Chronic Cough

Senor Coughing

WHAT IS CHRONIC COUGH? Cough is an important defense mechanism in healthy people.  It helps to clear mucous and other material from the main airways.  If it becomes persistent, cough may be a symptom of another lung process.  Cough that last at least 8 weeks or more is considered chronic.  It is a common reason for a referral to a pulmonologist.

WHAT CAUSES CHRONIC COUGH? In the vast majority of cases, chronic cough may be attributed to one or a combination of 4 conditions: (1) chronic bronchitis; (2) postnasal drip; (3) asthma and (4) gastroesophageal reflux disease (GERD).  Having a normal chest x-ray will suggest that your cough is likely caused by one of these 4 entities.

  • Chronic bronchitis is defined as cough on most days for 3 months of the year for 2 consecutive years.  Cigarette smoking is by far the most common irritant triggering chronic bronchitis (the cause in up to 83%) and chronic cough.
  • A wide variety of conditions can result in postnasal drip including allergic rhinitis, perennial rhinitis and sinusitis.  Although most patients will have symptoms that suggest the diagnosis, a large number will have “silent” asymptomatic postnasal drip.
  • Wheezing, shortness of breath and cough are considered hallmarks of asthma.  Some asthmatics can have cough as the predominant symptom of their asthma…so-called cough-variant asthma.
  • Some patients with GERD may have clinically significant disease without any of the symptoms of reflux.  Just because you do not have heartburn does not guarantee that stomach acid moving into the esophagus is not contributing to your cough.

HOW IS CHRONIC COUGH TREATED? The treatment of the cough is based on the disease causing the cough.  If the cause is thought to be chronic bronchitis we will prescribe bronchodilator or steroid inhalers and smoking cessation. If the cause is thought to be postnasal drip then we would prescribe antihistamine and nasal steroid spray.  If the cause is thought to be GERD then a antacid medication would be used.

WHAT TO EXPECT ON MY FIRST VISIT TO PCCS? We will perform full pulmonary function testing and an x-ray.  A full medical history will be taken and a physical exam will be done.  Some other test such as a CT of the chest, a barium swallow/Upper GI test, or bronchoscopy may be needed.

Learn more about some common respiratory infections.



Bronchitis means inflammation of the bronchi, or airways. Bronchitis can be “acute” meaning of relatively sudden onset and short lived, or “chronic”, meaning lasting weeks, or longer. Acute bronchitis can be caused by pollution, or inhaling dusts or chemicals. Most of the time, though, acute bronchitis is caused by an infection of the airways. Usually the infection is viral, caused by many of the same “bugs” that produce URIs. But bacteria are not an uncommon cause of bronchitis. The main symptom is a cough productive of sputum that is usually not clear. Sputum color can be from cream color, to yellow, green, tan or grey. Patients often have low grade fever. For most patients, treatment is, again, supportive. Rest, liquids and cough medicine are the mainstays. For patients with severe symptoms, especially those with significant underlying lung disease, such as COPD, antibiotics are usually called for. Sometimes, a patient’s sputum is collected and “cultured” to determine if and what kind of infection is causing the bronchitis. But a standard sputum culture takes two to three days to be reported. There are evolving technologies, to include blood tests, to help doctors more rapidly determine if a patient will benefit from antibiotics, besides clinical criteria.

For more information see The Mayo Clinic web site.

Nontuberculous Mycobacterium


Mycobacteria are a large group of bacteria which can cause disease in humans. Non tuberculous mycobacterium (NTM) is a group within the Mycobacterium family which includes all the other mycobacteria which can cause pulmonary disease, skin disease, lymphadenitis or disseminated disease.

Read More About Nontuberculous mycobacterium



Pneumonia is an infection of the lung tissue. It can be caused by viruses, fungi, or even parasites. But in adults it is usually caused by bacteria. Symptoms include cough, usually productive like in bronchitis, fever, chills, and sometimes difficulty breathing or chest pain. Diagnosis, unlike for a URI or bronchitis, usually requires a chest X ray in addition to examination by the doctor. Treatment, virtually always involves antibiotics, in addition to supportive care similar to that for URI and bronchitis.

For more information see The Mayo Clinic web site.

Upper Respiratory Tract Infection


An Upper Respiratory Tract Infection or “rhinopharyngitis”, is commonly known as the “common cold”. Symptoms are drainage from the nose, congested or “stuffy nose”, sore or irritated throat, a mild cough, and mild systemic symptoms such as low grade fevers, and malaise or a lack of energy. URIs are almost always caused by viruses. In fact, two hundred different types of viruses can cause a cold, but most are caused by common rhinoviruses. Treatment is usually supportive, and includes rest, drinking plenty of fluids, decongestants (nasal sprays rather than pills are recommended for older adults), and cough medicine, as needed. Antibiotics, are generally avoided, unless the URI is from an Influenza virus.

Symptoms of “the flu” are similar to upper respiratory tract infections but more severe and additionally include a high fever (greater than 100 degrees F), headache, and aching muscles. The symptoms (reflecting progressively severe infection of the respiratory system) may progress to include symptoms of bronchitis or even pneumonia. For most patients, antibiotics are not necessary for treating the flu, supportive care is enough. However, there are patients, such as those with severe underlying lung disease, who will not tolerate the virus. For such patients, we like to start antibiotics within 48 hours of symptom onset. There is rapid office based testing that helps us to sort out patients with this potentially severe viral infection.

For more information see The Mayo Clinic web site:


For information on other infectious diseases we recommend the American Lung Association website.