The 8 Most Common Causes of a Persistent Cough — and How to Get Rid of It

If you’re constantly coughing yet don’t feel unwell, you’re not alone. Persistent coughing is a leading reason many seek medical advice. However, there’s often no need for alarm. Coughing is the body’s natural way to keep the airways clear, acting as a defense mechanism. Typically, a cough will dissipate on its own, although it might persist for a few weeks following illnesses like colds or the flu.

Understanding the root of a stubborn cough can be challenging. In this guide, we’ll delve into potential reasons for your persistent cough, offer solutions, and advise on when it might be wise to consult a healthcare professional.

What is a persistent cough?

A persistent cough lingers for more than three weeks. It’s not uncommon for such a cough to persist up to three weeks following the resolution of an upper respiratory ailment.

While a dry, non-mucus producing cough might eventually fade on its own, a post-infection cough that brings up mucus should be reported to a healthcare professional. This could occasionally hint at conditions like pneumonia that demand medical attention.

What are the most common causes of a persistent cough?

Persistent coughs have various origins, but many are relatively benign. With a thorough assessment, healthcare professionals can usually devise effective treatments.

Here’s a list of eight primary culprits behind persistent coughs:

1. Reactive airways after an upper respiratory infection

After an upper respiratory infection, your airways can sometimes become inflamed, leading to sensitivity and a persistent cough.

The exact reason for this isn’t fully understood. It could be related to heightened sensitivity in the airway nerves, changes in the airways themselves, or an increase in mucus production.

Often, when the cause is reactive airways, X-rays and other tests will appear normal. While this kind of persistent cough typically goes away by itself, medications to minimize coughing, inflammation, and mucus can be beneficial for symptom relief.

2. Postnasal drip

Any irritation in the nose or sinuses can lead to mucus trickling down the throat, prompting a cough.

Colds, sinus infections, and allergies, such as hay fever, can cause postnasal drip. The resulting cough might be dry or slightly mucus-laden.

Indicators that postnasal drip is behind your cough include:

  • Feeling of mucus trickling down your throat.
  • Constant throat clearing.
  • Cough worsening at night.
  • Voice turning hoarse.
  • Runny nose.

Treatments range from antihistamines and nasal sprays to prescription drugs.

3. Asthma with cough 

While asthma usually involves wheezing and breathlessness, in some cases, coughing is the sole symptom, especially pronounced at night.

Exposure to cold, allergens, laughter, or even exercise can exacerbate this asthma-induced cough.

Over-the-counter treatments might not suffice. Prescription inhalers are the standard solution. If untreated, this cough variant asthma can evolve into full-blown asthma.

4. Acid reflux and gastroesophageal reflux disease

Acid reflux and GERD can sometimes lead to a persistent dry cough. While the exact reason is not fully understood, it’s believed that aspiration, where stomach contents like food or acid flow back into the throat and reach the airways, may be a factor. Coughing could be a reflex to keep these contents from reaching the lungs. While some might experience typical heartburn symptoms or a sour taste due to this reflux, up to 75% don’t show any obvious GERD symptoms.

To treat this, doctors often suggest proton pump inhibitors (PPIs) which decrease stomach acid. These medications, which may be prescribed for 2 to 8 weeks to determine their effect on the cough, include:

  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Omeprazole (Prilosec)
  • Esomeprazole (Nexium)

It’s also advised to elevate the head while sleeping and to avoid eating 3 hours before going to bed.

5. Medication side effects

Certain medications can be culprits behind a continuous dry cough.

A prime example is the angiotensin-converting enzyme (ACE) inhibitors. These are often prescribed for conditions like high blood pressure, heart ailments, and diabetes. Yet, a cough due to ACE inhibitors is reported in nearly 20% of its users.

Some well-known ACE inhibitors are:

  • Lisinopril
  • Benazepril
  • Captopril
  • Enalapril

Additionally, several other medications could induce a chronic cough, such as:

  • Sitagliptin (for blood sugar regulation in diabetic patients)
  • Calcium channel blockers (for controlling high blood pressure)
  • Nitrates (primarily for alleviating chest pain)
  • Latanoprost (eye drops for glaucoma treatment)

If you suspect that your medication might be behind your cough, it’s crucial to consult your healthcare provider. They can assess if a change in medication is needed.

However, remember to consistently take your medication until advised otherwise by your healthcare provider. If a drug is the cause, discontinuing it typically sees the cough subside within several weeks.

6. Lower respiratory infection

Chronic coughs are often attributed to lower respiratory infections, which encompass:

  • Pneumonia
  • Bronchitis
  • Bronchiolitis

While viruses are the typical culprits behind these infections, bacteria can also be responsible.

Signs indicating a potential lower respiratory infection include:

  • Elevated temperature
  • Difficulty in breathing
  • Reduced appetite

Should you experience these symptoms alongside your cough, it’s essential to inform your healthcare professional. A chest X-ray might be necessary to identify any lung alterations that demand additional care.

7. Smoking

Inhaling tobacco or marijuana often leads to a lingering cough due to the irritants released during smoking. These harmful substances can harm the lung’s lining, leading to bronchitis symptoms such as coughing and increased mucus production.

The cough associated with smokers, often characterized by mucus and being more pronounced in the morning, can diminish once you cease smoking. Within the first month of quitting, you might observe a reduction in your coughing.

8. Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) frequently presents with a chronic cough as one of its primary symptoms.

The primary cause of COPD is long-term exposure to lung and airway irritants, with smoking being the predominant culprit.

Signs of COPD encompass:

  • A cough that produces mucus
  • Breathlessness
  • A wheezing sound when breathing
  • Persistent tiredness

If you’ve been a smoker and have been experiencing a lasting cough, it’s crucial to inform your healthcare professional. They can help determine the root of your symptoms through additional evaluations.

Persistent cough treatment

The primary focus in treating a persistent cough is addressing its root cause. For those unsure about the cause, natural or over-the-counter solutions might offer respite. Some potential relief measures include:

  • Cough-relief formulations like Robitussin and Delsym.
  • Expectorants such as Guaifenesin like Mucinex and Bidex 400.
  • Using a humidifier.
  • Honey to soothe the throat.
  • Lozenges to curb irritation.

Should symptoms persist or worsen over a couple of weeks, consulting a healthcare professional is advisable.

When should you be concerned about a persistent cough?

If your persistent cough is paired with any of the symptoms listed below, it’s crucial to consult a healthcare professional immediately:

  • Elevated body temperature
  • Sweating at night
  • Expectoration with blood
  • Breathing difficulties
  • Pain in the chest
  • Fatigue
  • Feeling nauseous
  • Throwing up
  • Unexplained weight reduction.

The bottom line

While a lingering dry cough can be disruptive, it’s often not a severe health concern and might naturally subside.

However, if your cough endures beyond a fortnight or is paired with alarming symptoms like fever, hemoptysis, or breathlessness, seeking medical advice is imperative. Proper consultation can pinpoint the cause and suggest suitable treatment modalities.