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What is Causing My Cough?

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Updated October 12, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Question: What is Causing My Cough?
Answer: Coughing is a natural reflex that is important in keeping your lungs and airways clear of debris. While coughing is often not bothersome, a persistent cough that does not seem to go away is both bothersome and may be related to an illness. There are 3 different types of cough: acute, subacute and chronic.

Acute Coughs and Their Causes

Acute coughs usually only last up to about 3 weeks. This cough may be either productive (produces mucus) or non-productive (dry, no mucous). Acute cough is usually caused by the following illnesses:

Most treatments for acute cough have not been shown to be effective. In fact there is a movement away from even using cough suppressants unless the cough is causing other problems. If the cause is a treatable infection like pneumonia, then antibiotics would be the proper treatment to help fight the underlying cause of the cough. Speak to a doctor about your case.

Conditions Causing Subacute Cough

Subacute coughs typically last between 3 to 8 weeks. The subacute cough may need to be evaluated by a physician depending upon the severity of symptoms, as 60% of subacute coughs spontaneously resolve. In other words, there's a pretty good chance of a subacute cough going away on its own. Common causes of a subacute cough include:

  • post-infectious cough (most common)
  • post-nasal drip
  • cough-variant asthma
  • eosinophilic bronchitis

If your physician suspects that the cause of your subacute cough is post-infectious cough or postnasal drip, he may prescribe antihistamines plus a decongestant (such as chlorpheniramine and pseudoephedrine) for approximately 3 weeks to see if the cough will clear up.

Conditions Causing Chronic Cough

Chronic coughs last for greater than 8 weeks. Causes of the chronic cough can sometimes be difficult to isolate. To help isolate the cause of your chronic cough, your doctor may find it necessary to run several tests or even recommend that you see another specialist. Common causes of chronic cough include:

Treatment is targeted to the specific cause of the cough. Your physician will take a thorough history to look for likely causes of a cough.

If you are on ACE inhibitors for blood pressure, your physician may have you try an alternative medication to see if your cough resolves.

Further testing is likely to start with a chest x-ray and spirometry. If the chest x-ray is abnormal, a high-resolution CT scan of the lungs and/or a bronchoscopy may be ordered.

Unfortunately there are not many physicians willing to specialize in chronic cough. Initially, you may find that you are referred to a pulmonologist to "work-up" or diagnose the chronic cough, but many of the best pulmonologists may be unwilling to see patients for chronic cough and refer you to either a gastroenterologist or back to your primary care physician (PCP). Finding a physician you like that is willing to be patient is probably the key to success in finding a physician to treat your chronic cough.

Sources:

Irwin, R.S., Baumann, M.H., Bolser, D.C., Boulet, L., et. al. Diagnosis and Management of Cough Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006;129;1S-23S. Accessed: September 4, 2010 from http://chestjournal.chestpubs.org/content/129/5/1142.full.pdf

Kwon, N., Oh, M., Min, T., Lee, B., and Choi, D. Causes and Clinical Features of Subacute Cough. Chest 2006;129;1142-1147. Accessed: September 4, 2010 from http://chestjournal.chestpubs.org/content/129/5/1142.full.pdf

National Heart Lung and Blood Institute. Cough. Accessed: September 4, 2010 from http://www.nhlbi.nih.gov/health/dci/Diseases/cough/cough_whatis.html

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