Medical Moment: When to worry about a persistent cough

By Dr. Houssam Oueini, Houston Methodist Baytown Hospital

Whether it’s keeping you up at night or interrupting your day — or both — dealing with a cough is no fun. Particularly if it’s not going away.

“There are a variety of reasons a person may have a cough, whether that’s due to an acute infection or an underlying health condition,” says Dr. Houssam Oueini, a pulmonologist at the Houston Methodist Lung Associates in Baytown. “An over-the-counter cough medication is a good first step to finding relief, but if your cough is persistent, you should consult your doctor.”

When you have allergies or a cold, the resulting nasal congestion and postnasal drip can irritate the back of your throat. Some upper respiratory infections, like COVID-19, can cause inflammation in your throat, as can acute bronchitis and even the occasional bout of acid reflux.

“These types of temporary irritation and inflammation are very common triggers of a cough,” says Dr. Oueini. “But the cough should resolve with your other symptoms. For instance, once your nasal congestion clears up after a viral infection, your cough should clear up with it.”

This is why your doctor might recommend not only taking an over-the-counter cough suppressant but also addressing symptoms contributing to your cough — taking a nasal decongestant to help reduce postnasal drip if you have a cold; avoiding the common triggers of heartburn if your cough is due to acid reflux.

A persistent cough, on the other hand, is a cough that lingers. Sometimes it might not have a clear cause.

“A cough is considered chronic if it persists longer than eight weeks,” explains Dr. Oueini. “At that point, we start to worry whether the cause might be a chronic health condition that needs to be addressed.”

Plus, coughing frequently comes with its own problems. Not only can a cough keep you awake and cause poor sleep, but it can also lead to hoarseness, headaches and other uncomfortable and frustrating side effects.

The potential causes of a persistent cough include:

• Asthma
• Chronic bronchitis
• Emphysema
• Environmental triggers, like recurrent exposure to dust or smoke
• Gastroesophageal reflux disease (GERD)
• Heart failure
• Idiopathic pulmonary fibrosis (IPF)
• Interstitial lung disease
• Smoking or vaping (smoker’s cough)
• Vocal cord dysfunction
  
  Additionally, certain medications can cause a persistent cough. ACE inhibitors, which help lower blood pressure, are one example.

“If you have a cough that lasts beyond eight weeks, start by consulting your primary care doctor,” recommends Dr. Oueini. “He or she can assess your symptoms and work toward identifying the underlying cause of your cough and how best to treat it.”

The most important step in treating a persistent cough is identifying and managing the specific issue or underlying health condition causing it.

Sometimes this may be as simple as reviewing the medications you’re taking and making a substitution. Other times it may mean a referral to a specialist for further evaluation.

For instance, a pulmonologist can help treat and/or better manage asthma, chronic bronchitis, emphysema, IPF and other lung diseases; a gastroenterologist can help with GERD; and a cardiologist can help with heart failure.

With the underlying condition better managed, the cough should improve, too.

Also, cough drops and over-the-counter medications containing dextromethorphan can help suppress a cough that doesn’t dissipate entirely.

“Additionally, if your cough continues to be disruptive, your doctor can prescribe a stronger cough medication,” says Dr. Oueini.

Either way, however, cough medications alone aren’t a long-term solution to a persistent cough.

“It’s important to know that these medications aren’t curing the problem,” says Dr. Oueini. “They’re simply suppressing the cough. Symptomatic relief of your cough can help make your day-to-day life more bearable, but it’s still critical to work with your doctor to identify the root cause of your cough and treat it.”

To schedule an appointment with a pulmonologist call 281.428.4510 or visit houstonmethodist.org/pulmonology.