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Chronic Cough

Chronic Cough

What is chronic cough?

Chronic cough is a cough that persists. Chronic cough is not a disease in itself; rather it is a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits.

What are causes of chronic cough?

Some common causes of chronic cough include asthma, allergic, sinus problems (for example sinus infection), and esophagea reflux of stomach contents. In rare occasions, chronic cough may be the result of aspiration of foreign objects into the lungs (usually in children). It is very important to see a doctor who may order a chest X-ray if a chronic cough is present. The following are common causes of chronic coughing.

Cigarette smoking actually is the most common cause of chronic cough.

Asthma is a disease of airways, resulting in difficulty breathing or wheezing often characterized by abnormal breathing tests. Some asthma sufferers have chronic cough as their only symptom. They may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthma can be aggravated by cold air, exposure to air pollutants or pollen, smoke, or perfumes.

Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophageus. If stomach acid moves backward up the esophageus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be aspirated into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be cough.
Sinus problems and postnasal drip can also cause chronic cough with mucus. This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a "tickle in their throat" and frequent throat clearing.

Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungus. Viral infections do not respond to antibiotics. In patients with asthma, viral upper respiratory infections often result in a protracted cough even after the infection has cleared.

A particular strain of bacterial pneumonia, called Mycoplasma, may cause a chronic cough with fatigue, weakness, shortness of breath, and sputum production. This infection is sometimes referred to as "walking pneumonia," and commonly affects young and relatively healthy people.

Whooping cough (pertussis) is an acute, highly contagious respiratory infection caused by the bacterium Bordetella pertussis. Whooping cough commonly affects infants and young children, but can be prevented by immunization with pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.

Chronic cough in children is uncommon. Foreign material obstructing the airways of the lungs, asthma, and allergies are evaluated by a paediatrician.

Certain medications, notably ace inhibitors (enalapril [Vasotec], captopril [Capoten] etc.) used in treating high blood pressure, can cause chronic cough.

Less common causes of chronic cough include allergies, tumors,sarcoidosis, congestive heart failure, or other lung diseases such aschronic obstructive disease (COPD) or emphysema.
If chronic cough persists it is extremely important for the affected individual to be evaluated by a doctor. The doctor will consider the possibility of asthma, postnasal drip, oesophageal reflux, drug side effect, interstitial lung disease, or other unusual infections.

How is chronic cough treated?

The treatment of cough is directed toward the particular by the cause. However, patients may get symptomatic relief from over-the-counter cough medicines containing guaifenesin and/or dextromethorphan, drinking lots of water, inhaling steam, and using cough lozenges. In severe cases a doctor may prescribe codeine, which is an effective cough suppressant.
Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways, and reduce wheezing. In some cases, short-term oral steroids are prescribed.
Gastroesophageal reflux disease (GERD): Treatment includes avoiding foods that increase reflux, avoiding meals before lying down, elevating the head while sleeping, and taking medication such asfamotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac) to decrease stomach acidity.

Sinus problems and postnasal drip: Use of decongestants such aspseudoephedrine (Sudafed) or antihistamines such asdiphenhydramine (Benadryl) may improve symptoms of post nasal drip. Inhaled nasal steroids are very effective in treating allergic rhinitis (hay fever), a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide (Atrovent) can relieve post nasal drip. Antibiotics may be prescribed if the cause is determined to be sinusitis.

Infections: Bacterial pneumonia and bronchitis is typically treated with antibiotics such as cephalosporins and azithromycin (Zithromax). If the pneumonia is close to the chest wall inflammation of the surface of the lung can cause pain, known as pleurisy and analgesics can be helpful. Cough suppressants are used with caution in these situations because clearing the lung of the infected mucus by coughing helps clear the infection.

Most bronchitis in adults is from virus infections. Therefore, treatment is much the same as that of the common cold including rest, fluids, analgesics, and humidification. Some people find expectorant cough medicines containing guaifenesin helpful in alleviating their discomfort. Sometimes it is hard to differentiate a viral bronchitis from a bacterial bronchitis, and antibiotics are prescribed. In some cases, asthmatics can produce green mucus that looks infected. Your doctor can have the mucus examined to determine if an infection is present.

Medications: Patients taking blood pressure medicines called ace inhibitors (angiotensin converting enzyme) [for example, enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil), etc.] should talk to their doctor about switching medications. They should not stop their medicines on their own because a marked elevation in blood pressure can result from discontinuation. A newer generation of ace inhibitor like medicines called ARB's (Angiotensin receptor blockers), (for example, valsartan [Diovan], losartan [Cozaar], etc.) can be alternatives that have less potential to cause chronic coughing. There are a host of other medicines available to manage blood pressure.

Are there home remedies for chronic cough?

Chronic cough in adults can be treated with some home remedies. Consult your doctor for the home remedies that might be best for you.

Stay hydrated. Fluids can help thin secretions.

Gargling with hot saltwater can help cleanse the throat and rid it of mucus.

Elevate your head with extra pillows at night to ease a chronic dry cough.

Cough drops may soothe an irritated throat.

Do not smoke or use tobacco products.

Avoid inhaled irritants such as smoke, dust, or other pollutants.

Honey is often can be an effective treatment for a persistent cough. Add honey to hot tea, or even grape juice.

Ginger, prepared as a tea, is often used to help reduce symptoms of chronic cough and clear the nasal passages.

Other herbs such as eucalyptus or mint are often used to relieve cough symptoms.

Can chronic cough be prevented?

Don't smoke, as smoking is the most common cause of chronic cough.

Talk to your physician about managing your asthma, postnasal drip, or GERD to avoid cough symptoms.

Stay away from others known to be sick with bronchitis or pneumonia.

Eat fruit. Research suggests that diets high in fruit fibre and flavonoids may prevent chronic productive cough.


Home Remedies for You. Pertussis. Diet High in Fruit Fibre and Flavonoids May Prevent Chronic Productive Cough.

National Lung Health Education Program. Chronic Cough.

Up-To-Date. Patient information: Chronic cough in adults. Coughs Home Treatment.