Causes of Chronic Cough

A cough that just won’t go away is one of the most common reasons for a visit to the doctor. Many people initially visit their primary care physician, but if the issue isn’t easily resolved, other doctors and specialists may become involved, such as allergists, pulmonologists, otolaryngologists (ENT), and speech-language pathologists (SLP), such as ExcelENT’s SLP, Amy Pittman.

Amy sees patients often who complain of a chronic cough. It’s annoying for the person experiencing it and others in the home, and it can disrupt sleep and cause headaches. We’re thankful that there are many ways in which Amy can help get to the bottom of the cause and find an effective solution.

Definition & Causes of Chronic Cough

According to the American Speech-Language Hearing Association, coughing helps you clear your throat and lungs and can prevent infection. But sometimes a cough can become chronic, lasting more than four weeks in children and more than eight weeks in adults. Aside from the extended duration of the cough, signs and symptoms include the frequent need to cough and having a rough-sounding voice due to that frequent coughing.

Chronic cough can be tricky because there are several possible causes.

Here are the most common ones we see.

Postnasal Drip

Also called upper airway cough syndrome, postnasal drip is a common cause of a persistent cough. When a virus, allergies, dust, chemicals, or inflammation irritate your nasal membranes, they make runny mucus that drips down your throat. This makes you cough, especially at night when you lie down.

Asthma

When you have asthma, the muscles around your airways tighten, the lining of your airways swells, and cells in your airways produce thick mucus. Coughing is your body’s way of trying to get air into those restricted areas and can be triggered by infections, weather, allergies, tobacco smoke, medications, exercise, and emotions.

Infections

After you have recovered from a cold, flu, or pneumonia, you may continue to have a cough as your body completely heals and gets over the infection. COVID-19, the illness caused by SARS-CoV-2, sometimes leads to lasting lung inflammation and a lingering dry cough. The prolonged cough from COVID-19 is no different than any other virus that affects your lungs. The injured parts of your lungs are trying to clear out the infection and heal.

Laryngopharyngeal Reflux (LPR)

LPR, sometimes confused with gastroesophageal reflux disease (GERD), is a condition in which acid escapes from the stomach and goes into the esophagus and throat. This causes irritation to the throat, vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, sinus drainage, the frequent need to clear the throat, and chronic cough. 

Blood Pressure Medications

ACE inhibitors for blood pressure can cause a chronic dry cough. When a patient has a persistent cough and takes an ACE inhibitor, a slight change in medication often helps resolve the cough.

Smoking

Smoking damages your lungs, as well as the rest of your body. Smokers often experience chronic cough because chemicals and particles in tobacco smoke irritate the lungs. In response, the body makes mucus to try to get rid of it through frequent coughing. In all situations, we recommend stopping smoking to address a chronic cough and for many other reasons.

Irritable Larynx Syndrome (ILS)

ILS involves a range of conditions including chronic throat clearing, chronic cough, and others. With ILS, the larynx (voice box) becomes very sensitive to stimuli, such as strong smells, cold air, talking, and more. There are several possible causes, including viral illnesses that cause inflammation of the nerve that supplies the voice box, GERD, allergies, sinusitis, certain medications, environmental exposures, and stressful life occurrences.

Symptoms of ILS usually last longer than three weeks and have no other identifiable cause. Symptoms may include frequent non-productive throat clearing, chronic coughing attacks that bring up little or no mucus, and difficulty breathing with the sudden onset of stridor (noisy breathing).

Testing & Treatment for Chronic Cough

Our SLP, Amy Pittman, will likely work with you to get a comprehensive history regarding your chronic cough. She may perform a thorough laryngoscopic and stroboscopic examination to visualize patterns of vocal fold motion and vocal fold vibration. She may also test your voice to see if there are any changes in vocal quality that the cough might be causing.

We can work to find out more about what triggers your cough so that you can avoid those triggers. In some cases, treatment is straightforward, such as recommendations to stop smoking or making changes to medications. In other cases, you may need treatment for medical conditions, such as allergies, asthma, or LPR if those are triggers for your chronic cough. 

Many times, the goal of treatment for chronic cough is to give you the tools to better manage it, and Amy can teach you more about keeping your vocal cords healthy.

Address Chronic Cough with ExcelENT of Alabama

We are happy to answer questions about chronic cough and other ear, nose, and throat issues. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

How long does a cough have to last to be considered chronic?

A cough is considered chronic when it lasts more than four weeks in children and more than eight weeks in adults. Beyond the extended duration, common signs include the frequent need to cough and a rough-sounding voice from all that coughing. If your cough has lasted longer than eight weeks or hasn’t been explained, it’s worth seeking medical care.

What are the most common causes of chronic cough?

Chronic cough can be tricky to diagnose because there are several possible causes. The most common include postnasal drip (also called upper airway cough syndrome), asthma, lingering infections after a cold, flu, COVID-19, or pneumonia, laryngopharyngeal reflux (LPR), irritable larynx syndrome (ILS), ACE inhibitor blood pressure medications, and smoking.

What is irritable larynx syndrome and how does it cause a cough?

Irritable larynx syndrome (ILS) happens when the larynx, or voice box, becomes hypersensitive to stimuli like cold air, strong smells, talking, and more, making the cough reflex overreact even when no real threat is present. It often starts after a viral illness, allergies, sinusitis, certain medications, or stress, and symptoms usually last longer than three weeks with no other identifiable cause.

Why does irritable larynx syndrome turn into a cycle that won’t stop?

Once the voice box becomes irritated, it’s easy to get stuck in a loop. A trigger sets off coughing or throat clearing, which adds more irritation to the larynx, which heightens nerve sensitivity, which makes the throat react even more easily next time. Before long the cough sustains itself even after the original trigger is gone, and without the right treatment this pattern can linger for months.

How is irritable larynx syndrome treated?

Treatment focuses on reducing irritation and calming nerve hypersensitivity. Options include vocal hygiene changes like staying hydrated and avoiding throat clearing, reflux management through diet or medication, behavioral cough suppression therapy from a speech therapist, low-dose neuromodulator medications to calm overactive laryngeal nerves, and avoiding triggers like strong scents, smoke, and cold air. These often work best combined and tailored to the specific triggers.

Can blood pressure medication cause a chronic cough?

Yes. ACE inhibitors used for blood pressure are a known cause of chronic dry cough. When a patient on an ACE inhibitor has a persistent cough, a slight change in medication often resolves it. If you’re taking blood pressure medicine, bring the name of it to your appointment since it helps pinpoint the cause faster.

How does LPR (silent reflux) cause a chronic cough?

Laryngopharyngeal reflux (LPR) occurs when acid escapes the stomach and travels up into the throat, irritating the throat, vocal cords, and even the nasal passages. This can lead to voice problems, swallowing problems, sinus drainage, frequent throat clearing, and chronic cough. It’s often confused with GERD, but LPR tends to cause more throat-focused symptoms.

Can irritable larynx syndrome be cured?

For many patients, symptoms improve significantly once the voice box is properly evaluated and the underlying sources of irritation are addressed. ILS is usually related to an overly sensitive cough reflex rather than lasting damage, which means symptoms often ease as the larynx becomes less reactive over time with the right treatment.