Chronic cough that won’t go away

Common signs and symptoms

• Dry, tickly cough that won’t settle
• Cough that’s worse at night or when lying down
• Frequent throat clearing
• Feeling of mucus dripping down the back of the throat
• Coughing fits set off by talking, laughing or cold air
• Hoarse voice or a sore throat
• Heartburn or a sour taste in the mouth
• Coughing until you gag or run out of breath

When a cough becomes chronic

Most coughs fade within three weeks after a cold. A cough that lasts three to eight weeks is often post-viral and may settle on its own. Once it passes eight weeks in an adult, or four weeks in a child, doctors call it chronic and look for an underlying cause.

A chronic cough is more than a nuisance. It can cause sore chest muscles, headaches and poor sleep, and in some people it leads to leaking urine during coughing fits, a problem many are reluctant to mention.

Before an allergy workup, it’s important to rule out more serious problems. Coughing up blood, unexplained weight loss, night sweats, fever or a long smoking history need prompt evaluation, usually starting with a chest X-ray.

Common causes

• Cough-variant asthma
• Postnasal drip from allergies or sinusitis
• Acid reflux, including “silent” reflux
• ACE inhibitor blood pressure medicines
• A lingering cough after a respiratory infection
• Smoking or vaping
• Airway inflammation without asthma (eosinophilic bronchitis)

The usual suspects

In adults who don’t smoke and have a normal chest X-ray, a handful of conditions explain most chronic coughs. Several can be present at once, which is why a cough sometimes improves only partway with the first treatment.

If you take an ACE inhibitor, don’t stop it on your own. Talk with the doctor who prescribes it about alternatives. After a switch, the cough can take a few weeks or longer to fade.

• Upper airway cough syndrome, when mucus from allergies or sinus problems drips down the throat and triggers coughing
• Asthma, including cough-variant asthma, where coughing is the main or only symptom
• Acid reflux, which can irritate the throat even without heartburn
• ACE inhibitors, a group of blood pressure medicines whose names usually end in “-pril”
• Eosinophilic bronchitis, airway inflammation that responds to inhaled steroids but isn’t asthma

Cough-variant asthma explained

Some people with asthma never wheeze. Instead, they cough, often at night, with exercise or after breathing cold or dusty air. This is cough-variant asthma, and it’s easy to miss at a routine checkup because the lungs may sound normal.

Spirometry and a FeNO breathing test can point toward asthma-type inflammation, and many patients respond well to an inhaled controller medicine. Without treatment, some people with cough-variant asthma go on to develop typical asthma symptoms.

This type of asthma often flares during North Texas allergy seasons or after a cold. If your cough tends to return at the same time each year, that pattern is worth mentioning.

How we track down the cause

At Aller-Vista, your visit starts with a detailed history: when the cough began, what makes it worse, what you’ve already tried and every medicine you take. We then run breathing tests and, if allergies may be involved, skin or blood testing.

Before your visit, write down every medicine, inhaler and supplement you’ve tried for the cough and how long you used each one. A treatment stopped after a few days may still deserve a full trial.

Sometimes the clearest answer comes from a treatment trial. We may start a nasal spray, an inhaler or reflux measures and see how your cough responds over several weeks. If the cough persists, we’ll coordinate with lung, ENT or digestive specialists in the DFW area.

Easing the cough while you heal

While we work on the cause, a few simple steps may calm an irritated throat: sipping water often, using sugar-free lozenges, avoiding smoke and vapor, and running a humidifier during dry North Texas winters. Raising the head of your bed and avoiding late meals can help if reflux plays a part.

Over-the-counter cough syrups may take the edge off for a night or two, but they don’t treat the underlying cause. If testing shows that pollen, dust mites or pets keep your postnasal drip going, allergy shots can reduce that ongoing irritation for many patients over time.

For some people, the cough continues even after the triggers are treated, because nerves in the throat have become oversensitive. Breathing and voice exercises with a speech therapist can help in these cases, and we can coordinate that referral.

When to see an allergist

• Your cough has lasted more than 8 weeks, or 4 weeks in a child
• You cough at night, with exercise or around pets or pollen
• Antibiotics and cough medicines haven’t helped
• Your chest X-ray was normal but the cough persists
• You also have nasal allergies, sinus problems or reflux