Chronic Cough

Chronic Cough

Chronic cough is a persistent cough that lasts for at least eight weeks, and often much longer. Although cough is a common symptom of many lung diseases, chronic cough can't always be linked to another disease or condition and it often doesn't respond to treatment. If you have chronic cough it can feel like a burden on your daily life, with lack of sleep, mental and physical exhaustion and social stigma impacting your quality of life.

Learn About Chronic Cough

A cough is an important reflex that helps protect your lungs. An occasional cough is a normal and a healthy function in your body, however if it persists for longer than eight weeks, you should speak with your healthcare provider. Watch the animation and learn more about why we cough?

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A cough is an important reflex that helps protect your airways and lungs. Coughing can propel air and particles out of your lungs and throat at speeds close to 50 miles per hour. And this whole process is almost instantaneous and very effective! But a cough that last eight weeks or longer, should be discussed with your doctor. Watch Video 

What Is Chronic Cough?

Chronic cough is a persistent cough that lasts eight weeks or longer on some or most days.  While having a cough is a symptom of many lung diseases as well as some non-lung conditions, a chronic cough often last much longer than eight weeks and continues despite treatment of any other condition and in some cases, when other diseases have been ruled out. 
 There are different types of chronic cough:

• "Symptomatic" chronic cough is caused by an underlying disease and can treated and often resolved once the disease is diagnosed.
• "Refractory" chronic cough is often caused by an underlying reason that persists despite guideline-based treatment.
• “Unexplained” or “idiopathic” chronic cough means that no cause is found for the cough even after a thorough evaluation.  

Terms to Describe Chronic Cough

• Chronic: This means long term.  When diagnosing cough, there are three lengths:
  • "Acute cough" is one that lasts less than three weeks
  • "Subacute cough" is one that lasts three to eight weeks
  • "Chronic cough" lasts longer than eight weeks

• Refractory: This means the cough hasn’t been controlled after multiple testing and specific treatments, as well as having tried various over-the-counter treatments from your healthcare provider.

What Causes Chronic Cough?

Some common causes of chronic cough include:

• Lung diseases such as chronic obstructive pulmonary disease (COPD), asthma, non-asthmatic eosinophilic bronchitis (NAEB) or pulmonary fibrosis.
• Allergies, sinus issues like postnasal drip and digestive issues such as gastroesophageal reflux or GERD
• Medications such as ACE inhibitors for blood pressure
• Smoking tobacco products

Often when the cause of the cough has been identified, it can be successfully treated. But sometimes a chronic cough persists, either because treating the underlying cause is not effective, only one of the causes have been identified or the cause of your chronic cough is unknown. 

Chronic Cough Symptoms and Diagnosis

A chronic cough lasts eight weeks or longer because this threshold makes it less likely that the cough is caused by a respiratory infection or common cold. You may also experience cough spasms which are sometimes called “spells,” “fits” or “bouts.” These are sudden, often intense and uncontrollable coughing episodes that may last several minutes. These coughing spells may cause physical symptoms such as chest pain, vomiting, difficulty breathing or bladder leakage.

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Chronic cough isn’t contagious and it can’t always be linked as a symptom to any other disease. Watch Video 

May Be a Symptom of Another Disease

Alternatively, a chronic cough could be a symptom of a lung disease that hasn't yet been diagnosed by your healthcare provider. Your healthcare provider will work with you to take a thorough history and physical exam to attempt to identify the cause of your chronic cough. 
It is important to understand that a chronic cough can also be a sign of a disease not related to the lung at all.  Your healthcare provider may have you evaluated by other specialists besides a lung doctor.  This could include an allergist, an ear, nose and throat specialist (ENT), heart doctor (cardiologist) or an esophagus/stomach specialist.

When to see your healthcare provider

A cough that lasts less than eight weeks is usually caused by a respiratory infection and will go away on its own.
If you have developed a cough of any kind that goes on for longer than eight weeks, you should see your healthcare provider for a thorough exam to determine what is causing it.

Questions about Your Chronic Cough

Talk with our experts at the American Lung Association Lung HelpLine. Our service is free and we are here to help you by phone, web chat or email. Visit the Helpline

How Is Chronic Cough Diagnosed?

To identify the cause of your chronic cough, your healthcare provider will ask questions about your medical history, do a physical exam and run some tests. Learn more about diagnosing a chronic cough.

Medical history

Your healthcare provider will most likely ask you several questions about your cough, overall health and activities:

About Your Cough
About Your Activities
About Your Overall Health
Diagnostic tests

Your healthcare provider may order tests. Some diagnostic tests may need to be completed by a specialist besides your primary health care provider. The tests ordered may include:

• Chest X-ray: Quick and easy chest picture
• Blood sample: To see if your body is fighting an infection or if there are signs of allergies
• CT scan of the chest: A better-quality picture of the chest
• Throat swab: Usually done with a long cotton swab
• Phlegm or sputum sample: Collected after a deep cough
• Lung function tests: Are a series of tests that can tell how well your lungs are working. The most common lung function test is spirometry.
• Methacholine challenge test: A breathing test often used to diagnose or rule out asthma

Questions about Your Chronic Cough?

Talk with our experts at the American Lung Association Lung HelpLine. Our service is free and we are here to help you by phone, web chat or email. Visit the Helpline

Treating and Managing Chronic Cough
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Chronic cough can affect your entire life – from lack of sleep, social stigma or concern over a misdiagnosis. Watch Video 

What to Expect

A diagnosis of chronic cough can be both confirming and frustrating. It is a relief to know there is a name for the symptoms you have experienced for so long. But that doesn't always mean that the cough itself will go away. Your healthcare provider may instead work with you to manage living with chronic cough.
A chronic cough can impact your quality of life and may cause more severe challenges such as vomiting, muscle pain, rib fractures, urinary incontinence, tiredness or fainting. It is important to talk to your healthcare provider about managing any symptoms you are experiencing along with your chronic cough. 

Treatment Options

There is no FDA approved medication in the United States to treat chronic cough however clinical trials are happening to find new treatments and therapies. If your cough is identified as being caused by a specific medical condition such as asthma, COPD, pulmonary fibrosis, sinus drainage issues, nasal polyps, gastroesophageal reflux (GERD) there may be specific treatments prescribed by your healthcare provider that can be helpful in getting rid of the cough or at least making it more manageable.
Certain off label neurological medications may help reduce the cough reflex for people living with a refractory or unexplained chronic cough. If your provider prescribes this type of medication, you will need to work together to find the right dosage and monitor any side effects. Your provider may also recommend working with a speech-language pathologist to learn behavioral cough suppression therapy.
Even if your cough does not respond to treatment, often termed "chronic refractory cough" be sure to keep the conversation with your healthcare provider going to let them know how things are changing – or not.

Managing Chronic Cough - Lifestyle Changes

Lifestyle changes are not a cure for your chronic cough but may help in managing your cough.

• Avoid irritants. If you are aware of something that triggers your cough, try to decrease your exposure to this irritant. As an example, dust may cause you to cough so it can be helpful to damp dust your home and wear a mask to reduce your exposure.
• Be mindful of outdoor air quality, pollen or molds. Your local news or weather station often tracks the different pollen and molds in the air. You can also check the air quality at airnow.gov.
• Drink lots of fluids. This can help thin mucus and will keep you hydrated.
• Avoid tobacco smoke. Tobacco smoke is a lung irritant and can worsen your cough.  If you currently use tobacco products, learn more about quitting tobacco.
• Soothe your throat. Hard candy, cough drops or honey can help to soothe your throat.   However, do NOT give honey to infants under one as it may contain bacteria that is harmful to them.
• Moisturize the air. Use of a cool-mist humidifier may help decrease your cough.  Be sure to clean the water basin of your humidifier frequently to prevent mold growth.
• Discuss with your healthcare provider any physical and emotional impacts related to your chronic cough or coughing spells.

Managing your Emotional Health

Living with a chronic cough may cause a range of mood changes and emotions such as anger, anxiety, depression, embarrassment, frustration or helplessness. You may also feel self-conscious about your cough, especially in social situations.
While a chronic cough can feel isolating, you are not alone.  You may find comfort and support in reaching out to others experiencing similar challenges. In sharing stories, voicing frustrations and affirming hope, the emotional toll chronic cough has on your life may lessen. 

Check out some of the supportive resources available to you:

Online Support Communities
Clinical Trials
Better Breathers Club
Patient & Caregiver Network

Talk to an Expert

Talk to our trained lung health professionals at the American Lung Association Lung HelpLine. Our service is free and we are here to help you. Visit the HelpLine 

Newly Diagnosed - Steps to Take After Being Diagnosed with Chronic Cough

Step 1 - Communicate with Your Healthcare Team

• If you have been diagnosed with chronic cough, you most likely have seen several specialists such as a lung doctor, allergist and heart specialist to determine any other possible causes for your cough.  It is important to have ruled out any other reasons for your cough.
• If your healthcare providers do not work in the same healthcare system, encourage them to communicate with each other for the most comprehensive approach to your care.
• Talk to your provider about ways you can manage your cough.

Step 2 - Protect Your Lungs

• Avoid tobacco smoke. Smoking or breathing in secondhand smoke irritates your lungs and can worsen your cough.
• Occupational exposure, chemicals in the home and workplace, and mold can all act as irritants with the potential to worsen your cough.
• Stay up to date on vaccinations that protect against infectious respiratory diseases since coming down with one can make your cough worse.

Step 3 - Get Support

• Living with a chronic cough can be frustrating. Joining a support group can provide you with a community that understands the types of challenges you may be facing. Online support groups and in person support groups are available
• Consider professional support if you feel overwhelmed with your chronic cough diagnosis. Ask your primary healthcare provider to provide a referral to a counselor or check with your insurance for an in-network provider that can help you with managing the stress and frustration of your diagnosis.

Chronic Cough Resources and Videos

This resource library includes videos and other resources for people living with a chronic cough.

Videos

• Chronic Cough: A Doctor’s Perspective [Video]
  A cough is considered chronic if it lasts eight weeks, and often it lasts much longer. And it often doesn’t respond to treatment.
• Chronic Cough: A Patient’s Perspective [Video]
  Chronic cough can affect your entire life – from lack of sleep, social stigma or concern over a misdiagnosis.
• Chronic Cough: A Patient’s Perspective [Video]
  Chronic cough isn’t contagious and it can’t always be linked as a symptom to any other disease.
• The Process of a Cough [animation]
  A cough is an important reflex that helps protect your airways and lungs.  

Resources

• Chronic Cough One Pager
• Chronic Cough Diagnosis Roadmap
• Blog: After 25 years, a Chronic Cough Clinic Provides Answers 
• Blog: The Story of One Woman's Lifelong Struggle with Chronic Cough

Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/chronic-cough