Chronic cough
"A cough that persists for more than eight weeks should not be considered normal. Identifying its cause and understanding the mechanisms that sustain it makes it possible to offer personalized treatment and improve quality of life".
DR. EDUARDO JOSÉ GARCÍA
SPECIALIST. PNEUMOLOGY DEPARTMENT
What is chronic cough?
Coughing is a natural defense mechanism of the body that helps keep the airways clear and protected.
However, when a cough persists for more than eight weeks in an adult, it is considered a chronic cough, and a specific medical evaluation is recommended to determine its cause.
A persistent cough can have a significant impact on daily life. It can disrupt sleep, cause fatigue, interfere with speaking or working, and lead to physical discomfort or limitations in social activities.
In addition, we now know that in many patients the cough reflex itself can become overly sensitive. This is known as cough hypersensitivity syndrome. In these cases, everyday stimuli that would not normally trigger coughing —such as talking, laughing, certain odors, or changes in temperature— can trigger episodes that are difficult to control.
What are the symptoms of chronic cough?
In addition to a cough that lasts for more than eight weeks, other characteristic symptoms or situations may occur:
- Frequent need to clear the throat.
- Itching, tickling, or a feeling of irritation in the throat.
- A sudden sensation or strong urge to cough that is difficult to control.
- Coughing episodes when talking, laughing, singing, or exercising.
- Cough triggered by perfumes, cleaning products, smoke, cold air, or changes in temperature.
- Sleep disturbances, tiredness, or exhaustion.
- Voice changes or hoarseness.
- Chest discomfort after intense coughing episodes.
- Urinary leakage associated with severe coughing fits.
Identifying when the cough occurs and which situations trigger it can provide very useful information during the medical evaluation.
When should you seek medical attention more promptly?
Although most cases of chronic cough can be evaluated on a scheduled basis, certain symptoms require more urgent medical assessment.
Seek medical attention more promptly if your cough is accompanied by:
- Coughing up blood.
- Increasing difficulty breathing.
- Severe chest pain.
- Persistent fever.
- Unexplained weight loss.
- Difficulty swallowing.
- A significant decline in your general condition.
Do you have a chronic cough problem?
If you have had a cough for more than eight weeks, a specialist evaluation can help identify what is causing it and determine the most appropriate treatment for your particular case.
What are the causes of chronic cough?
Chronic cough does not have a single cause. It may be related to one or more medical conditions and, in some patients, it may persist even after the associated conditions have been appropriately treated.
Causes and situations that may be associated with chronic cough include:
Respiratory diseases
- Bronchial asthma.
- Eosinophilic bronchitis.
- COPD.
- Bronchiectasis.
- After-effects of respiratory infections.
- Other lung diseases.
Upper airway problems
- Rhinitis, rhinosinusitis, and other nasal conditions can contribute to persistent cough.
- There may also be abnormalities of the larynx or increased laryngeal sensitivity.
Gastroesophageal reflux
- In some patients, gastroesophageal or laryngopharyngeal reflux may be associated with cough. Its importance should be assessed individually, taking into account symptoms and the results of the medical evaluation.
Medications and irritating substances
- Some medications used to treat high blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors, can cause cough as a side effect.
- Smoking, vaping, and frequent exposure to smoke, dust, or other irritants can also contribute to or perpetuate the cough.
Cough reflex hypersensitivity
In some patients, the nerve mechanisms that control the cough reflex become altered.
This can cause seemingly harmless stimuli to trigger an exaggerated response. The cough may persist even when there is no single identifiable cause or even after associated conditions have been appropriately treated.
Who can develop chronic cough?
Chronic cough can occur at any age and can affect both smokers and people who have never smoked.
It is more common in patients with respiratory diseases, rhinitis, laryngeal disorders, exposure to irritating substances, or a history of respiratory infections.
However, it can also occur in people in whom no obvious lung disease is initially detected.
In these cases, a specialist evaluation can help identify treatable causes and determine whether cough reflex hypersensitivity is present.
How is chronic cough diagnosed?
The first step in evaluating a chronic cough is to understand its characteristics in detail.
During the consultation, the specialist will assess how long you have had the cough, how often it occurs, which situations trigger it, whether there are any other symptoms, which medications you take, and how much the cough is affecting your daily life.
Based on this initial assessment, the most appropriate tests will be selected for each patient.
These may include:
- Physical examination and chest imaging tests.
- Spirometry and other pulmonary function tests.
- Measurement of fractional exhaled nitric oxide (FeNO), which can help detect certain types of airway inflammation.
- Tests to assess whether the bronchi react excessively to certain stimuli or whether eosinophilic inflammation is present.
- Specific questionnaires to assess the severity of the cough and how it affects quality of life.
- Evaluation by Otorhinolaryngology, Allergy, or Gastroenterology specialists when necessary.
- Specific tests to assess the cough reflex in selected patients.
Not all patients need all of these tests. The goal is to select those that can truly help identify the cause or the mechanisms responsible for the cough in each individual case.
How do we treat chronic cough?
Treatment for chronic cough should be tailored to each patient.
If the evaluation identifies asthma, eosinophilic inflammation, nasal disease, or another condition related to the cough, the appropriate specific treatment will be prescribed.
However, in some patients the cough persists despite appropriate treatment of these conditions. This is known as refractory chronic cough.
When cough reflex hypersensitivity is also present, different strategies may be used:
- Understanding the mechanisms and triggers of the cough. Knowing why the cough occurs and learning to recognize the situations that trigger it can help improve control.
- Specific cough control therapy, which may include speech therapy or specialized physical therapy.
- Neuromodulator medications in selected patients, aimed at reducing the excessive sensitivity of the nerve mechanisms involved in coughing.
- Treatments specifically targeting the cough reflex, when indicated and available.
- Medical follow-up, to assess the response to treatment and avoid continuing therapies for long periods when they are not providing benefit.
The goal is not only to reduce how often the patient coughs. Treatment aims to reduce the frequency and intensity of coughing episodes, improve the patient’s ability to control them, and restore quality of life.
The Department of Pneumology
of the Clínica Universidad de Navarra
Specializing in smoking and tobacco-related diseases, the Department has over 15 years of experience in smoking cessation and lung cancer early detection programs.
The department's specialists have received training at leading centers around the world, including centers in the United States, and have extensive experience in the diagnosis and treatment of all respiratory diseases, both common and rare.
Diseases we treat
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Why at the Clínica?
- Leading clinical assistance with great work in research and teaching.
- Specialized nursing team.
- We work together with the Sleep Unit and the Lung Cancer Area.
Our team of professionals
