Chronic cough: What are the causes, and how is it treated?

Written by: Mr Nick Hamilton
Edited by: Carlota Pano

cough is an automatic reflex from the body that removes mucus and irritants from the airways. While most coughs usually go away on their own, some can linger for weeks – even lasting several months.


Here, Mr Nick Hamilton, renowned consultant ENT surgeon and laryngologist based in London, provides an expert insight into a chronic cough.



How is a chronic cough defined?


A chronic cough describes a persisting cough that lasts for eight weeks or longer in adults, and for four weeks or longer in children. It can be dry or productive of phlegm.


What are the most common causes of a chronic cough?


The causes of a chronic cough are multiple. They can be broadly divided into lower airway causes, such as asthma or smoking-related chest diseases, and upper airway causes.


Within the upper airway, the most common cause for a chronic cough is believed to be allergy within the nose and throat, and reflux of stomach contents into the throat. The voice box can also become hypersensitive, and initiate coughing secondary to environmental stimuli such as cooking or smoke that would normally not induce coughing.


Coughing can also become habitual, and the act of coughing can drive inflammatory changes in the throat that create a cycle of irritation and more coughing.


Another common cause that should be considered is the use of ACE inhibitor medication for hypertension that can cause a chronic dry cough.


Can it be a sign of something serious? When should you see a doctor about a chronic cough?


While most chronic coughs turn out not to be something serious, serious health conditions can cause a chronic cough. It is therefore advisable to seek medical attention if you have a chronic cough to exclude a serious cause.


Which tests are usually performed to establish the cause of a chronic cough?


Tests are usually guided to identify the underlying cause. These can be initiated either by a respiratory physician or an ENT doctor.


Respiratory physicians focus on lower airway causes, and may perform imaging of the chest with an x-ray or a CT scan. Tests to look for reactive airway disease, such as lung function testing, are also useful.


In contrast, ENT doctors will examine the upper airway with a flexible endoscope to look for signs of allergy and to assess for signs of acid reflux. This test can also exclude lesions and problems with vocal cord movement that can cause a chronic cough. ENT doctors may also request allergy tests to support the diagnosis of upper airway allergy, and may consider referral to a gastroenterology specialist for assessment of acid reflux in certain circumstances.


How is a chronic cough treated?


A chronic cough is treated by addressing the underlying cause.


Within the upper airway, this can involve the use of nasal steroid and saline antihistamines, and the use of alginate liquids to control acid reflux. Within the lower airway, asthma inhalers may be given.


A number of cases are resistant to treatment, especially if there is a good history of hypersensitivity within the throat. These patients often benefit from cough control therapy to help overcome the urge to cough which is driving part of the sensitivity. If this does not work, medication such as amitriptyline can be given to try and reduce sensitivity.


In certain circumstances, an injection of local anaesthetic and steroid can be given to block the nerve that provides sensation to the voice box. This is particularly helpful if the irritation that is driving the cough is felt on one side around the voice box.



Mr Nick Hamilton is a highly distinguished consultant ENT specialist with over 15 years’ experience.


If you require expert assessment and treatment for a chronic cough, do not hesitate to book an appointment with Mr Hamilton via his Top Doctors profile today.

By Mr Nick Hamilton
Otolaryngology / ENT

Mr Nick Hamilton is a respected consultant ENT surgeon and laryngologist who specialises in all aspects of ENT and has a sub-specialist interest in voice, swallow and airway disorders. His private practice is at The Harley Street ENT Clinic, OneWelbeck ENT, Highgate Hospital, and The London Clinic. His NHS base is the Royal National Ear Nose & Throat Hospital which is part of University College London Hospitals NHS Foundation Trust.

Mr Hamilton, became a consultant at UCLH in 2022 and is expertly qualified. His primary medical qualification is from the University of Manchester and he also holds a first-class bachelor of science degree from University College London (UCL). His specialist training in ENT was based within the North Thames Deanery where he worked at the Royal National Throat & Ear, Royal Free and University College London Hospitals. He gained expertise in all areas of ENT and laryngology, and completed his training in 2021.

After completing specialist training, Mr Hamilton undertook a fellowship in Laryngeal Surgery at Massachusetts General Hospital in the USA and was a Research Associate at Harvard University. Mr Hamilton is also a Fellow of the Royal College of Surgeons.

Alongside Mr Hamilton's exceptional clinical practise and educational achievements, he has significant clinical research and teaching experience. He has a PhD in Regenerative Medicine from UCL, has published over 40 peer-reviewed research papers and has won a number of national awards for his research. He is an Associate Professor at UCL and his current research is focused on developing new treatments for the effects of ageing and fibrosis on the vocal cords. He is also interested in the long-term effects of COVID-19 within the throat as well as developing new treatment pathways for common throat conditions.

He is a member of various professional organisations including the Royal College of Surgeons of England (RCS Eng), ENT UK and the British Laryngological Association (BLA). He is also a member of the Royal Society of Medicine (RSM).

View Profile

Overall assessment of their patients

  • Related procedures
  • Facelift
    Neck lift
    Thread lift
    Buttock lift
    Botulinum toxin (Botox™)
    Dermal fillers
    Facial reconstruction
    Congenital malformations
    Facial plastic surgery
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.