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Can’t Get Rid of Your Cough? When (and When Not) to Worry

by Dr. Sharon Orrange on March 21, 2017 at 4:31 pm

Cough is one of the most common symptoms people schedule a visit with their doctor about. During cold and flu season, persistent dry cough fills the primary care doctors schedule. It’s just a cough, but it won’t go away . . . could it be lung cancer? Tuberculosis? Coworkers, friends and family will tell you “go see a doctor for that cough.”

So here’s what you need to know:

  • What qualifies as a persistent dry cough? An annoying dry cough, where you aren’t coughing up much junk, that has been present for more than three weeks . Dry cough is often the symptom that hangs on after the rest of your respiratory symptoms have resolved.
  • Cool fact: women tend to cough more than men due to a heightened cough reflex sensitivity.

What is causing your persistent dry cough?

  • Post-infectious reactive airway disease. At this time of year, this is the most common cause of lingering dry cough. It occurs after an acute upper respiratory illness and though it may linger it will resolve without specific therapy. Airway inflammation after infection causes them to be hyperresponsive and twitchy, making you cough.
  • Upper airway cough syndrome (used to be called post nasal drip). Hints that this may be the cause of your cough: the sensation of liquid dripping down the back of your throat, throat clearing, and nasal discharge. A course of an intranasal spray like Flonase (fluticasone) or Nasacort over the counter may help solve that.
  • Cough variant asthma. The second leading cause of persistent cough in adults is called “cough-variant asthma.” Hints here: it may follow an upper respiratory infection, and worsen with exposure to cold or certain allergens (dust, certain fumes). If your doctor suspects this, an oral inhaler will be part of the solution.
  • Reflux. Gastroesophageal reflux disease (GERD) is a common cause of persistent dry cough. Know that for many people, cough due to reflux will NOT come with heartburn or a sour taste in your mouth. A two week course of Prevacid, (pantoprazole), Prilosec (omeprazole), or Nexium (esomeprazole) may solve your cough if this is the cause.
  • Medication side effect. ACE inhibitors like lisinopril, ramipril, or quinapril are well known culprits of a persistent dry cough. The cough will resolve within 1 – 4 days of stopping your medication if this is the cause.

Now, ask yourself these three questions:

  1. Am I a smoker now or was I in the past?
  2. Do I take an ACE inhibitor medication?
  3. Did my doctor do a chest x-ray and is it normal? (Any cough present more than 8 weeks should be evaluated with a chest x-ray).

If you’ve answered no to these questions, 99.4% of you have one of the above 5 causes of persistent cough—so no need to read any further.

What is NOT a likely cause of persistent dry cough?

Here are the dangerous things patients worry may be the cause of their cough . . . and why you probably don’t have them:

  • Lung cancer. Lung cancer is the cause of chronic cough in less than 2 percent of the cases. Smoking history matters here and more so than cough—weight loss, shortness of breath, coughing up blood—those are serious warning signs of lung cancer.
  • Pulmonary Embolism (PE). A clot in the deep veins of the leg that breaks off and lodges in your lungs, a PE, will cause shortness of breath, pain in the chest and difficulty breathing. Just a dry cough is very very unlikely to be a PE.
  • Tuberculosis (TB). With TB infection of the lungs you will have a cough, but also night sweats, weight loss, low grade fevers, and you won’t feel good at all. Not just a dry cough.

Final note: if you have a cough along with fever, shortness of breath, chest pain, weakness, and/or nausea and vomiting, it is NOT a persistent dry cough. That’s a different story. See your primary care doctor if this is the case.

Dr O.


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