What is chronic cough?
Chronic cough is cough lasting 8+ weeks. Three causes (Upper Airway Cough Syndrome from post-nasal drip, asthma, GERD) account for about 90% in non-smokers. ACE inhibitors are another common cause.
Empiric treatment of the top causes, one at a time, is the standard approach. A clinician can work through the differential.
Do I have chronic cough? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Upper airway cough syndrome (post-nasal drip — allergies, sinusitis), asthma (cough-variant especially), GERD/LPR, ACE inhibitors (lisinopril etc.), chronic bronchitis (smoking), eosinophilic bronchitis, less commonly: lung cancer, TB, sleep apnea, pertussis aftermath.
Is it contagious?
Most chronic cough is not contagious. Infectious causes (pertussis, TB) are.
If you're on lisinopril (or any ACE inhibitor) and have a chronic dry cough — switch to an ARB. The cough resolves in weeks.
Can it be treated online?
Routine chronic cough is well-suited to telehealth. Hemoptysis (coughing blood), unintentional weight loss, smoker over 50 with new cough, abnormal chest imaging, fever — need in-person workup including imaging.
How chronic cough is treated
Treat most likely cause empirically. UACS: intranasal steroid + antihistamine + saline rinse 4–6 weeks. Asthma: inhaled steroid + bronchodilator. GERD: PPI 8 weeks plus lifestyle. ACE inhibitor: switch to ARB. Smoking: cessation. If empiric trials fail, in-person workup with chest imaging, spirometry, sometimes scope.
Self-care while you wait
- Stop ACE inhibitor if on one (switch to ARB with clinician)
- Quit smoking
- Hydration
- Avoid dairy if it worsens for you
- Honey for symptomatic relief
- Treat allergies, GERD aggressively
- Humidifier
- Elevate head of bed if reflux suspected
- Identify and avoid triggers
How long does it last?
With identification and treatment of cause, weeks to months to resolve.
Frequently asked questions
How can post-nasal drip cause cough?
Mucus dripping into upper airway irritates cough receptors. Often unaware of the drip itself.
Why does GERD cause cough?
Reflux into upper airway irritates cough receptors. Often without classic heartburn (silent reflux/LPR).
Is it cancer?
Most chronic cough isn't cancer. Smoker over 50 with new cough warrants imaging. Hemoptysis or weight loss needs workup.
Will cough syrup help?
OTC dextromethorphan has weak evidence. Treating cause works better than suppressing cough.
Could it be COVID lingering?
Post-COVID cough can last weeks. Persistent beyond 8 weeks warrants standard workup.
