Chronic cough

Coughing is usually completely normal, as it helps to clear particles and secretions from the lungs and prevent infection. A chronic cough is an ongoing, persistent cough that lasts longer than 8 weeks in adults and 4 weeks in children. You should speak to a doctor if you or your child has a chronic cough, as it can be a sign of a condition that needs treatment.  

Treatment for a chronic cough depends on the underlying cause. For example, it may include an inhaler if it is asthma, or antibiotics if it is due to an infection. A chronic cough can also be a symptom of lung cancer.  

Our world-leading lung specialists at Evelina London Children’s, Harefield and Royal Brompton hospitals are experts in diagnosing and treating all types of chronic cough in adults and children. 

What is a chronic cough?

A chronic cough is defined as a cough that lasts over 8 weeks in adults and more than 4 weeks in children.  

A constant cough can have a big impact on your daily life, affecting your sleep quality, causing mental and physical exhaustion and even embarrassment when coughing a lot in public. 

While a long-term cough isn’t always a sign of a serious health problem, it can be a symptom of a condition that needs treatment, so it’s important to speak to a doctor.  

What are the symptoms of a chronic cough? 

Other than the cough itself, it’s common to notice the following symptoms with a chronic cough: 

• a runny or stuffy nose, with our without frequent sneezing 
• postnasal drip (feeling of mucus running down the back of your throat) 
• heartburn or reflux 
• a sore throat and sometimes a change in your voice 
• frequently clearing your throat

Less commonly, you may notice more serious symptoms: 

• unintentional weight loss 
• coughing up blood or mucus 
• wheezing or shortness of breath 
• persistent hoarseness 
• night sweats, with or without fevers

Having a constant cough can also lead to issues including: 

• tiredness 
• poor sleep 
• headaches 
• dizziness 
• vomiting 
• urinary incontinence (loss of bladder control) 
• fractured ribs 
• fainting 
• minor bleeding in your eye (subconjunctival haemorrhage) 
• hernia 

If you or your child have symptoms of a chronic cough and you would like to speak to one of our lung specialists, contact our team to book an appointment.

What causes a chronic cough? 

Up to 90% of all cases of chronic cough are caused by postnasal drip, asthma or acid reflux, or a combination of these. 

Other, less common, causes include:

• lung cancer 
• respiratory infections, such as colds, flu, pneumonia, whooping cough (pertussis), fungal infections of the lung, tuberculosis infection or lung infection with nontuberculous mycobacterial organisms 
• chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema 
• blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors 
• sinus conditions, like sinusitis 
• respiratory conditions, including bronchiectasis, bronchiolitis, cystic fibrosis, nonasthmatic eosinophilic bronchitis, sarcoidosis and idiopathic pulmonary fibrosis 
• laryngopharyngeal reflux (stomach acid flows up into the throat) 
• obesity, particularly in the tummy area 
• aspiration (accidental inhalation) of a foreign object 

The leading risk factor for developing a chronic cough is being a current or former smoker. Frequent second-hand smoke exposure can also lead to coughing and lung damage.

Diagnosing a chronic cough 

During a consultation with one of our respiratory specialists, they will ask you about your symptoms and perform a physical examination to make a diagnosis of a chronic cough.  

Working out the cause of a chronic cough is crucial in our consultants providing the best possible treatment.  

To help identify what’s causing your persistent cough, our specialists may run some tests, including: 

• lab tests – to test a sample of mucus for bacteria that indicates an infection 
• blood tests – to identify an infection or allergies 
• imaging scans – X-rays, CT scans or ultrasound scans may be used to check for signs of lung disease or inflammation 
• bronchoscopy – a procedure used to examine the airways in your lungs and identify signs of irritation or disease 
• lung function tests – such as spirometry to assess your lung function 
• acid reflux testing – to measure the acid level of fluid in your oesophagus  

If you need a fast and accurate diagnosis for the underlying cause of a chronic cough, whether for yourself or your child, our respiratory consultants are here to help. Contact our team today to arrange an appointment.

Treating a chronic cough

Once the cause of your chronic cough has been identified, our specialists will provide you with a personalised treatment plan.  

Here are some examples of how the various causes of a chronic cough may be treated: 

• postnasal drip – medications including decongestants to help dry up secretions, antihistamines to suppress or block allergic response and steroid nasal sprays to bring down swelling in your nasal passages 
• gastrointestinal reflux – dietary and lifestyle changes, or medications, such as antacids, H2 receptor blockers and proton pump inhibitors, to neutralise, reduce or block acid production 
• asthma – prescription medications, such as inhaled steroids and bronchodilators, which bring down swelling in the airways and widen narrowed air passages to improve breathing 
• COPD – prescription medications, including bronchodilators and inhaled steroids 
• infections – prescription antibiotics to treat pneumonia or other bacterial infections 
• medications – ACE inhibitors for high blood pressure may be changed to alternative medications 

While the cause of your chronic cough is being determined, our specialists may recommend an over-the-counter cough medicine or give you a prescription to provide some symptom relief before you receive a personalised treatment plan. 

As well as providing you with a personalised treatment plan, our specialists may suggest you try some lifestyle changes and home remedies to support your recovery. These may include: 

• ensuring good levels of hydration – this will help to loosen and thin any mucus, while warm drinks can help soothe an irritated throat 
• using a humidifier or steam machine – adding moisture to the air can help open up your airways and alleviate a dry, tickly throat 
• Use of specialist techniques to help modify an urge to cough or provide a way of supressing any underlying tendency to cough.   
• avoiding overeating, eating certain foods and drinks, such as chillies, coffee and citrus fruit, and eating close to bedtime – all of these things can contribute to indigestion and acid reflux 
• using a saline nose spray or a nasal irrigation device – the salt water solution will loosen up and help drain any mucus that’s making you cough 
• stopping smoking – smoking or breathing in second-hand smoke irritates the lungs and can make a pre-existing cough worse. Our specialists can provide you with help and support on how to stop. 
• avoiding medications that may be causing cough

Treating a refractory chronic cough 

In a proportion of patients, a chronic cough does not fully respond to the treatment approach outlined above – this is called a refractory chronic cough. Our consultants have expertise in novel treatments to help people with refractory chronic cough and often provide secondary or tertiary opinions (this includes a review of your condition and advice).    

Whatever the cause of your chronic cough, our dedicated specialists can provide the most effective treatment. Contact our team to arrange an appointment.