Key takeaways:
A persistent dry cough is common after an upper respiratory infection, like a cold or the flu. It usually goes away on its own.
A dry cough that lingers may have an underlying cause that needs additional treatment.
If you have a persistent cough that lasts longer than 8 weeks or comes with a fever, shortness of breath, or chest pain, see a healthcare professional immediately.
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Are you coughing a lot but don’t feel sick? You’re not alone. A persistent cough is one of the most common reasons people visit their doctor’s office. But it’s not always a cause for concern. After all, a cough is a natural reflex that helps you clear your airway, and it can be protective.
Most coughs usually go away on their own. But sometimes a cough can last a few weeks after an infection like a cold or the flu. It can be hard to know what to do about a cough that won’t go away. Here, we’ll cover some possible causes of your cough, what you can do about it, and when to get professional help.
What is a persistent cough?
It’s common to have a cough that lasts up to 3 weeks after an upper respiratory infection has resolved.
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But a persistent cough is one that has been around for more than 3 weeks.
A persistent dry cough is one where you aren’t coughing up much mucus. It can sometimes present as a cough with no other symptoms. This will sometimes go away on its own.
If you have a persistent productive cough — meaning you’re coughing up mucus — you should see your primary care provider, even if you were recently treated for an upper respiratory infection. You may still have a more serious infection, like pneumonia, that needs more treatment.
What are the most common causes of a persistent dry cough?
There are many reasons for a lingering cough, and most of them aren’t too serious. The good news is that, with the right evaluation, your cough can usually be treated quickly.
Here are 10 of the most common reasons you might have a persistent cough.
1. Reactive airways after an upper respiratory infection
Sometimes your airways can become inflamed after an upper respiratory infection. This can make your airways sensitive and hyperreactive, which can trigger a cough. It’s common to have a lingering dry cough after:
Pharyngitis (sore throat)
Influenza (the flu)
Over-the-counter cough remedies: Explore top tips to get rid of wet and dry coughs without needing a prescription.
Does honey really help a cough? Honey is a simple remedy for a nagging cough. You can take it by the spoonful or in a hot drink to soothe and coat your throat.
Should you see your doctor for your cough? Most coughs resolve on their own. But sometimes they can be a sign of a serious health condition, like pneumonia or heart problems. Learn when to get checked out for a cough.
How much can your cough tell you about what’s wrong with you? Quite a lot. The sound of your cough, its timing, and what you’re coughing up can give you useful clues about what type of illness you may have.
It’s not clear why this happens. It may be due to the nerves in your airways or the airways themselves becoming more sensitive. It could also be caused by your body producing extra mucus.
In most cases of reactive airways, X-rays and other test results are normal. This type of persistent cough will usually resolve on its own. But taking medication to reduce coughing, inflammation, or mucus may help relieve symptoms.
2. Postnasal drip
Postnasal drip, also called upper airway cough syndrome, can occur anytime your nose or sinuses become irritated or inflamed. This causes mucus to drain down your throat, triggering a cough.
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There are many causes of postnasal drip, including colds, sinus infections, and allergies like hay fever. The result may be a dry cough or it may come with some mucus.
Signs that postnasal drip may be the cause of your persistent cough include:
The sensation of liquid dripping down the back of your throat
Always having to clear your throat
Symptoms that worsen when lying down, like at night
Nighttime cough
Hoarse voice
Nasal discharge
Postnasal drip may improve on its own. Or you may need treatment with antihistamines, steroid nasal sprays, or other over-the-counter (OTC) nasal sprays. In some cases, prescription medication may be useful.
3. Asthma with cough
Asthma normally includes symptoms like wheezing, difficulty breathing, and chest pain. But sometimes, coughing is the only symptom. In this case, the cough is typically worse at night.
Asthma-related coughing may follow an upper respiratory infection and worsen if you’re exposed to cold temperatures or certain allergens, like dust or fumes. It can also be triggered by laughing or exercise.
An asthma cough won’t get better with OTC medication. It’s usually treated with prescription inhalers, which help control the cough. In cases in which this type of asthma goes untreated, up to 40% of adults go on to develop further symptoms of asthma.
If you have a cough with no other symptoms, you may want to visit your primary care provider to get checked for asthma.
4. Acid reflux and gastroesophageal reflux disease
Acid reflux and gastroesophageal reflux disease (GERD) are other possible causes of persistent dry cough.
It’s still unclear why GERD might make you cough, but experts think it’s related to something called aspiration. This is when food or stomach acid rises up into your throat and enters your airways. Coughing happens as a reflex to help prevent the food and acid from entering your lungs. More research is needed to understand this relationship.
For some people, a cough from acid reflux will be accompanied by the typical symptoms of heartburn or a sour taste in the mouth. But up to 75% of people with GERD have no symptoms at all.
It’s often worth trying a GERD medication for 2 to 8 weeks to see if the dry cough goes away.
Proton pump inhibitors (PPIs) work by reducing the amount of acid in your stomach and are commonly used. Here are some common examples of PPIs:
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
Omeprazole (Prilosec)
Esomeprazole (Nexium)
Other recommendations may include sleeping with your head elevated and not eating within 3 hours of bedtime.
5. Medication side effects
Sometimes the medications you take can cause a persistent dry cough. A classic example is a cough caused by a class of medications called angiotensin-converting enzyme (ACE) inhibitors. These medications are commonly prescribed for people with high blood pressure, heart disease, or diabetes. But ACE inhibitor-induced cough is reported in up to 20% of people who take them.
Popular ACE inhibitors include:
Lisinopril (Zestril)
Benazepril (Lotensin)
Enalapril (Vasotec)
Other medications may also cause a persistent cough. The most common include:
Sitagliptin (used to help control blood sugar in people with diabetes)
Calcium channel blockers (used to manage high blood pressure)
Nitrates (most often used to treat chest pain)
Latanoprost (eye drops used to treat glaucoma)
If you think medication might be the reason for your cough, talk with your prescriber. They can help you safely stop or switch medications if needed. The good news is that if a medication is causing your cough, it usually goes away within a few weeks after you stop taking the medication.
6. Lower respiratory infection
Lower respiratory infections are a common cause of chronic cough. These include infections like:
Bronchiolitis
COVID
These infections are typically caused by viruses but may also be caused by bacteria.
Clues you may have a lower respiratory infection include symptoms like:
Fever
Shortness of breath
Decreased appetite
If you have any of these symptoms with your cough, let your medical care team know. You may need a chest X-ray to check your lungs for changes that require further treatment.
7. Smoking
Smoking tobacco or cannabis can cause a persistent cough. This is because the toxins released during smoking are irritants to your airways. These toxins can damage the lining of your lungs and cause symptoms of bronchitis, like cough and excess mucus.
The “smoker’s cough” is typically a cough with mucus that’s worse in the morning. But it can improve once you stop smoking. You could notice a decrease in your coughing within the first month after you quit smoking.
8. Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a condition commonly linked to chronic cough. In fact, cough is one of the most reported symptoms of COPD.
COPD is usually caused by repeated exposure to irritants of the lungs and airway. The most common reason for this is smoking.
Symptoms of COPD include:
Productive cough
Wheezing
Shortness of breath
Fatigue
If you have a history of smoking and a chronic cough, you may need further testing to figure out the cause of your symptoms.
9. Allergies
About 1 in 4 U.S. adults get seasonal allergies. In addition to itchy, watery eyes and a runny nose, seasonal allergies commonly cause a persistent cough. If your cough is caused by seasonal allergies, it will go away on its own once the cause of your allergies is gone.
For example, if you’re allergic to pollen, your cough will get better once the seasons change and there’s less pollen in the air. In the meantime, you can take allergy medicine to help relieve your symptoms.
10. Serious (but less common) health conditions
A dry cough can sometimes signal a more serious health problem. These causes are much less common than things like postnasal drip or a lingering cold, but it’s important to know about them — especially if your cough has lasted more than 8 weeks, is getting worse, or is accompanied by other concerning symptoms.
Serious conditions that can cause a persistent dry cough include:
Heart failure: When the heart doesn’t pump properly, fluid can build up in your lungs and cause a dry, hacking cough that’s often worse when lying down.
Lung cancer: A new, persistent cough may sometimes be one of the earliest symptoms of lung cancer.
Pulmonary embolism (PE): A sudden cough, sometimes with chest pain or shortness of breath, can be a sign of a blood clot in your lungs.
Sleep apnea: People with untreated sleep apnea may wake up coughing or choking at night due to disrupted breathing.
Tuberculosis (TB): TB infections often cause a cough lasting more than 3 weeks, sometimes with blood-streaked sputum, weight loss, and fever.
Interstitial lung disease: This group of conditions causes inflammation and scarring in your lungs, often leading to a dry, chronic cough.
Sarcoidosis: This rare inflammatory disease can affect your lungs and cause coughing, along with fatigue and chest pain.
If your cough is persistent and you also have symptoms like fever, chest pain, coughing up blood, or unexplained weight loss, it’s important to get checked out by your primary care provider.
Treatment and home remedies
To treat a persistent dry cough, focus on addressing the cause, like allergies, asthma, or acid reflux.
If you’re not sure what’s causing your cough, you could try natural treatments or OTC medications, for example:
Cough suppressant to quiet the cough (for example, Robitussin)
Expectorant to thin mucus (for example, Guaifenesin)
Humidifier to loosen mucus
Honey to decrease mucus secretions
Lozenge to soothe cough and throat irritation
If your cough doesn’t improve within 1 to 2 weeks, or if your symptoms are worsening, it may be time to get professional help. You should always get medical attention if you have a cough that won’t go away.
Why am I coughing so much but not sick?
We usually think of a cough as a sign of being sick, like having a runny nose or a fever. But the truth is that a cough doesn’t always mean that you’re sick. You can have a cough for a lot of reasons — from acid reflux to allergies.
If you’ve ever had a coughing fit while eating a meal, you know that something as simple as swallowing wrong can cause lots of coughing — even in an otherwise healthy person. Coughing is just a reflex our bodies have developed to protect our breathing tubes from things that don’t belong in them, like dust or food. You can be completely healthy, but if your cough reflex is triggered, it can cause you to cough.
When should you be concerned about a persistent or dry cough?
Even though a cough usually isn’t anything to worry about, it’s always possible there could be a more serious cause. You should see a healthcare professional right away if your persistent cough comes with any of the following symptoms:
Fever
Night sweats
Shortness of breath (difficulty breathing)
Chest pain
Weakness
Vomiting
Unexplained weight loss
Frequently asked questions
A dry cough at night is often a sign of postnasal drip, which happens when mucus from your nose or sinuses drains into your throat. This causes inflammation that makes you cough. Because lying flat makes more mucus drip into your throat, postnasal drip will make you cough more at night.
There are also other reasons why your cough may seem worse at night: Your body’s circadian rhythm can send your immune system into overdrive overnight, and increase your stress hormones. Since you’re less distracted at night, the cough feels worse.
If your cough gets worse during daytime hours and better when you lie down, it could be a sign of acid reflux or GERD. Coughing from GERD happens when stomach contents go up your esophagus where they don’t belong. A muscle called the lower esophageal sphincter usually helps prevent this. But this muscle naturally relaxes when you’re sitting up to eat (and tightens when you sleep), so sitting up and eating can make this type of cough worse.
If your cough is due to an infection, one sign of improvement is when it goes from a wet cough to a dry cough. This is because a wet cough usually means that the infection is still active in your body. On the other hand, a dry cough comes from airway inflammation, which can happen even after the infection is gone. Other signs of improvement include coughing less often and with less intensity.
There are lots of reasons why talking can trigger a cough. Acid reflux, asthma, and problems with your larynx (voice box) can all make coughing more likely while talking. If you experience coughing while talking, speak with your primary care provider to find out why this might be happening to you.
Coughing is a protective reflex. Like all reflexes, some people have stronger reflexes than others. In people with a strong cough reflex, taking a deep breath alone can be enough to trigger that reflex and cause a cough. If inhaling causes you to cough, it could just mean you have a sensitive cough reflex.
A dry cough at night is often a sign of postnasal drip, which happens when mucus from your nose or sinuses drains into your throat. This causes inflammation that makes you cough. Because lying flat makes more mucus drip into your throat, postnasal drip will make you cough more at night.
There are also other reasons why your cough may seem worse at night: Your body’s circadian rhythm can send your immune system into overdrive overnight, and increase your stress hormones. Since you’re less distracted at night, the cough feels worse.
If your cough gets worse during daytime hours and better when you lie down, it could be a sign of acid reflux or GERD. Coughing from GERD happens when stomach contents go up your esophagus where they don’t belong. A muscle called the lower esophageal sphincter usually helps prevent this. But this muscle naturally relaxes when you’re sitting up to eat (and tightens when you sleep), so sitting up and eating can make this type of cough worse.
If your cough is due to an infection, one sign of improvement is when it goes from a wet cough to a dry cough. This is because a wet cough usually means that the infection is still active in your body. On the other hand, a dry cough comes from airway inflammation, which can happen even after the infection is gone. Other signs of improvement include coughing less often and with less intensity.
There are lots of reasons why talking can trigger a cough. Acid reflux, asthma, and problems with your larynx (voice box) can all make coughing more likely while talking. If you experience coughing while talking, speak with your primary care provider to find out why this might be happening to you.
Coughing is a protective reflex. Like all reflexes, some people have stronger reflexes than others. In people with a strong cough reflex, taking a deep breath alone can be enough to trigger that reflex and cause a cough. If inhaling causes you to cough, it could just mean you have a sensitive cough reflex.
The bottom line
A dry, persistent cough can be bothersome and disruptive to your daily life. But it normally isn’t anything to worry about and it’ll usually go away on its own.
If you have a cough that lasts longer than 2 weeks, or comes with other symptoms like fever, shortness of breath, or blood in your mucus, you need to see a healthcare professional. They’ll help you determine what might be causing your cough and recommend treatment options for you.
Why trust our experts?
References
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