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Chronic Cough

A cough lasting eight weeks or more is considered a chronic cough.

Talking to your healthcare provider about your cough is the first step to managing your cough and treating its cause.

Overview

Coughing is normal — it's your body’s way of keeping things like germs or dust or out of your throat and lungs or clear extra mucus from your airways. Coughing is often a symptom of a cold, flu or allergies. Acid reflux or reflux of non-acid contents of your stomach can also cause you to cough.

A cough that lasts less than three weeks and goes away on its own is called an acute cough. A sub-acute cough lasts more than three weeks, but less than eight weeks. This type of cough is also usually caused by an infection. It may go away by itself, however respiratory infections should be assessed by your healthcare provider and you may require treatment to get rid of your cough.

A persistent cough lasting eight weeks or more is considered a chronic cough. A chronic cough can affect you physically and socially and can disrupt your life. It is estimated that chronic cough affects about 16% of Canadians between the ages of 45 and 85.

Chronic cough can be caused by many different things; it's not always the sign of a serious health issue. The most common causes of chronic cough are:

· respiratory infection,
· asthma,
· postnasal drip,
· tobacco use,
· gastroesophageal reflux disease (GERD), or
· a side effect of certain medications.

Finding the cause of your chronic cough will help your healthcare team recommend the best treatment for you. Even if the cause of your cough isn't clear, your healthcare team can provide you with different options that will help you manage your cough. There are also things that you can do on your own to keep your cough from disrupting your life.

You can download a printable summary of our chronic cough resources here.

A patient's perspective

What's it like living with chronic cough? Hélène Robitaille shares her experience.

Watch the video now

Living with chronic cough

Chronic cough can have a significant affect on your day-to-day life. It can cause physical symptoms and it can affect you emotionally, including affecting your relationships and social life.

Living with chronic cough

How chronic cough can affect you physically

  • Scratchy or irritated throat
  • Feeling breathless or unable to catch your breath
  • Wheezing
  • Trouble sleeping
  • Fatigue (weakness, tiredness) or exhaustion
  • Problems with speech
  • Gagging or vomiting
  • Dizziness, feeling lightheaded or fainting
  • Wetting yourself with cough
  • Change in your voice
  • Chest pain, broken ribs, hernia due to force of the cough
Living with chronic cough

How chronic cough can affect you socially and emotionally

Chronic cough can interfere with your life and have social and emotional consequences.

It can make you anxious or scared that you have a serious health problem.

You may worry that people think you have a contagious disease or that you are a heavy smoker. There can be stigma associated with chronic cough, especially following the COVID-19 pandemic.

You may also worry that your cough bothers your family or friends. This can cause you to become lonely and isolated, which may lead to depression or other mental health issues.

Living with chronic cough

When to speak to a healthcare provider

Even if your cough has not lasted more than eight weeks, you still may need to see a healthcare provider. If you're not sure, ask yourself the following questions. If you answer yes to any of them, you should see someone on your healthcare team.

  • Are you coughing up blood?

  • Are you short of breath?

  • Has your cough changed over time?

  • Are you losing weight without trying?

  • Are you coughing up phlegm?

  • Do you have a fever?

  • Do you currently smoke?

  • Did you smoke in the past?

  • Are you living with asthma or COPD or other respiratory conditions?

  • Is your cough causing abdominal pain? Is your cough causing incontinence or leakage of stool?

A doctor's perspective

McMaster University's Dr. Andrew McIvor gives an overview of chronic cough and why it's important to speak to your healthcare provider if you think you have a chronic cough.

Watch the video now

Causes of and treatment for chronic cough

Most chronic coughs are caused by either postnasal drip, GERD, asthma, infections like chronic bronchitis or medications called ACE inhibitors. Smoking and smoking-related lung conditions are common causes in smokers. 

Treating the cause of your chronic cough can help reduce or get rid of your cough. Your healthcare team will recommend the best treatment for you depending on its cause.

The first medication recommended by your healthcare team may not successfully treat your cough. You may need to try several different medications before your healthcare team finds the right medication for you. It is also important, no matter the cause of your cough, to identify what triggers your cough and avoid these triggers as much as possible.

Chronic infection of your airways, called chronic bronchitis, can cause chronic cough for some people. There are other, less common infections that can cause chronic cough, for example tuberculosis (TB) or whooping cough (pertussis). Both children and adults can get whooping cough.

If an infection is causing your cough

You may receive antibiotics if a bacterial infection is causing your cough. Remember that antibiotics do not work against viral infections, however getting vaccinated against infections is a good way to prevent flu, COVID-19 and other common causes of lingering coughs.

When you have asthma, things like certain chemicals or scents or cold air can cause you to cough.

Asthma can also make it more likely that you will get an infection like a cold or flu. Taking regular medication to control your asthma can prevent the cough in most cases.

If asthma is causing your cough

You will be given inhalers to take if your cough is due to COPD or asthma. It is important to take them daily or as directed to treat the cause of the cough.

Postnasal drip happens when extra mucus from your nose drips down the back of your throat. This can cause you to cough. PND is usually a symptom of allergies or an infection like a cold.

If PND is causing your cough

You may be asked to take antihistamine (allergy) pills if your PND is caused by allergies. Decongestants (pills or spray) can help, however they should only be used for a few days.

Nasal sprays with corticosteroids or ipratropium bromide can be helpful to treat PND. Some people also find nasal rinses with saline helpful.

People who smoke may have a "smoker's cough". This is your body trying to get rid of the chemicals in your lungs and airways after long-term use of tobacco.

Even if you smoke, a chronic cough is not normal. It may be a sign of chronic obstructive pulmonary disease. Quitting smoking will improve your lung health and help you get rid of your cough.

If smoking is causing your cough

If you need help to quit smoking or are worried about your cough caused by smoking, there are supports available to you. Speak with your pharmacist or other healthcare provider about how you can quit smoking.

COPD is a lung disease associated with smoking. Symptoms of COPD include breathlessness and chronic cough.

If COPD is causing your cough

Quitting smoking and treatment for COPD can help improve chronic cough. There are supports available to you. Speak with your pharmacist or other healthcare provider about how you can quit smoking.

You may also be given inhalers to take if your cough is due to COPD or asthma. It is important to take them daily or as directed to treat the cause of the cough.

GERD, sometimes called heartburn or acid reflux, can cause stomach acid to back up into the throat, which can cause you to cough.

If GERD is causing your cough

Ask your healthcare provider about lifestyle changes you can make that can help prevent or treat GERD. If this doesn't work, you may be prescribed a medication called a proton pump inhibitor.

PPIs work by reducing the amount of acid your stomach produces. There are six PPIs available in Canada: omeprazole (Losec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Pantoloc), rabeprazole (Pariet) and dexlansoprazole (Dexilant).

ACE inhibitors prescribed for high blood pressure or heart failure can cause coughing for some people. There are also other types of medications known to cause chronic cough.

If your medication is causing your cough

Speak to your healthcare provider about the medications you're taking. They will help you find a different medication that will control your condition without causing cough.

 

People with no obvious illness or infection can experience chronic cough. Cough hypersensitivity syndrome (CHS) describes various cough-related conditions or unexplained cough.

CHS is a new concept in healthcare, and its cause is not yet fully understood. It is thought that the nerves that trigger the body’s urge to cough are overly sensitive to certain triggers. These triggers could be things like perfume, cold air, exercise, stress, singing or talking. People with CHS often feel the urge to cough, like a sensation of irritation or itching in the throat before they cough.

If CHS is causing your cough

Behaviour modification therapy, typically provided by speech language therapists, is sometimes recommended to treat CHS.

Finding the cause of your cough

Before your healthcare provider can treat your chronic cough, they will try to find out what is causing it. They'll start by asking you questions about your health. It is good to prepare for your appointment by reviewing the list of questions they could ask you.

Physical exam and testing

Your provider will do a physical exam including listening to your lungs. They will likely order tests such as  a chest x-ray and/or spirometry.

A chest x-ray is a two-dimensional image of your lungs. Chest x-rays are helpful to rule out more serious but rare causes of chronic cough, like pneumonia, tuberculosis (TB) or lung cancer.

Spirometry is a kind of pulmonary function test (PFT). It is the most common test to measure how well your lungs are working. You will be asked to blow into a mouthpiece that is attached to a small device called a spirometer. A spirometer will tell you how much and how fast you can move air in and out of your lungs and if there is something blocking your airway. This test can be used to diagnose COPD or asthma.

It is possible your cough is unrelated to a disease or condition of your airway or lungs. Your healthcare provider may refer to you an ear, nose, throat specialist (ENT), or someone who specializes in treating conditions of the stomach or esophagus. They may refer you for more testing, like a CT scan or endoscopy.

Questions about chronic cough?

Call our Health Information Line at 1-866-717-2673 to speak to a certified respiratory educator. You can also email info@lung.ca.

Controlling your cough

If your cough is getting in the way of you living as you would like, speak to your healthcare team. Even if they aren't sure of its cause, it's still possible for you to get relief from chronic cough. There are also things that you can do on your own to control your cough.

Controlling your cough

Prescription medications

Your healthcare team will discuss the pros and cons of different medications and work with you to choose the best option for you.

Often you will be asked to take medication for a couple of months to see if there is any change in your cough. You may be asked "rate" your cough (for example, how often you are coughing, if your cough is interrupting your sleep). This will help you and your healthcare provider know if the medication is working.

Ipratropium is used to relax the muscles around your airways so that you can breathe easier. Ipratropium bromide comes in an inhaler or puffer.

Amitriptyline is an antidepressant medication that is sometimes used for chronic pain. Some research has shown that it can lessen chronic cough.

Your healthcare team may give you a low dose of slow-release morphine if your cough is interfering with your daily life and other treatments have not helped.

Gabapentin and pregabalin are anti-seizure medications that have been shown to lessen the cough for some people.

Controlling your cough

Behaviour modification therapy

Behaviour modification therapy, typically delivered by speech and language therapists, involves teaching people to have more control over their cough symptoms and includes education, strategies to suppress the cough, vocal hygiene training and counselling.

The therapist will teach you ways to suppress your cough, using swallowing or relaxed breathing. They will also help you identify what causes you to cough and how you can avoid these triggers. They will also help you with any anxiety you feel because of your chronic cough.

What you can do to control your cough

There are things you can do on your own to help control your cough and keep it from getting worse.

Quit smoking

If you smoke, the best thing you can do is quit. There is help available for you. Start with your healthcare team. There is also information available on our website.

Avoid sources of smoke and other irritants

Smoke from tobacco, wood fire or other sources can irritate your lungs and cause you to cough. Make your home smoke free and avoid sources of smoke outside your home. Avoid environments where irritants such as smoke, dust, pollen or pollution may be present.

Read more about how air quality can affect your lung health.

Drink fluids

Water or other fluids can help thin mucus and soothe your throat. Honey or lemon (or both) in hot water and tea is also soothing. Make sure the temperature of the fluid is not too hot to cause burns or hurt your mouth and throat.

Suck on cough drops or hard candy

Sucking on hard candy or cough drops can soothe your throat. Hard candy may work as well as cough drops, so choose whatever drops or candy you prefer. Medicated cough suppressant lozenges (cough drops) or expectorant (cough syrup) are not recommended for chronic cough and are not recommended for children under 14.

Keep yourself from getting sick

You should do what you can to keep yourself from getting infections that can make your cough worse.

  • Ask your healthcare team about recommended vaccinations to prevent flu or COVID-19.

  • Wash your hands or use hand sanitizer.

  • Avoid being around people who may be sick. If you do get sick, stay home so that you don't get worse. Consider wearing a mask if you are around large groups of people, may be around people who are sick or are sick yourself.

  • Always remember to cover your cough and keep tissues on hand to cover your mouth when you cough.

Even if you smoke, a chronic cough is not normal.

If you smoke, a chronic cough may be a sign of chronic obstructive pulmonary disease. Speak to your healthcare provider.

Working with your healthcare team

Your healthcare team should include your primary care provider (a family doctor or nurse practitioner) and your pharmacist. Other members of your healthcare team may include a registered nurse or health professionals with a focus on lung health, like a respirologist, a respiratory therapist or a certified respiratory educator. It is also important for your support person or caregiver to be a member of your care team. 

Respirologists are medical doctors with additional education to specialize in the care and treatment of lung diseases and disorders.

Respiratory therapists are health professionals who monitor, assess and treat patients who have trouble breathing. They often work in hospitals, but they can work in other areas like home care or as part of a primary care team.  

Certified respiratory educators are healthcare professional (like nurses, pharmacists or occupational therapists) with additional training to teach patients about their respiratory conditions, like asthma or COPD

Preparing for your appointment

It's helpful for both you and your healthcare provider if you're prepared for your appointment. This patient tool provides suggestions for what to bring with you and the questions you may be asked.

Download the patient tool now.

Chronic cough in children

It is possible for a child to have a chronic cough. If a child has a cough that lasts more than four weeks, they may be diagnosed with a chronic cough.

In children the most common causes of cough are asthma, bronchitis or postnasal drip. Environmental triggers, like pollution, smoke or allergens, something stuck in their airway, GERD or whooping cough can also trigger coughing in children.

Your child's healthcare provider will start by asking you questions about your child's cough. You may be asked to describe your child’s cough as "wet" (phlegmy) or "dry". Other questions will include when the cough happens, for example, does your child cough when eating or drinking? Children may require different testing than is done for adults, depending on their age. For example, spirometry is not used for children under the age of six. Your child may be tested for whooping cough. To check if your child has asthma, they may be given different inhalers to test.

Psychiatric or psychological causes of cough

Some children may not respond to any treatment that their healthcare provider recommends. In some cases, a child may have a "tic". Tics can be caused by conditions, like Tourette's syndrome, an anxiety disorder or obsessive-compulsive disorder (OCD). These are involuntary muscle spasms that your child cannot control.

There is also something called a "habit cough" or a psychogenic cough. Like a tic cough, this cough has no obvious cause and does not respond to usual treatments, but it is not considered a tic. If their healthcare provider suspects your child may have a tic or habit cough, they will refer you to someone who can evaluate and treat your child. It is also possible for an adult to have a tic cough or a habit cough.

This web section was made possible by an educational grant from Merck Canada. 
The content featured in this section is for informational purposes only and not intended as medical advice.