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Chronic cough: when to seek help


Sometimes it starts with a tingling in your throat, other times you get hit with a full-blown coughing attack. But how do you know when a cough is serious enough that you should see a doctor?

Sucharita Kher

The anatomy of a cough

“A cough is caused by sensors in the throat that trigger the cough reflex through the vagus nerve,” explained Fadi Ramadan, MD, Primary Care Physician at Tufts Medical Center. “So, if things go down the wrong way or there are foreign particles or dust trapped in the throat, these sensors send a message to the nerves that there is something there that shouldn’t be.”

Coughs are protective – they are our brain’s way of telling our throat to try to stop foreign materials from going down into our lungs. Typically, a few coughs will take care of the issue. But why do some coughs linger? And when could it be an indication of something more serious?

A cough that lingers

To be classified as a chronic cough, you should be coughing at least a couple of times a day, most days of the week for 8 weeks or longer in adults.

“The causes of a chronic cough are very different from a more acute, short spurt of coughing,” said Sucharita Kher, MD, Pulmonologist and Director of the Outpatient Pulmonary Clinic at Tufts Medical Center. “The cough can impact your life – interrupt your sleep and make you feel tired.”

Some of the common causes of chronic cough include:

What’s causing your cough?

“If you have a cough that is persisting for two weeks or more, call your primary care doctor,” said Dr. Ramadan. “We’ll start with a medical history and use that to see if your cough is caused by some of the more typical causes.”

For example, if your cough is worse in the morning after meals, it may be caused by acid reflux or GERD. If it’s seasonal and seems to come on in the late spring or September, it is likely being caused by post-nasal drip associated with allergies. And, if it tends to happen after exercise, it could be asthma that is causing the cough.

There are, of course, more rare and serious causes of chronic cough that could be of concern.

Meet Fadi Ramadan, MD

Examples include:

  • Dysphagia in seniors – our swallowing reflex weakens over time. This change is a common cause of chronic cough in the elderly. Patients tend to have a cough with eating or drinking certain foods/liquids.
  • Medications – blood pressure medications like ACE inhibitors can cause coughing.
  • Environmental exposures – dust, smoke, pollution and other environmental factors can cause irritation in the throat. Similarly, other allergens such as pet dander and mold can trigger a cough.
  • Bacterial, fungal or tuberculosis (TB) infections – these can be associated with risk factors, such as travel to geographic areas where fungal infections and TB are prevalent. Patients may have other symptoms of fever, night sweats, weight loss, etc.
  • Cancer – If you are seeing blood in the phlegm when you cough and have associated weight loss, this could be a cause.

“When we see patients who have a chronic cough, depending on history and examination, we use tests like a pulmonary function test to tell us what might be causing the symptoms,” said Dr. Kher.

The bottom line – don’t assume a chronic cough is nothing.

“Visit your doctor so we can diagnose the problem and get you on the road to recovery,” noted Dr. Kher.