What's Behind Your Persistent Cough?

No one wants to be the person who can’t stop coughing. Not only is it uncomfortable on your throat, but it also draws angry stares from others in elevators, subway cars, and restaurants—especially during respiratory virus season.

Why do some coughs seem to take forever to resolve? A pulmonologist and an otolaryngologist explain the causes of a chronic cough and what you can do about it.

Defining chronic cough

In order to know what’s behind a constant cough, it helps to first keep track of how long you’ve had it. And there are specific timeframes that make a cough chronic or not. 

An acute or fleeting cough lasts for up to three weeks, explains Dr. Natalie Earl, an otolaryngologist at the Centers for Advanced ENT Care—Feldman ENT Division in Maryland and Washington, D.C. These short-lived coughs are usually related to a virus you caught and will resolve on their own, she says.

Read More: What to Eat When You’re Sick

On the other hand, a persistent or chronic cough lasts more than eight weeks, Earl says, sometimes even despite home remedies or over-the-counter cough medicine.

Somewhere in the middle are subacute coughs, which last between three and eight weeks, says Dr. Soo Jung Cho, a pulmonologist at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

Causes of chronic cough

If your cough has lasted eight weeks or more, you’re likely dealing with one of the following three causes. Around 90% of chronic coughs are due to one of these culprits, Cho says. (The other 10% are rare conditions like chronic bronchitis, lung cancer, or a side effect of certain medications.)

Asthma

If you can’t stop coughing, you may be dealing with cough-variant asthma, Cho says. Coughing is the main symptom of this breathing disease.

When you have asthma, you might cough more easily in reaction to irritants like pollen, fragrances, cold air, or even stress, according to the American College of Allergy, Asthma, and Immunology. You may have also noticed that your symptoms don’t improve much with over-the counter cough meds.

A pulmonologist or allergist can assess you for potential asthma symptoms and take an X-ray or CT scan of your chest to look for underlying lung disease, Cho says. 

Postnasal drip

Otolaryngologists (also known as ENTs) are very familiar with this cause of a cough that won’t go away. It’s “the most common presenting reason for cough in an ENT office,” Earl says.

Postnasal drip occurs when secretions in the back of your nose drip down into your voice box, forcing you to cough, she explains. “Allergies, viruses, sinus infections, and non-allergic rhinitis are typical sources for postnasal drip.”

Read More: Why Do I Always Have a Runny Nose?

You might be tipped off that your cough is caused by postnasal drip if you feel like there’s liquid running down the back of your throat. You’ll likely also have an urge to clear your throat, but a dry cough when you do, she says.

Your doctor may want to use a laryngoscope, a camera on a thin tube placed down your throat, to examine your voice box and determine if postnasal drip or something else is causing your symptoms, Cho says. 

Acid reflux or GERD

Sometimes, heartburn presents itself as a cough rather than indigestion. “Instead, what is present is hoarseness, throat clearing, and a dry, nonproductive cough,” Earl says.

An ENT or pulmonologist might refer you to a gastroenterologist for imaging of your esophagus and stomach to assess the degree of your acid reflux, Cho says. If it’s chronic and severe, you may be diagnosed with gastroesophageal reflux disease or GERD.

What to do about it

You don’t have to suffer through coughing bouts without support. Seek immediate medical attention if you have any major red flags along with your cough, such as shortness of breath, chest pain, unintentional weight loss, or if you’re coughing up blood, Cho says—especially if you smoke.

If you don’t have any major concerns about your coughing yet, you can test out a few at-home methods. Over-the-counter cough medicines and home remedies like tea with honey are worth trying, Cho says.

Read More: Are Allergy Shots Worth It?

If you suspect your cough is due to postnasal drip, try over-the-counter medications like guaifenesin (sold as Mucinex and other brands) that aim to dry up those secretions, Earl adds. If you think you have acid reflux, over-the-counter antacids or proton pump inhibitors may help, according to the National Institute of Diabetes and Digestive and Kidney Diseases.  

But after you’re tried some OTC meds, if your symptoms persist or get worse, it’s time to talk to a health care provider, Earl says. They may want to do imaging tests, refer you to another specialist, or start you on prescription treatment.

If you already have an underlying lung condition like asthma or COPD that affects your breathing, consider talking to your health care provider sooner than eight weeks if you’re coughing more than normal, Cho says. You’re at a higher risk for any acute cough to become a chronic cough, she says, but your doctor may be able to adjust medications you’re already taking to avoid that outcome.