What is Chronic Cough?

A chronic cough is a cough that lasts more than 8 weeks. It often happens because the nerves in the throat and airways are extra sensitive. This can start after an infection such as whooping cough, COVID-19, or the flu.

People with chronic cough often notice that everyday things can trigger their cough. These irritants can include strong smells (e.g., air-fresheners, deodorants, and propellants in inhalers), changes in temperature (both cold to hot and hot to cold), and changes in posture (lying down at night and after getting up in the morning). Other triggers for cough may include laughing or talking, especially on the phone.

Chronic Cough Patient Navigator

A cough is a normal reflex that helps protect the body by clearing irritants from the airways. However, when a cough lasts for a long time, it may be a sign of an underlying health issue.

It is defined as a cough that lasts more than 8 weeks in adults or more than 4 weeks in children. Chronic cough can affect sleep, daily activities, and quality of life.

Many different conditions can cause chronic cough, including asthma, sinus problems, acid reflux, and certain medications. In some cases, cough may continue even after common causes have been treated.

Because there are many possible causes, understanding chronic cough can sometimes be confusing. The information below is designed to help you learn more about:

  • what chronic cough is
  • common symptoms and triggers
  • possible underlying conditions
  • how chronic cough is diagnosed
  • treatment options and coping strategies

Use the Patient Navigator below to explore each topic and learn more about chronic cough and how it may be managed. When you have reviewed all of the information, take the quiz to test what you learned.

Unlike other types of coughs, chronic cough usually produces little or no mucus production. It also is not usually linked to any “red flag” symptoms such as coughing up blood or losing a lot of weight. It can be made worse by conditions such as asthma, sinus problems or post-nasal drip, and acid reflux (GERD).  

Doctors sometimes use different names for chronic cough with different causes or triggers.

  • Sometimes a cough doesn’t go away even after doctors treat the most common causes. This is called Refractory Chronic Cough.
  • If no clear cause is found, it’s called Idiopathic Chronic Cough. 
  • Many people have Cough Hypersensitivity Syndrome, or neurogenic cough, where airway nerves are overly sensitive. 
  • Long-lasting cough can also happen with lung diseases.
    • One example is Idiopathic Pulmonary Fibrosis (IPF), a condition where the lungs become stiff and scarred. 
    • Another example are Interstitial Lung Diseases (ILDs), which are a group of conditions that cause inflammation or scarring in the lungs. Knowing these types helps patients and doctors choose the best care.

Living with chronic cough can have a big impact on quality of life.  Frequent coughing fits can be exhausting, especially if they disrupt sleep and lead to severe tiredness. 

Chronic cough can also feel embarrassing, which may cause some people to avoid social situations and become isolated. Over time, this can lead to feelings of sadness or depression. 

Strong coughing spells can sometimes cause other problems, such as:

  • Gagging or vomiting
  • Stress urinary incontinence (leaking urine during coughing), which is especially common in women
  • Rib pain, or in rare cases, rib fractures
  • Fainting or passing out (syncope)

Doctors usually recognize chronic cough based on your symptoms. Still, it is important to rule out serious conditions, like lung cancer (especially in smokers or former smokers) or lung conditions like fibrosis. 

In some lung diseases, such as idiopathic pulmonary fibrosis (IPF) or other interstitial lung diseases (ILDs), chronic cough may share the same nerve sensitivity seen in refractory chronic cough (RCC). However, in IPF, frequent coughing may also worsen scarring in the lungs. For this reason, doctors often use special imaging, such as high-resolution CT scans (HRCT), to rule out these conditions before moving forward with chronic cough treatment.

Common tests include: 

  • Lung imaging
    • X-rays or CT scans help exclude serious disease and may point to conditions that cause chronic cough 
  • Lab work
    • Identifies signs of inflammation or allergy in your blood or sputum (phlegm) 
  • Lung function tests
    • These check how well your lungs work and can help diagnose conditions such as asthma and COPD. The most common is spirometry, but you may have other tests for lung volume or how well your lungs exchange oxygen and carbon dioxide.
  • Tests using a scope (a camera on a tube)
    In cases where your doctor is not able to determine the cause of your cough, they may order special scope (camera) tests such as :
    • Rhinoscopy – which looks at the sinuses and nasal passages
    • Bronchoscopy – looks directly at the airways and lungs. Sometimes they will take a small tissue sample (biopsy) for lab testing.
  • Cough monitoring to track chronic cough

Special devices or apps can track how often you cough. This helps you, your caregiver, and your doctor see if treatments are working and if your treatment needs to be adjusted.

The best treatment depends on the cause of your cough. If doctors can find and treat the underlying condition, such as asthma, reflux, or allergies, the cough often improves.

If no cause is found, which is sometimes called idiopathic chronic cough, treatment can be more challenging. Here are some options your doctor may discuss with you.

  • Cough medicines

Over-the-counter cough suppressants are sometimes suggested, but they do not usually work well for chronic cough.

  • Prescription medicines
    • Opiates (such as codeine, diamorphine, or morphine) may be prescribed in certain cases, but only under close medical supervision.
    • Newer medications, called P2X3 receptor antagonists, which calm overactive nerve fibers in the airways, are available in some countries for adults with chronic cough that doesn’t respond to other treatments. Ask your doctor or pharmacist if these are available where you live.
  • Speech and Language Therapy

Special techniques taught by therapists can help you control coughing fits and improve quality of life. 

  • Airway Clearance Techniques

Certain exercises or devices can help clear mucus from the airways, if that is one of your symptoms. It is important to know that a productive cough is not usually found in chronic cough. If you have sputum production, talk to your doctor.

  • Home remedies 

Staying hydrated, using a humidifier, sucking on lozenges, or drinking warm tea with honey may ease throat irritation.

  • Lifestyle changes 

Avoiding smoke, pollution, and chemical fumes can lower your risk. If you smoke, talk with your doctor about quitting or joining a support group.

  • Vaccines

Keeping up with recommended immunizations help protect your lungs and overall health.Learn more here about the power of immunization for people with chronic respiratory disease.

Most people experiencing chronic cough first see their family doctor, pediatrician (children) or general practitioner in their community. If the cough continues, you may be referred to a specialist such as:

  • Pulmonologist – lung doctor
  • Allergist – allergy specialist
  • Gastroenterologist – digestive system doctor
  • Otolaryngologist – ear, nose, and throat doctor, also known as an ENT)

Certain things can make you more likely to develop or keep a chronic cough. Some risks that can be avoided or reduced are:

  • Smoking
    • People who smoke often have a morning cough that can improve after they quit smoking. Research shows that smoking even 100 cigarettes in a lifetime double or triples the risk of chronic cough compared to non-smokers.
  • Blood pressure medicines or ACE inhibitors (ACE 1)
    • Some medicines for high blood pressure (those ending in -pril, like lisinopril) cause coughing in up to 1 in 10 people. If this happens, your doctor may be able to switch you to another medication that usually doesn’t cause coughing.
  • Environment/Air pollutants 

Being around smoke, dust, or chemicals can cause chronic cough.

  • Secondhand smoke: living with or being around people who smoke.
  • Indoor and outdoor air pollution: dust, chemicals, indoor cooking fuel, or other airborne particles that irritate the lungs.

It is important to note that while chronic cough affects individuals across ages, genders, and nationalities, the most commonly reported profile is women over the age of 50 of white ethnicity.

Chronic cough affects people everywhere, but how common it is can vary by region. Studies show it is reported more often in places like Australia and New Zealand (over 20% of people) and less often in Asia, Latin America, and Africa. In North America and Europe, about 10-15% of people report chronic cough.

The reasons for these differences aren’t fully understood. They may be due to under-reporting, differences in diagnosis such as being labeled as asthma or allergies, instead, or environmental or genetic factors.

Researchers are studying new medicines to better treat chronic cough, and some are in the final stages of testing.

GAAPP supports this research and helps connect patients with information about clinical trialsTo find a clinical trial recruiting in your area, you may search the trial registry clinicaltrials.gov using terms like “chronic cough,” adding your location (country) and selecting “Recruiting and not yet recruiting studies.”

Educational Flyers

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Pause your Cough education and patient ambassador program 

In a pivotal advancement for chronic respiratory disease management, in April 2024 GAAPP has joined forces with Esperity, a frontrunner in patient-centric healthcare solutions, to introduce a state-of-the-art portal dedicated to chronic cough, with a particular emphasis on refractory chronic cough. This collaboration is set to elevate awareness and enhance outcomes for this underserved patient community by offering comprehensive educational resources and an in-depth Patient Ambassador program.

Pause your cough

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Content reviewed by a member of GAAPP Clinical and Scientific Advisory Panel