I have a cough that won’t go away – what could it be?

Written by: Dr Sundeep Kaul
Published: | Updated: 08/01/2019
Edited by: Nicholas Howley

If you have a cough which has lasted for more than eight weeks, it’s important to seek medical advice, ideally from a cough specialist or cough clinic. In this article Dr Sundeep Kaul, a leading expert in respiratory care, explains that a cough could mean many things – which often makes the diagnosis challenging.

What are the main causes of a chronic cough?

Most patients with chronic cough fall under what I call “the big three” causes:

  • Asthma – this is a chronic lung disease that causes your air passages to become inflamed and/irritable. This inflammation usually restricts your breathing, but in some cases a cough might be the only manifestation.
  • Gastric reflux – also known as gastro-oesophageal reflux disease (GORD), this is a condition where acid from your stomach comes back up your food pipe. Usually we’ll treat this with intensive acid suppression.
  • Rhinosinusitis – this is an inflammation of the sinuses and nasal cavities that can cause a blocked nose in addition to a cough.

Certain environmental factors can also bring on or exacerbate a cough, such as:

  • Allergy – a cough could be caused by air pollution or proximity to animals.
  • Smoking – many smokers find that stopping smoking will significantly improve their symptoms.
  • Medication – taking ACE inhibitors is associated with cough in some patients.

Because there are various potential environmental factors at play, it’s always important to fully explore your occupation and hobbies when investigating why you have a cough.

Finally, a cough can be caused by pulmonary fibrosis, vocal cord disease , or lung cancer – but thankfully, this is much less common.

Why is it hard to diagnose a chronic cough?

Diagnosing a chronic cough is difficult for many reasons:

  • As you can see, there are lots of reasons why you might have a chronic cough. A cough could be a sign of a problem with your lungs, but it can also indicate a problem with the nose, the throat, or with your digestive system. Investigating all of these issues properly takes time – and sometimes involves multiple specialists from different disciplines.
  • You might have multiple issues contributing to a cough. Your cough could be a combination of asthma, post-nasal drip and environmental factors such as smoking or pollution. If your doctor successfully treats one of these issues but fails to address the others, your cough can persist.
  • Some causes of cough are difficult to diagnose without further testing. For example, a spirometry test may be helpful in diagnosing a lung condition , but a normal reading doesn’t rule out conditions such as asthma. If asthma is suspected you may need more specialist tests.

Therefore, if you have a cough that won’t go away, or you’ve had treatment in the past that was unsuccessful, it’s important to see a cough specialist. Specialists in chronic cough have the necessary experience to offer a systematic approach to managing chronic cough.

By Dr Sundeep Kaul
Pulmonology & respiratory medicine

Dr Sundeep Kaul is one of London's leading experts in both respiratory medicine and critical care. Practising from his NHS base at Royal Brompton and Harefield Hospital he has a special interest in a wide range of areas including breathlessness, coughs, sleep disorders, lung cancer and brochoscopy. Outside of his clinic he is dedicated to passing on his expertise, serving as a senior lecturer at Imperial College, London and has delivered over 100 talks in primary care. He is often invited to appear as a guest speaker by such organisations as the British Thoracic Society.

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