What Causes Chronic Cough?
Medically reviewed by Ronald Lubelchek, MD
Why am I coughing so much? Coughing is a bodily reflex that offers protection from germs or irritants. When you are coughing too much, however, it can be concerning—especially if it lasts for a long time. A chronic cough is a cough that lasts more than eight weeks.
You can cough a lot but not be sick. Chronic cough has various possible causes, such as asthma or allergies, chronic obstructive pulmonary disease (COPD), air pollution, and gastroesophageal reflux disease (GERD).
Inflammation of the lungs may cause a high-pitched or wheezing sound. Other chronic coughs can have a barking sound. Here's more about the most common causes of chronic cough and what you can do about them.
Related: 15 Reasons You're Short of Breath
Causes of Cough
People can experience long-term coughing for different reasons. A chronic cough does not always mean you are sick. Health conditions, environmental factors, and lifestyle factors may be responsible.
1. Allergies, Asthma, Irritants
Why am I coughing so much but not sick? Asthma, allergens, and irritants are common triggers of a cough that's not caused by illness. Asthma is a chronic disease that affects the lungs and causes asthma attacks. Triggers like certain foods or airborne irritants result in asthma attacks. These attacks include repeated episodes of wheezing, shortness of breath, chest tightness, and nighttime or early morning coughing.
You do not need to have asthma to be affected by airborne irritants. Around 40–60 million Americans have allergic rhinitis (hay fever). Allergic rhinitis causes coughing and other symptoms like a stuffy nose and sneezing. Common triggers include pollen, dust, and pet dander.
2. Chronic Obstructive Pulmonary Disease (COPD)
Problems with your lungs, like chronic obstructive pulmonary disease (COPD), can lead to chronic coughing. COPD is a term that covers two main conditions: emphysema and chronic bronchitis.
Emphysema damages the walls between many of the air sacs. This damage causes the air sacs to lose their shape and become floppy. The walls of the air sacs can also be destroyed, leading to fewer and larger air sacs instead of many tiny ones and reducing the amount of gas exchange.
Chronic bronchitis causes the lining of the airways to be constantly irritated and inflamed. This causes the lining to swell. A lot of thick mucus forms in the airways, making it hard to breathe.
Most people with COPD have both emphysema and chronic bronchitis. The severity of each disease varies from person to person. Symptoms other than coughing include wheezing, shortness of breath, and tightness in the chest.
3. Gastroesophageal Reflux Disease
Heartburn is the main symptom of GERD, a digestive disorder. Coughing is another common symptom, along with chest pain and wheezing.
GERD affects people of all ages, from infants to older adults. People with asthma are at higher risk of developing the disorder. Asthma attacks can cause the lower esophageal sphincter to relax, which lets stomach contents flow back into the esophagus.
4. Air Pollution
Various pollutants and irritants in the air can cause a persistent cough. Even short-term exposure to fumes can result in cough, phlegm, and lung irritation. Fumes can also exacerbate the symptoms of allergies or asthma. Mold spores found in and around homes may similarly cause wheezing and coughing if you inhale them.
5. Smoking
People who smoke often develop a cough. The body's natural response to get rid of chemicals that enter the airways and lungs from tobacco use causes coughing. This chronic cough is often known as a smoker's cough. A smoker's cough may begin as a dry cough but can eventually turn into a wet cough, which produces phlegm.
A study published in 2016 looked at the prevalence of chronic cough and possible causes in the general population. The researchers used data from the Korean National Health and Nutrition Examination Survey and included 119,280 adults older than 40. They found that 47.7% of people with chronic cough were current smokers.
6. Respiratory Tract Infection
Coughing is one of the most common symptoms of colds, flu, and other respiratory tract infections. These infections interfere with normal breathing. Other symptoms, such as a stuffy nose and a fever, are telltale signs that a viral infection is causing your cough. A cough can outlast all other symptoms if the air passages in your lungs remain sensitive and inflamed.
7. ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors treat heart failure and high blood pressure. These medications often cause a persistent dry cough.
A study published in 2019 found that one out of five people discontinued ACE inhibitors use due to side effects, the main one being chronic cough. It's unclear why these drugs lead to long-term coughing.
8. Pertussis
Pertussis (whooping cough) is a highly contagious respiratory illness caused by Bordetella pertussis bacteria. Common symptoms include a slight fever, a runny nose, and, most notably, a violent cough that can make breathing hard.
Attempting to inhale air into the lungs between coughs can produce a distinctive, high-pitched whooping sound. Many people do not have a fever after the initial stage. The cough that accompanies pertussis, however, can persist for several weeks.
Types of Coughs
There are different types of coughs based on various factors. These include:
Acute cough
Chronic cough—including refractory cough, which does not resolve with treatment
Dry cough, which does not produce mucus
Productive or wet cough
Some coughs also come with certain sounds. Other than a whooping cough, you might have a barking or wheezing cough.
Acute vs. Chronic Coughs
A main difference between chronic and acute coughs is the length of time that they last. A cough is considered acute if it persists for less than eight weeks. An acute cough lasts no longer than three weeks, while a subacute cough lasts from three to eight weeks.
Acute coughs also tend to be less serious, clear up on their own, and do not require a visit to a healthcare provider. Chronic coughs are often associated with more severe health conditions.
Risk Factors of Chronic Cough
Some people may be more at risk of experiencing a chronic cough than others. Risk factors for persistent coughing include:
Allergic rhinitis
Asthma
Older age
Rhinosinusitis (sinus infection)
Smoking
Treatment
Treating chronic cough will depend on the underlying cause. The options available to you will be specific to your individual case. Identifying and avoiding allergens or taking allergy medications, for example, can help resolve allergy-related chronic coughing. A healthcare provider may also advise treatments to manage the coughing if it cannot be resolved.
Home Remedies
A few home remedies exist to help treat or manage chronic coughing. Avoiding or limiting exposure to allergens or irritants, including tobacco smoke, can ensure your cough does not get worse.
Coughing can irritate your throat. Soothing your throat is another way to relieve a chronic cough. You can use cough drops, hard candies, or honey to decrease discomfort from a sore throat.
Hydration is another essential way to reduce a chronic cough. Drinking plenty of fluids thins mucus that might make you cough. Using a humidifier to moisten the air in your home can also decrease coughing.
When To See a Healthcare Provider
Consult a healthcare provider if you are concerned about coughing. You'll also want to see a healthcare provider if you have a chronic cough that lasts for more than eight weeks. They'll want to do an exam to help figure out what's causing the prolonged cough.
Seek medical attention in general if you have:
A fever
Coughing up blood or thick phlegm or mucus that smells bad
Difficulty breathing or swallowing
Stridor, a high-pitched noise when you breathe in
Violent coughing that starts quickly
Worsening cough upon lying down
Related: Why Am I Getting Heartburn All of a Sudden?
A Quick Review
There are different types of coughing, including a chronic cough that lasts for a long time. Chronic coughing can be due to allergies or air pollutants. Coughing a lot for long periods can also be a symptom of a health condition, such as COPD or GERD, or a respiratory tract infection.
It's important to get a chronic cough checked out if you have symptoms that last two months or longer. Only a healthcare provider can confirm what's going on with a long-lasting cough and recommend what can give you relief.
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