Chronic cough

The condition tends to affect people later in life, with a peak age of around 50 years. Women are two times more likely to experience chronic cough than men.

You may have chronic cough as part of another condition, including asthma, rhinitis (a blocked, itchy, or runny nose), COPD, bronchitis or an interstitial lung disease (ILD). Although this may explain the reason you have a cough, healthcare professionals from around the world are suggesting that even when cough exists at the same time as another condition it may need separate treatment.

Some of the main causes/ triggers for cough include:

• Nerve damage (also known cough hypersensitivity)
• Inflammation in the upper or lower airways (e.g.asthma, rhinitis or rhinosinusitis, where the sinus is inflamed)
• ACE inhibitor drugs (e.g.ramipril, perindopril), which are used to treat high blood pressure and heart failure
• Smoking
• Reflux from the stomach or poor movement of the food pipe (oesophagus), where contents come up the oesophagus  into the throat
• Occupational or other irritants

It is common for chronic cough to be caused by long-term bronchitis due to cigarette smoking. However, it is rare for people who smoke to get medical advice just because of their cough. Most of the people who are treated by lung-health doctors or at cough clinics are non-smokers.

People with chronic cough have hypersensitive nerves. There are certain things that can trigger a coughing fit. Below is a list of common triggers:

• Irritants, such as tobacco smoke, perfumed products and pollution
• Changes in physical activity
• Hot or cold environments, or moving into a different environment, such as leaving your home on a cold day
• Speaking or singing
• Lying down
• Getting up in the morning
• Eating
• Stress/emotions

The main symptom of chronic cough is the cough itself, but it can affect people in very different ways including how often you cough and how long each coughing fit lasts. Other symptoms include:

• Persistent tickling in your chest and throat
• Irritating, or itching, sensation in your chest and throat
• Hoarseness of your voice, or other types of vocal issues
• A feeling that your throat is blocked
• A funny taste in the mouth
• Headache
• Chest or abdominal pain
• Passing out (cough syncope)
• Incontinence (problems with controlling the bladder and bowel)

Chronic cough can have a huge impact on your quality of life. You may find that the things that can trigger a coughing fit, including eating and speaking, cause you to limit your social life and make you feel isolated. People with chronic cough often worry about the impact of their cough on their spouses, families and friends, and that their cough will be disruptive during every day social activities, such as going to the cinema or a restaurant.

“I was always really conscious of coughing around other people. I worked as a clinical director for a large organisation, which involved lots of meetings. “If I needed to talk, I used to drink gallons of water to lubricate my throat and would avoid eating during the day, which meant I was very hungry at night.”

Sue Nelson, UK, who has experienced chronic cough for 17 years

Despite the fact that it is very common, many people with chronic cough may find it difficult to get a diagnosis from their healthcare professional, due to a lack of understanding or awareness of the condition. A chest X-ray, a lung function test (known as spirometry test) and full blood count to look for allergic cells (eosinophils) should be performed.

To give a diagnosis of chronic cough, your doctor will normally need to ask you questions about your cough, such as:

• When do you first cough in the morning?
• Do you experience any other symptoms?

The history is useful to find any underlying conditions or irritants that could be causing the cough. Some symptoms may suggest an underlying cause, for example wheeze due to asthma and COPD, heartburn (reflux), or runny nose (rhinitis). Cough that is triggered by lots of different factors such as certain smells, cold air, speaking, changing body position, or eating certain foods, may suggest cough hypersensitivity. This is when underlying problem is a disorder of airway nerves.

Worrying symptoms that may require an urgent referral include weight loss, fever, recurrent chest infections, persistent (but not when it comes and goes) hoarseness, swallowing problems and coughing up blood. Always seek medical help if you experience these symptoms. There may not be a serious cause, but it is worth getting checked out.

The doctor may ask you how severe your cough is or how the cough affects your life, directly or by using special scales or questionnaires, such as:

• Numeric scale (usually from 1 to 10, when 10 means the most severe cough)
• Visual Analogue Scales (VAS) (usually 1-100 mm, when 100 mm means the most severe cough)
• Cough related quality-of-life questionnaires, e.g. Leicester Cough Questionnaire
• Hull Airway Reflux Questionnaire (useful to diagnose non-acid airway reflux)

Several treatments are available for chronic cough. Different treatments work for different people so you may need to try a few options to find the best one for you.

Removing irritants

Firstly, your doctor will recommend removing any obvious irritants. If you smoke, it is recommended you stop (most smokers find their cough gets better after stopping). Learn more about the benefits of quitting smoking and smoking when you have a lung condition.

If you are taking an ACE inhibitor drug, your doctor may stop this and replace it with an alternative. An ACE inhibitor cough may take a few weeks to settle after withdrawal of this medicine. You should only change your medication after discussions with your healthcare professional.

Treating underlying conditions

Your doctor may treat you for any other underlying condition that may be causing the cough. They will need to find an underlying condition and decide on the best treatment.

Conditions that may be associated with cough commonly include asthma, reflux and blocked nose (rhinitis) and doctors usually start treatment targeted to these conditions.

If you have a cough that brings up mucus (known as a wet or productive cough), it may result from chronic bronchitis, bronchiectasis or rhinosinusitis. To treat this, healthcare professionals may offer you treatment with mucolytics, antibiotics or refer you to a physiotherapist.

When cough persists

If the cough persists despite treating underlying conditions or no underlying conditions are identified, you may be diagnosed with a ‘refractory chronic cough’ (RCC). The underlying problem here is usually a disorder of airway nerves known as cough hypersensitivity and needs specific treatment. Your healthcare professional may suggest you try one of these treatments depending on the type of cough you have:

• Low dose morphine sulphate tablets are usually well tolerated and effective in just over half of patients with persistent cough. Common side effects include constipation and drowsiness.
• Neuromodulator drugs such as gabapentin, pregabalin and amitriptyline. There is some limited evidence that these drugs may be useful. Side effects, particularly drowsiness, tend to be an issue.
• Non pharmacological cough control therapy. This treatment does not involve drugs, but instead uses exercises to suppress cough. It is usually delivered by speech therapists, but also other therapists e.g. physiotherapy. There are 2 randomised controlled trials (RCTs) showing it can be effective. RCTs are considered to provide the most reliable evidence on how effective treatments are.

Several trials of new drugs are currently underway drugs specifically targeting the nerves which cause the sensation of irritation.

Results of these trials are encouraging, and one of these drugs, gefapixant (Lyfnua), has been approved for use in some countries in Europe, Japan, and Switzerland.

As cough varies from person to person, individuals tend to find different ways of managing their cough that work for them. If you are overweight, losing even a small amount of weight can help to reduce the severity of coughing symptoms. Studies have shown that specialised speech therapy sessions can also be highly effective in managing cough.

Below are some techniques that people with chronic cough use to manage their symptoms.

“To manage my asthma and cough, I try to keep moving as much as possible. I walk a lot, as well as cycling and swimming, which are effective for me.”

Betty Frankemölle, The Netherlands, who has chronic cough and asthma.

“I make sure that I always carry water with me, because if I start talking my voice weakens and triggers my cough. I avoid really hot places and make sure that I wrap up warm and cover my mouth if I’m going out in the cold. I also make sure that I take my medication exactly as instructed.”

Sue Nelson, UK, who has experienced chronic cough for 17 years.

“I have been learning to focus on my breathing to try to gain some control, and I think that this is successful to some extent.”

Ing-Marie Osterlund, UK, who has experienced chronic cough for 10 years.

Healthcare professionals from around the world recently produced a new statement on chronic cough, which suggests for the first time that chronic cough should be managed as a separate condition. This statement will be shared with healthcare professionals in Europe to raise awareness of chronic cough and help them diagnose and treat the condition.

Now that chronic cough has been defined in this way, experts hope that more people will receive a targeted approach to managing their cough. It will also enable further research into the syndrome and its causes, leading to improved treatment, care and support for people living with chronic cough.

Read the expert statement on chronic cough.

Read the lay summary of the clinical guidelines here: Chronic cough

This material was compiled with the help of Professor Alyn Morice, Professor Lorcan McGarvey, Dr Sean Parker, Dr Marta Dąbrowska, Sue Nelson, Betty Frankemölle, Jill Adams and Ing-Marie Osterlund.

This page was last updated April 2025.