signals an underlying condition that needs evaluation.

What are the most common causes of chronic cough in adults? 

Common causes include asthma, postnasal drip (upper airway cough syndrome), gastroesophageal reflux disease (GERD), and certain medications. Smoking, lung disease and chronic sinus problems can also contribute.

When should I be worried about a chronic cough? 

You should see a doctor if a cough lasts more than eight weeks, produces blood, causes chest pain or shortness of breath, or disrupts sleep. Persistent coughing can sometimes indicate a more serious condition.

How is chronic cough diagnosed? 

Diagnosis begins with a detailed medical history and physical exam. Your provider may order lung function tests, imaging (such as chest X-rays or CT scans), or allergy and reflux testing to identify the cause.

Can GERD cause chronic cough without heartburn? 

Yes. Some people experience “silent reflux,” where stomach acid irritates the throat or airways without causing heartburn. This can trigger chronic coughing, especially at night or after meals.

Which medicines can cause a chronic cough?

ACE inhibitors, a class of drugs commonly used to treat high blood pressure and heart failure, can cause a dry cough in some people. Stopping or changing medication under a doctor’s supervision usually resolves the cough.

What is cough hypersensitivity syndrome? 

Cough hypersensitivity syndrome refers to a heightened sensitivity of the airways. Even mild irritants—like perfume, cold air, or talking—can trigger coughing. It may occur after infections or in people with asthma or reflux.

How do you treat a chronic cough that won’t go away? 

Treatment depends on the cause. Managing allergies, asthma, or reflux often helps. For unexplained cough, medications that calm the cough reflex and specialized therapies can significantly improve symptoms and quality of life.