Top 3 Chronic Cough Culprits
Reasons why your cough just won’t go away — plus, what you can do about it
Nothing is more annoying than a hacking cough that just doesn’t seem to go away. If you’ve ever experienced sleepless nights with the cough awakening you and your significant other, work conversations that get interrupted by your coughing spasms, or that fear of public places where others glare and run in the other direction for fear of catching your diseased cough – then you know what I’m talking about. But you feel fine overall – no fever, fatigue, or cold and flu symptoms. You seem to have had it for weeks. What in the world could it be?
I see patients like this quite frequently in my practice. That’s why today, we’ll discuss the top 3 causes of a chronic persistent cough – the answers may surprise you. The top causes are:
- Acid reflux
- Asthma
- Postnasal drip
So what can be causing your persistent hacking cough when you feel so well overall? First of all, infection is not one of the top 3 causes. It’s not common for people to have a bacterial or viral illness for such a long time when they feel so well. Viral illnesses tend to last 7 to 10 days and self-resolve, while bacterial illnesses typically cause other symptoms, like fever, malaise, and fatigue. The presence of mucus also does not equal infection in many cases, as other causes of cough can also produce phlegm.
Chronic Cough Culprit 1: Acid Reflux
I dissected the issue of acid reflux in a recent episode, and believe it or not, it is one of the top 3 causes of a persistent non-infectious cough. Some people may not sense the acidic contents of the stomach refluxing upward into the esophagus, but may present with a chronic cough instead. That’s because the acidic contents irritate and inflame the esophagus and in turn cause a cough. Some people even say they feel as though something feels “stuck” in their throat, or that they have an “itchy throat.” Prescription medications for a month or two will often do the trick, along with some simple dietary changes, which you can learn more about in my earlier podcast.
Chronic Cough Culprit #2: Asthma
Most people think of asthma as causing wheezing, but many people with asthma will cough instead of wheeze. When there are irritants in the air that people are sensitive to, like dog or cat hair, or simply during exercise for some, the upper lung airways become inflamed and tighten. This in turn can cause a cough. Most people nowadays get diagnosed with asthma in childhood, however, adults can develop similar forms of it later in life, especially if they are smokers or have been exposed to certain chemicals in the air through their work or environment.
Diagnosing asthma is easily done with a special breathing test that your doctor can order, called a “pulmonary function test.” An asthma inhaler can be prescribed to see if your cough goes away.
Chronic Cough Culprit #3: Postnasal Drip
The last, but certainly not the least, common cause of a chronic cough is a postnasal drip. Postnasal drip is simply a drip from the back of your nose down the back of your throat. It’s not supposed to do that. So when it does, it irritates the throat and causes you to develop a terrible cough, with or without phlegm. Patients often say that it awakens them during the night, or that it’s worse in the morning when they first wake up. That’s because during sleep, gravity really does a number on the snot dripping nose and lets it all hang loose down the throat. You may feel some phlegm hanging around in your throat when you first awaken. But it can really set up shop in your throat all day long, without you even realizing that your nose is dripping back there.
What’s the treatment? A prescription nasal spray typically takes about a week to kick in is often enough to reclaim your throat and relieve your cough.
NOTE: Don’t use over-the-counter nasal sprays as they can worsen postnasal drip.
Last Note
Now that you know the 3 top causes of a persistent cough, I want to make it clear that they are certainly not the only causes. There’s a seemingly endless list of other possible culprits, such as medications, chronic bronchitis, tuberculosis, lung disease, walking pneumonia, etc. So if you have a chronic cough, it’s really important to see your doctor right away for an exam and treatment, especially if you have also experienced any:
- Weight loss
- Coughing up of blood
- Difficulty breathing
- Night sweats
- Fever or malaise
- Fatigue
- You’re a cigarette smoker
- You have a history of cancer
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Man Coughing image courtesy of Shutterstock
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About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
