Chronic Cough

UT Southwestern Medical Center provides expert care for people who have a chronic cough and other conditions affecting the airways, larynx (voice box), throat, and lungs. Using the latest technology, we work to evaluate, diagnose, and treat the underlying causes of chronic cough. We work closely with pulmonologists, gastroenterologists, allergy specialists, and speech-language pathology specialists to provide multidisciplinary care.

Expert Diagnosis and Treatment for Chronic Cough

An occasional cough is normal and serves a useful purpose: to keep the throat and airways clear. However, too much coughing can be a sign of illness and can cause other problems such as injury to the larynx (voice box), disrupted sleep, or even rib fractures. A cough that lasts longer than eight weeks in adults or longer than four weeks in children is considered chronic.

Our multidisciplinary approach often combines the expertise of fellowship-trained laryngologists, pulmonologists, speech-language pathologists, allergists, and other care professionals focused on voice, throat, and lung conditions. Our physicians, therapists, and researchers are widely recognized as experts in the accurate diagnosis and effective treatment of chronic cough. Through our research, we have made important contributions to the standard of care and are improving the lives of patients, here and across the country.

Causes of Chronic Cough

The most common causes of chronic cough are:

• Allergies that affect the nose or sinuses
• Asthma
• Chronic bronchitis, emphysema, or other types of chronic obstructive pulmonary disease (COPD)
• Gastroesophageal reflux disease (GERD)
• Infections of the upper respiratory tract such as cold, flu, or pneumonia
• Postnasal drip
• Smoking

Some less common causes of a chronic cough include:

• Certain medications, such as ACE inhibitors to treat high blood pressure
• Cystic fibrosis
• Heart failure
• Interstitial lung disease (pulmonary fibrosis)
• Laryngeal sensory neuropathy, damage to the nerve responsible for sensation in the larynx (voice box)
• Lung cancer

Symptoms Occurring with Chronic Cough

Other signs and symptoms can occur along with a chronic cough. Depending on the cause, these can include:

• Bloody phlegm (coughed-up mucus)
• Feeling of fluid running down the back of the throat
• Heartburn
• Hoarseness
• Runny or stuffy nose
• Shortness of breath
• Sore throat

Diagnosis of Chronic Cough

At UT Southwestern, our experienced doctors conduct a thorough evaluation, which includes a:

• Physical exam
• Review of medical history
• Discussion of symptoms

Depending on each patient’s specific needs, we sometimes work with specialists from other areas of medicine, such as gastroenterology. Based on our evaluation, we often begin treatment for one of the common causes of coughing. If initial treatment doesn’t help, we then order additional tests for a less common cause.

Patients might need one or more additional tests, such as:

• Acid reflux/pH/impedance test: Measures the amount of acidic and non-acidic fluid inside the esophagus
• Allergy testing: Skin or blood test to assess for systemic allergies
• Bronchoscopy: Test that uses a narrow, lighted scope inserted through the mouth into the windpipe to look inside the lungs
• Chest X-ray: Imaging technology that uses radiation to produce images of the lungs to check for cancer, pneumonia, or other lung diseases
• Computed tomography (CT) scan: Specialized X-ray technology that takes cross-sectional images to produce 3D images of the chest to look for disease
• Lab tests: Tests of phlegm to check for infection
• Laryngoscopy: A test that uses a narrow, lighted scope for visualization of the throat and upper airway
• Lung function tests: Noninvasive tests that can diagnose asthma and COPD by measuring lung capacity and exhalation speed
• Rhinoscopy: Test that uses a lighted scope to look inside the nasal passages

Treatment for Chronic Cough

Treatment for chronic cough involves remedying the underlying cause, and options include: 

• Acid blockers and dietary modifications for acid reflux
• Antibiotics for bacterial infections
• Antifungals for fungal infections
• Antihistamines and sometimes decongestants for allergies and postnasal drip
• Bronchodilators and inhaled steroids for bronchitis and other types of COPD
• Cough suppressant medications to control the cough
• Cough suppression techniques, taught by our speech-language pathologists, to help reduce the severity and frequency of the cough
• Inhaled asthma drugs for asthma-related coughs
• Neuromodulators and in-office nerve blocks for laryngeal sensory neuropathy
• Smoking cessation

Self-Care for Chronic Cough

Steps that patients can take on their own include:

• Drinking plenty of fluids to thin mucus and soothe the throat
• Sucking on glycerin lozenges to ease a dry cough and sore throat
• Using a humidifier to add moisture to the air
• Inhaling steam to help add moisture to the throat
• Reducing or stopping smoking