We all know what it’s like to suffer for days from a hacking cough left over from a cold. But when that cough hangs on for weeks or even months, you know something else is going on.
The short-lasting cough, also known as an acute cough, will go away within about three weeks. When it continues more than eight weeks, it is considered a chronic cough, according to the National Heart, Lung and Blood Institute (NHLBI).
There are many potential causes of a chronic cough, said Dr. Norman Edelman, senior scientific advisor for the American Lung Association. Some are more common than others.
9 Reasons for Chronic Cough
1. Sinusitis. Either a cold or allergies can develop into sinusitis, which is an infection of the sinuses. It’s marked by thick mucus from the nose and post-nasal drip, which can cause the cough. You may also have pain in the upper jaw, teeth, ears or throat. A cough with sinusitis may worsen at night, according to the Mayo Clinic.
2. Gastroesophageal Reflux Disease (GERD). GERD is a condition in which food travels back up from the stomach into the esophagus, causing discomfort or heartburn. You may wake up coughing in the middle of the night when those small particles of food drip back down into the airway, said Dr. Zab Mosenifar, a pulmonary specialist and executive vice chair of the department of medicine at Cedars-Sinai Medical Center, Los Angeles.
While asthma is often diagnosed in childhood, many people have a first attack in middle age.
3. Asthma. With asthma, the lining of the airways is swollen and inflamed. They can become even more constricted by any one of a number of triggers, such as air pollution, pet dander, pollen, dust, smoke, chemicals, cold weather and stress. In addition to coughing, asthma symptoms include wheezing, tightness in the chest and shortness of breath, according to the American Lung Association. Most people are able to manage the disease. But a sudden worsening of symptoms, known as an attack or flare-up, may require use of a “rescue” inhaler and/or a trip to the emergency room.
While asthma is often diagnosed in childhood, many people have a first attack in middle age. Among the people who come to his clinic with a chronic cough, Mosenifar said, hidden asthma is the most frequent diagnosis. “It’s very, very common,” he said. “They may have had sort of an indolent asthma that was not symptomatic or got exasperated after an infection, or even just got triggered [for the first time].”
4. Chronic Obstructive Pulmonary Disease (COPD). The major cause of COPD is smoking, Edelman said. Other causes include second-hand smoke and ongoing exposure to air pollution, smoke from a fireplace or chemical fumes.
In the United States, the term COPD refers to both emphysema and chronic bronchitis. In addition to chronic cough, symptoms include having to clear your throat when you wake up, frequent lung infections, chest tightness, wheezing, shortness of breath (especially with exertion), lack of energy, foot or leg swelling and blueness of the lips or fingertip beds, says the Mayo Clinic.
COPD develops slowly and gets worse over time — eventually interfering with everyday activities like walking and taking care of oneself. Diagnosis occurs most often in middle and older age. COPD is the third leading cause of death in the U.S. according to the NHLBI.
5. Pulmonary Fibrosis. Mosenifar sees pulmonary fibrosis, or scarring of the deep lung tissue, most often in men who are former smokers. But it may or may not have an obvious cause, according to the NHLBI. The scarring prevents the lungs from being able to move oxygen into the bloodstream.
Symptoms include a dry, hacking cough; shortness of breath; fatigue; gradual weight loss without trying; fast, shallow breathing; and “clubbing” (widening and rounding) of the fingertips or toes, the American Lung Association says. Pulmonary fibrosis is most common in middle-aged or older adults, and many people live only three to five years after diagnosis.
6. Bronchiectisis. In bronchiectisis, the airways lose the ability to clear out mucus, and infection is more likely to develop. It can lead to serious medical problems. Mosenifar said he sees bronchiectisis most commonly in middle-aged women who had a lung infection like pneumonia in the past — even years before. The infection can cause a “small architectural problem” in the lung that leads to inflammation.
Symptoms include daily coughing up of yellow or green mucus, fatigue, shortness of breath, fever and/or chills, wheezing and possibly coughing up blood with the mucus, the American Lung Association says. Early treatment improves the chances of keeping the disease from getting worse, according to the NHLBI.
7. Tuberculosis. Rates of tuberculosis (TB) in the United States have fallen, fortunately. But Mosenifar said when he sees patients who are coughing up blood, experiencing night sweats and come from Latin America or the Middle East where the disease is more common, he tests for TB. According to the CDC, symptoms of tuberculosis may also include decreased appetite, weight loss and fever.
8. Lung Cancer. Lung cancer is most commonly caused by smoking, but those subject to secondhand smoke and non-smokers can develop it, too. The second most common cause of lung cancer is exposure to radon gas, according to the National Cancer Institute. Unsafe levels of radon can build up in homes or workplaces, but it’s easy to test for and can be ameliorated.
Unfortunately, most symptoms of lung cancer do not show up until the later stages of the disease. Symptoms of lung cancer may include coughing up blood, even a slight amount; a new cough that doesn’t subside; changes in a chronic cough; shortness of breath; wheezing; chest pain; a hoarse voice; unintended weight loss; headache; and bone pain, according to the Mayo Clinic.
9. Heart Failure. Chronic cough can also be a sign of heart failure, Edelman said. The American Heart Association recommends that you see a doctor if you have a cough along with one or more of these additional symptoms: shortness of breath, nausea, swelling due to a buildup of fluid, fatigue or lightheadedness, a fast heartbeat or confusion.
Experts say a chronic cough should viewed with greater urgency if it is accompanied by any of the following:
- You are coughing up blood
- You are losing weight without trying
- You have chest pain
- You have trouble breathing.
Keeping Your Lungs Healthy
“The best thing you can do for lung health is to prevent lung disease,” Edelman said. “Not smoking, getting all your vaccinations. Don’t visit your grandkids if they’re coughing or sneezing — or if you do don’t let them cough in your face.”
The Centers for Disease Control recommends the following vaccinations:
- For all people age 6 months and older: Flu shot.
- For people 65 and older: One of the versions of the flu vaccine specially formulated for this age group, which is at highest risk for dangerous flu complications.
- For people 65 and older: Two pneumonia (pneumococcal) vaccines, given at least one year apart.