Addressing Lingering Cough

Imagine coughing day after day, even after a cold has cleared. What begins as a protective reflex to clear the airways can, over time, morph into a persistent, disruptive force, with research revealing that lingering coughs take a significant toll on physical and emotional well-being. 

According to a 2021 survey, 5% of Americans report lingering coughs. If you are part of this statistic, keep reading to learn what could be causing you to cough and what to do about it. 

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Understanding Lingering Coughs

Cough is one of the most common medical complaints, responsible for 30 million doctor visits every year. The cause of a cough is often classified based on its duration.

What Is a Lingering Cough?

A lingering cough persists for weeks to months. It differs from an acute cough, which is generally associated with an infection or irritation and resolves within three weeks. 

A persistent cough is categorized into: 

• Subacute Cough: lasts between three and eight weeks
• Chronic Cough: lasts longer than eight weeks

Common Causes of Lingering Coughs

Lingering coughs can arise from various causes. Some of the reasons you may have a chronic cough include: 

• Asthma: A chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty breathing, wheezing, coughing, and shortness of breath. Cough-variant asthma is a type of asthma that causes a dry cough as the only symptom.
• Nonasthmatic Eosinophilic Bronchitis: Inflammation of the airways with an elevated number of eosinophils (white blood cells that play a role in allergies) but without the airflow obstruction typical of asthma.
• Chronic Bronchitis: A type of chronic obstructive pulmonary disease (COPD) characterized by chronic inflammation in the airways, which leads to narrowing, excess mucus production, and difficulty breathing.
• Gastroesophageal Reflux Disease (GERD): Chronic backflow (reflux) of stomach acid from the stomach into the esophagus, irritating the throat.
• Upper Airway Cough Syndrome (UACS): Formerly called postnasal drip syndrome, this is characterized by mucus dripping down the back of the throat from the nose or sinuses, often due to allergies, sinus infections, or other environmental irritants. 
• Smoking: A smoker's cough is experienced by up to 44% of long-term smokers. This chronic cough is often productive (produces phlegm) and worse in the mornings.
• Medications: Cough is a side effect of some medicines, particularly angiotensin-converting enzyme (ACE) inhibitors, used to treat high blood pressure and heart failure. 
• Infection: Postinfectious cough is a subacute cough that continues after the resolution of an upper respiratory infection.

Symptoms That Should Not Be Ignored

While many lingering coughs are not cause for immediate alarm, certain warning signs indicate a more serious underlying issue.

Red Flags in Persistent Coughs

It is important to watch for warning signs that could suggest a more serious condition, such as lung cancer or tuberculosis:

• Change in mental status
• Shortness of breath (dyspnea)
• Chest pain
• Prolonged or high fever (above 104 degrees F)
• Respiratory rate greater than 20 breaths per minute
• Requiring the use of accessory muscles (such as those in the neck, upper chest, and abdomen) to breathe
• Inability to speak normally
• Blue or purple discoloration of the lips and fingers (cyanosis)
• Coughing up blood (hemoptysis)
• Difficulty swallowing (dysphagia)
• Unexplained weight loss or fatigue

If you experience red-flag symptoms, contact a healthcare provider to discuss your concerns.

Differentiating Between Harmless and Serious Coughs

It can sometimes be difficult to tell if a cough is harmless or signifies something more serious. A systematic approach to evaluating cough, emphasizing the importance of red flags and specific cough characteristics, can help differentiate between the two. 

Signs pointing towards a cough being more serious include:

• Lasting more than eight weeks
• Alarm symptoms, such as weight loss, persistent fever, night sweats, chest pain, and difficulty breathing. 
• Personal history of smoking and/or drug use
• Family history of lung cancer or other chronic respiratory diseases
• Exposure to tuberculosis or other environmental hazards

Diagnosis and Medical Insights

Understanding the cause of a lingering cough requires a thorough diagnostic process, which may involve a physical exam, medical history review, and specific diagnostic tests.

How Doctors Diagnose Lingering Coughs

Doctors typically begin by reviewing the patient's medical history and conducting a physical exam. They may ask questions about:

• How long you have been coughing
• What makes the cough better or worse
• The presence of other symptoms
• Allergies
• Medications and supplements
• Smoking history
• Recent illness 
• The work you do

As part of a physical exam, a doctor will: 

• Collect vitals (weight, blood pressure, temperature, heart rate, and respiratory rate)
• Measure the oxygen saturation of the blood
• Listen to your heart and lungs
• Look inside your mouth and throat
• Palpate your sinuses
• Measure peak flow rate (the highest speed at which a person can forcefully exhale air from their lungs) with a peak flow meter

Your doctor may also determine that other tests and imaging are necessary, such as: 

• Chest X-Ray: An imaging test that provides a picture of the lungs and chest structures. It helps detect conditions like pneumonia, lung tumors, heart failure, and other lung diseases that may be causing the chronic cough.
• Complete Blood Count (CBC): A blood test that measures the levels of different blood cells, including white blood cells.
• Sputum Culture: This test involves collecting a sample of mucus (sputum) from the lungs to identify pathogens that could be causing infection. 
• Spirometry: A lung function test that measures how much air a person can breathe in and out and how quickly to diagnose conditions like asthma and COPD. 
• Chest CT Scan: An imaging test that provides more detailed images of the lungs than a chest X-ray. 
• Methacholine Challenge Test: This test measures airway reactivity and may be used to diagnose asthma.

The Role of Specialists in Persistent Coughs

Specialists might be involved in the diagnosis and management of persistent coughs. Depending on your symptoms and suspected diagnosis, these specialists could include:

• Pulmonologists: Experts in lung conditions, they can help diagnose asthma, COPD, or other respiratory diseases.
• Gastroenterologists: If GERD or other digestive issues are suspected, a gastroenterologist can assist in diagnosis and treatment.
• Allergists: Allergists diagnose and treat allergies.

Effective Remedies and Treatments

Managing a lingering cough requires addressing its underlying cause. Both home remedies and medical treatments can play an important role in easing symptoms.

Home Remedies for Lingering Coughs

Home remedies can provide relief for mild, non-serious lingering coughs. Common at-home treatments include:

Honey Tea

Research shows that honey may support a healthy immune response and reduce mucus secretion, helping to ease symptoms like sore throat and cough.  

A 2018 systematic review concluded that in some scenarios, honey was more effective than some medications (e.g., salbutamol and diphenhydramine) for managing cough.

Mix one tablespoon of honey in 1 cup of hot water to make honey tea. Giving honey to children under one year old isn't recommended due to the risk of botulism.

Steam Inhalation

Breathing in warm air, such as steam from a hot shower or using a humidifier, has been shown to reduce bronchoconstriction (narrowing of the airways) in people with asthma. 

In one study, researchers noted transient improvements in lung function in patients with asthma and chronic bronchitis during sauna use, which might suggest some potential relief for respiratory symptoms like cough. 

Lifestyle Changes

Depending on the type of cough, your doctor may recommend some or all of the following lifestyle modifications for cough management:

• Discontinuation of an ACE inhibitor medication usually results in cough cessation within two weeks.
• Most patients who quit smoking will have cough resolution within four weeks.
• Medical guidelines support dietary and lifestyle modifications in GERD management, including weight loss (for overweight patients), elevating the head of the bed, tobacco and alcohol cessation, staying upright after finishing a meal, and eliminating common dietary triggers.
• To avoid allergic triggers, keep pets out of bedrooms, clean regularly to remove dust from your home, and use air filters or keep windows closed when air quality is low.

Medical Treatments for Persistent Coughs

If the underlying cause is identified, medical treatments can help manage and resolve a lingering cough. 

Common treatments might include include:

• Over-the-counter cough suppressants, such as dextromethorphan, can temporarily relieve coughing symptoms so they don't interfere with work or sleep.
• Depending on the severity of asthma, your doctor may prescribe a combination of medications, including a rescue inhaler, inhaled corticosteroid, long-acting bronchodilator, oral corticosteroid, and leukotriene receptor antagonist.  
• If lifestyle modifications are insufficient in managing GERD symptoms, your doctor may prescribe an H2 blocker (e.g., famotidine) or a short course of a proton pump inhibitor (e.g., omeprazole).

Preventing Lingering Coughs

You can help prevent coughs caused by infections by supporting the immune system and taking steps to prevent the spread of disease:

• A balanced and healthy diet, supplemented with a multivitamin if necessary, ensures you meet the daily requirements for the vitamins and minerals your immune system needs to function properly. 
• Wash your hands often with soap and warm water.
• Avoid contact with people who are sick.
• Stay up-to-date on vaccines that protect against respiratory illnesses like influenza (flu), COVID-19, respiratory syncytial virus (RSV), and pneumonia.

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Key Takeaways

• A lingering cough is defined as one that lasts more than three weeks. While frustrating, understanding their potential causes and recognizing when medical attention is needed can lead to faster resolution. 
• Up to 90% of chronic coughs are caused by asthma, upper airway cough syndrome (postnasal drip), and GERD. 
• Many chronic coughs can be managed with lifestyle modifications, natural remedies that support respiratory function, and medications. 
• Because more serious health conditions can cause chronic cough as a symptom, it is always recommended that you discuss this symptom with a healthcare provider, especially if you begin to experience more concerning symptoms like coughing up blood, persistent fever, and weight loss.