6 Times Your Persistent Cough Is Something More Serious

When your cough isn’t caused by a cold or allergy, it may be time to call the doctor.

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A cough is the body’s natural reflux that helps clear the airways of foreign particles and irritants. 

“The whole purpose of the cough is to help clear the lungs of mucus, infection or anything that develops in the lungs,” says Nicholas Roy, DO, an expert in in internal medicine, pulmonary medicine and critical care with Pulmonary and Sleep Associates of South Jersey in Cherry Hill, New Jersey. 

The most common cause of a persistent cough is postnasal drip, in which mucus drips down the throat and triggers a cough. Allergens are another common irritant, and when these cause you to cough, you don’t likely need to worry. A chronic cough however, may be a sign of a more serious health concern. 

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Common Signs of Trouble

These symptoms may be first indicators of an underlying condition:

Presence of blood: Coughing up blood, or hemoptysis, shouldn’t be ignored. “It’s not uncommon to have very small blood vessels rupture from coughing violently,” says Roy. “Sometimes you can get a little blood mixed in with the mucus.” He advises that you notify your doctor any time your cough generates blood.

Mucus: “Any cough that results in a consistent production of green, brown or dark sputum along with fever, chills or sweats should be worked up by a physician, since it may be a sign of infection,” Roy says.

Persistence: It's not uncommon to experience a persistent cough after a chest cold, but a cough lasting more than two weeks may be something else. “It’s not uncommon after a chest cold to have what’s called a post-infectious cough, where the infection or virus that caused it has run its course,” says Roy. “But if you’re left with a dry, nagging cough, your healthcare provider should probably get involved.”

Beyond these general symptoms, here are six possible causes of a persistent cough that merit a visit with your healthcare provider. 

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Asthma is a chronic condition that impacts the lungs and can make breathing difficult. Typically, signs of asthma include shortness of breath, wheezing, chest tightness, coughing or a combination.

Sometimes, a chronic cough is the only symptom. “Some asthmatics actually have what's called cough-variant asthma,” Roy says. “Instead of wheezing as their primary symptom, they have a dry, hacking cough,” he adds.

So what sets off these attacks? Asthma triggers vary from exposure to allergens or irritants to a change in temperature to exercise and even stress. And although the cough itself isn’t dangerous, it could be disruptive. For many, the cough worsens at night, making sleep difficult. A persistent cough may also lead to vomiting, lightheadedness and cracked or fractured ribs. 

If you’re experiencing a cough with no known cause for several weeks, or shortness of breath or wheezing develop, seek medical attention. Your doctor may diagnose you with cough-variant asthma and prescribe treatments, like an inhaler, oral medication or both.   

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A persistent cough is common among those with bronchitis—the inflammation of the passageways that carry air to and from the lungs. Bronchitis can be caused by a virus, bacteria or particles that irritate the passageways, like cigarette smoke or dust.

The main symptom of bronchitis is a cough that may produce mucus. Other symptoms include a wheezing, chest tightness and shortness of breath.

Bronchitis comes in two forms: acute and chronic. Acute bronchitis is common, produces a cough that generally lasts for a few weeks and is typically caused by a virus.

Chronis bronchitis never goes away completely, though symptoms may subside from time to time. Although cigarette smoking is the most common cause, this chronic condition is the result of repeated exposure to any irritant that damages the lungs and airways.

Bronchitis caused by a viral infection cannot be treated with antibiotics. In most cases, the condition will clear itself up in a few weeks. Symptoms can typically be treated with a cough suppressant, adequate rest and plenty of fluids.

There is no cure for chronic bronchitis. The best advice? Kick the smoking habit or steer clear of irritants. Your doctor may also prescribe medication—inhaled or pill form—to clear away mucus and oxygen therapy to help make breathing easier.              

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Lung Cancer

Lung cancer is the leading cause of cancer-related death among both men and women in the United States. The most common cause of lung cancer? Cigarette smoke. Despite this, lung cancer can develop in nonsmokers and those with no history of prolonged exposure to secondhand smoke. 

Symptoms of lung cancer include a cough, shortness of breath, wheezing, fatigue, chest pain, weight loss and loss of appetite. Other cough-related symptoms include a hack that worsens or refuses to go away or one that produces blood. 

If you experience these symptoms, make an appointment to speak with your healthcare provider. A physical exam, imaging tests and lab tests are used to diagnose lung cancer. Your doctor will then prescribe the best course of treatment for your condition, which may include surgery, chemotherapy, radiation therapy, targeted therapy or a combination. And, of course, stop smoking.

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Gastroesophageal Reflux Disease (GERD)

Acid reflux is a common condition in which stomach acid flows up into the esophagus and causes heartburn, characterized by a burning sensation in the chest. Many people experience acid reflux on occasion; usually it’s not cause for concern.

When heartburn occurs two or more times a week, or is accompanied by symptoms like trouble swallowing, the taste of a sour liquid, nausea or a dry cough, what you’re experiencing may be gastroesophageal reflux disease. GERD is a long-term and more serious form of acid reflux and, if left untreated, can lead to permanent damage to the esophagus. Speak with your healthcare provider if you experience these symptoms. 

People carrying extra weight, smokers and those taking certain medications, like painkillers or antihistamines, are more likely to have GERD. So, losing a few pounds, kicking your smoking habit and talking to your doctor about your medication may relieve some symptoms. Avoiding meals before bed, eating smaller portions and reducing your intake of specific foods that aggravate your symptoms can also help.

When prevention isn’t enough, your doctor may prescribe medication or recommend taking over-the-counter antacids. In rare cases, surgery is necessary.       

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Reaction to ACE inhibitor

If you notice a persistent cough after starting medication to manage high blood pressure, it may not be a coincidence. “Another that’s pretty common, but underappreciated, is a cough that’s secondary to medications, like an ACE inhibitor,” Roy says.

Angiotensin-converting enzyme (ACE) inhibitors are a group of medications used to treat heart disease. These medications work to lower blood pressure and reduce the likelihood of heart attack and stroke, but they also come with the risk of some mild side effects.

In addition to headache, fatigue, loss of appetite and diarrhea, ACE inhibitors may also cause a dry cough. Although the cough may dissipate eventually, it may not. In this case, your doctor may adjust the dosage or prescribe a new medication.   

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Damage to the large airways in the lungs that causes the passageways to widen is known as bronchiectasis. “Bronchiectasis is a dilation of some of your airways that causes mucus impaction in the lungs and can cause a chronic cough,” Roy says.

For some, bronchiectasis is present at birth, while others develop the condition later in life. The condition is rather uncommon. It affects a total of just 110,000 people in the United States and is usually the result of an infection or chronic inflammation. Cystic fibrosis, an autoimmune disorder or some cancers can also cause it.

Whatever the initial cause, those with bronchiectasis struggle to clear mucus out of their airways. Symptoms may appear months or years after the event that sparked the condition, and can include wheezing, weight loss, fatigue and bad breath. The largest indicator of the condition though, is a chronic cough that produces large amounts of smelly mucus.

Although there is no cure, treatment options, like medication, respiratory therapy and surgery, make it possible for most people with bronchiectasis to enjoy a good quality of life.

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