All the possible causes of a lingering cough beyond the cold and flu—and when you should take all that hacking seriously.

By By Emily Shiffer
Updated: February 24, 2019
Photo: Ariel Skelley / Getty Images

Coughs seem to go with the territory in winter-you can't go long without hearing someone on the subway or in the office having a coughing fit.

Usually, coughs are just part of getting over the common cold, and other than downing some DayQuil, there's not much you can do to make them go away. (Related: The Best Way to Fight a Cold)

"Acute coughs are most commonly caused by viral upper respiratory infections that can persist for oftentimes two, even three weeks," says Judy Tung, M.D., section chief of ambulatory internal medicine at NewYork-Presbyterian Lower Manhattan Hospital. They can be accompanied by a myriad of symptoms, including cough, runny/congested nose, and fever.

But if your cough has been lingering for longer than you can remember, don't expect it to simply run its course sans intervention. "A cough that goes beyond three weeks and definitely beyond eight weeks is considered chronic, and may no longer be attributable to a time-limited infection such as a cold or flu virus," explains Dr. Tung.

The Most Common Reasons for a Chronic Cough

1. Post-nasal drip

Symptoms: If you have a cough that's wet (mucus/congestion in your lungs in your cough) and if you can feel the congestion dripping from your sinuses down the back of the throat into the airway, then you know you have a cough caused by a post-nasal drip, says Angela C. Argento. M.D., interventional pulmonologist at Northwestern Memorial Hospital.

How to treat it: First line of defense?"Nasal sprays that can include steroids or just saline (salt water) or treatments to clear the sinuses, such as a sinus rinse or Neti pot," Dr. Argento says. In severe cases, you may require a procedure with an ear, nose and throat doctor to address the issue, along with antibiotics, she adds.

2. Acid reflux

Symptoms: If you have a persistent dry cough and it's accompanied by heartburn, then acid reflux could be the cause. "Acid reflux creates a burning feeling that starts in the center of your chest just under the rib cage and moves upwards, mostly experienced after large meals, after acidic or caffeinated food/beverages, or if you lie down right after eating," says Dr. Argento.

How it's treated: Use acid suppressants (like Pepcid AC or Zantac) once or twice a day, typically before breakfast and/or dinner, to prevent acid reflux, she says.

3. Asthma

Symptoms: If the only symptom you have is a dry cough, it could be asthma. "With asthma, your cough might be worse with exercise, exposure to cold, or certain smells or chemicals," says Dr. Argento. Symptoms like chest tightness, shortness of breath, and wheezing are also clues that it's asthma at play, Dr. Argento explains.

How it's treated: "Asthma is typically treated with inhaler medications, but some patients with severe asthma may need steroids, biologic agents (a new injectable asthma medication), or a procedure called bronchial thermoplasty," says Dr. Argento.

4. Chronic bronchitis

Symptoms: If you've had a cough for at least three months of the year for two years in a row, then you may have chronic bronchitis, explains Dr. Argento. Other symptoms include shortness of breath or phlegm production (which can be white, clear, gray, or even yellow or green during a respiratory infection).

How it's treated: "Inhalers are typically the mainstay of treatments for chronic bronchitis," she says. "Flare-ups are treated with antibiotics and steroids, as well as supplemental oxygen if needed."

5. Pneumonia

Symptoms: If you have a cough with lots of thick green or yellow phlegm, accompanied by chest pain or discomfort when you take a deep breath in, it's probably pneumonia, says Dr. Argento. "Most people will also have fever, possibly a sore throat, and fatigue or weakness."

How it's treated: Pneumonia can be caused by bacteria, viruses, or fungus and the treatment will vary depending on the cause. Pneumonia caused by bacteria can be treated with antibiotics; viral pneumonia will resolve with hydration, rest, and supportive care; fungal pneumonia (seen in immune-compromised patients) is treated with antifungal medications, says Dr. Argento.

At What Point Should You Take Your Cough Seriously?

Chronic coughs can be accompanied by super-disruptive symptoms like sleep loss, lightheadedness, and even rib fractures, according to the Mayo Clinic-so they're worth taking seriously.

"Coughs lasting longer than six weeks should be brought to the attention of a provider. And any cough that is also associated with alarming symptoms, such as bloody sputum (a mixture of saliva and mucus), weight loss, fever, night sweats, shortness of breath, or wheezing, should also be brought to the attention of a doctor," says Dr. Argento.

While rare, your cough may signal an even more serious health issue, including whooping cough or even lung cancer, she adds. So if you're worried that your cough may be something more serious, it is always best to check in with your doctor.

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