Should I Be Concerned About a Persistent Cough?

The symptom of cough is one of the primary reasons patients come to see me. It is also one of the most annoying and persistent symptoms for patients and one of the most difficult to treat. Across the United States, evaluation and management of cough can account for up to 40 percent of patient visits to doctor's offices. 

Acute cough, which lasts up to 3 weeks, is most commonly attributed to upper respiratory infection. Other causes include asthma, COPD, pneumonia, and blood clots. Cough that persists beyond 3 weeks but less than 8 weeks is defined as subacute cough. A cough that lasts longer than 8 weeks is defined as a chronic cough. 

Interestingly, patients who go to their doctor for chronic cough are more likely to be female. Women also tend to cough more often and to have heightened cough reflex compared to men. 

The most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux (acid reflux).

Upper airway cough syndrome is often caused by allergies, post-nasal drip (drainage), runny nose, or sinus issues. Treatment includes addressing the underlying cause including treatment with antihistamines or decongestants. 

Asthma is often associated with night time cough and/or wheezing. Treatment includes inhalers and steroids. 

Gastroesphogeal reflux or acid reflux is often associated with night time symptoms as well and patients often report a sour taste in their mouth in the morning. The cough is typically better during the day. Treatment includes addressing the underlying factors contributing to acid reflux and sometimes reflux medications like Nexium or Pepcid. 

A post-infectious cough is also a common cause of subacute and chronic cough with symptoms often persisting well beyond when other symptoms have resolved. A post-infectious cough may be the cause of subacute cough in half of all cases. 

Other causes include blood pressure medicines (ACE inhibitors) like Lisinopril, bronchitis, lung disease, or cancer. 

When to be concerned?

Common reasons to be concerned and to consult with your doctor include cough persisting longer than eight weeks, a history of smoking, fever, weight loss, or worsening cough. In general, I recommend getting a chest xray for cough persisting beyond 8 weeks or sooner if there are other warning signs. 

The good news is that upper airway cough syndrome, asthma, and gastroesophageal reflux are responsible for the vast majority of cases of chronic cough. These conditions are very treatable in most cases.

For those with questions or concerns about a persistent cough I advise you to consult with your doctor. I am happy to help as well.