By: Joseph L. Chow, MD,
President, TeamHealth Ambulatory Care
Shyamal Majithia, MD,
Medical Director
Cough is a reflex that helps clear secretions from the lungs to prevent infection. Coughs can be persistent due to a variety of causes, last different durations, respond to various treatment methods, and represent underlying conditions, ranging from minor to more serious. Dr. Joe Chow, President, WNY Immediate Care, and Dr. Shyamal Majithia, Medical Director of WNY Immediate Care – Buffalo, break down patients’ common questions about the causes, symptoms and treatments for that cough that just won’t go away.
Most coughs are caused by viral illnesses, such as your typical upper respiratory infection or bronchitis (chest cold). A cough caused from a viral illness will typically resolve on its own, but may last for weeks, called a post infectious cough. Other causes may include sinusitis, pneumonia, walking pneumonia, asthma, or other infections such as flu, COVID, RSV, whooping cough or postnasal drip.
If you have fever, shortness of breath and/or chest pain accompanying the cough, blueness to your lips, or blood in your sputum, you should be seen immediately by a healthcare provider.
A cough that persists can be a sign of an underlying health condition, which can range from minor to more serious. The most common causes of a persistent, chronic cough (lasting greater than 8 weeks) include: asthma, postnasal drip, GERD, pneumonias, medications such as ACE inhibitors or malignancy in patients with risk factors. A patient who is coughing for 6-8 weeks without a known cause or beyond expected should be seen by a healthcare provider to help determine the root cause.
Signs that you may need medication to help treat a cough, including medications for symptomatic relief (cough suppressants), may include but are not limited to: fever, shortness of breath, chest pain, headaches or dizziness, rib pain related to cough, poor fluid intake or interference with sleep.
An unexplained cough or one that lasts more than an expected duration from an illness should be evaluated by a healthcare professional. Additionally, a cough that is associated with chest pain, shortness of breath, blue lips, persistent fever or coughing up blood should be evaluated immediately.
Over-the-counter cough suppressants may help ease a cough, while decongestants and antihistamines may help ease a cough if related to nasal congestion and postnasal drip, whether from illness or allergies. Studies have shown that honey works just as well as medicated cough medicine in children[i]. However, it’s important to understand that a cough suppressant will only address the symptoms of the cough to help provide relief and won’t address the underlying cause. Always check with your healthcare provider before beginning any course of medication, including over-the-counter medication.
To treat a cough caused by a bacterial infection, which can cause fever, shortness of breath, and last for a longer duration, antibiotics may be prescribed by your healthcare provider.
A cough caused by the common cold can last up to several weeks. During cold and flu season, while recovering from one illness, a patient could potentially catch another virus which can make a cough seem to last longer.
A wet cough is usually due to expectoration of mucus; the wet sound is mucus shifting in the airways as the cough reflex attempts to clear it.
A dry cough is a consistent sound as there is no mucus that is expectorated, often due to irritation of the airways.
Treat the cause of the cough. Viral coughs call for supportive treatment such as cough suppressants, humidified air vs cool air in certain circumstances, and time. If bacterial, antibiotics work. If a cough is caused by asthma, inhalers and steroids are effective. For GERD, try proton pump inhibitors (PPI). Postnasal drip is treated with antihistamines or nasal steroids.
Additionally, warm fluids can help soothe the throat and thin secretions to loosen a cough. Humidifiers/vaporizers moisten the air which can help ease a dry cough. And, since honey has been shown to be equally as effective as medicated cough medicine[ii], it can serve as a good alternative for children under age 4 as cough medicine is contraindicated. Please note, honey is not an option for children under the age of 1.
If you are experiencing persistent cough symptoms and need to be evaluated by a qualified clinician, find us here.
[i] https://pubmed.ncbi.nlm.nih.gov/20618098/ & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9583571/
[ii] https://pubmed.ncbi.nlm.nih.gov/20618098/ & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9583571/