8 Reasons Why You May Be Coughing So Much

Is your persistent cough just a hard-to-shake cold or something more serious?

a mother giving boy cough syrup at home
Photo: cottonbro / Pexels

You've been coughing for weeks—but how do you know if it's just a hard-to-shake cold or something more serious? A chronic cough, defined by the American Lung Association (ALA), is a cough that lasts more than eight weeks and has various possible causes. According to the ALA, common causes include asthma, chronic obstructive pulmonary disease (COPD), and digestive disordered like GERD.

Here are the most common causes of chronic cough—and what you can do about it.

1. Asthma and Allergies

Asthma, a chronic disease that affects the lungs, causes repeated episodes (known as asthma attacks) of wheezing, shortness of breath, chest tightness, and nighttime or early morning coughing, per the Centers for Disease Control and Prevention (CDC). It's one of the most common diseases affecting kids, but it can also affect adults.

Asthma triggers are different for everyone, with everything from exercise and certain foods to cigarette smoke and other airborne irritants bringing on an attack. Identifying and avoiding triggers (or at least minimizing exposure to them) is a key part of managing asthma.

But you don't need to have asthma to be affected by airborne irritants. According to the American College of Allergy, Asthma & Immunology, 40 to 60 million Americans suffer from allergic rhinitis, commonly known as hay fever, which causes coughing along with other symptoms like a stuffy nose and sneezing. Common triggers for hay fever include pollen, dust, and pet dander.

You may determine whether your cough is caused by allergies by keeping track of whether it comes and goes in certain situations. If your coughing magically stops when you step into an air-conditioned room on a dry, pollen-heavy day, or it gets worse every time you are near your friend's cat, you probably have allergies. If you're not sure what's triggering your allergic cough, your healthcare provider can give you a skin test or blood test to pinpoint the allergy.

2. Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a term that covers two main conditions—emphysema and chronic bronchitis, per the National Institutes of Health. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage can also destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced.

In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. To be diagnosed with chronic bronchitis, you must have a cough and mucus most days for at least three months a year, for two years in a row, according to Johns Hopkins Medicine. Plus, other causes of symptoms, such as tuberculosis or other lung diseases, must be ruled out.

Most people diagnosed with COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. As well as coughing, symptoms include wheezing, shortness of breath, and tightness in the chest.

According to the National Heart, Lung, and Blood Institute, smoking is the leading cause of COPD, but up to 25% of people with COPD have never smoked at all. Other causes of COPD include long-term exposure to air pollution, chemical fumes, and other lung irritants.

Your healthcare provider may check you for COPD (particularly if you have risk factors, such as smoking), after ruling out other common causes of cough. To determine if you have COPD, your healthcare provider is likely to conduct some tests, including spirometry, which involves inhaling as deeply as you can and then exhaling into a tube.

3. Gastroesophageal Reflux Disease

The main symptom of gastroesophageal reflux disease (GERD), a digestive disorder that occurs when stomach acid, food, and fluids back up into the esophagus due to a weak valve, is killer heartburn. But coughing is another common symptom, along with chest pain and wheezing.

According to the American Academy of Allergy, Asthma & Immunology (AAAAI), GERD affects people of all ages, from infants to older adults, and people with asthma are at higher risk of developing the disorder. This is because asthma attacks can cause the lower esophageal sphincter to relax, which lets the contents of the stomach flow back into the esophagus.

The AAAAI recommends various lifestyle changes to help ease the symptoms of GERD (including that nasty cough), such as elevating the head of the bed by six to eight inches, losing weight, stopping smoking, drinking less alcohol, restricting portion sizes, avoiding heavy evening meals, and cutting down on caffeine.

4. Respiratory Tract Infection

Coughing is one of the most common symptoms of colds and flu, and other respiratory tract infections (infections that interfere with normal breathing). The other symptoms that accompany colds and flu, such as a stuffy nose and a fever, are telltale signs that a viral infection is causing your cough, per the U.S. National Library of Medicine.

A cough can outlast all those other symptoms, perhaps because the air passages in your lungs remain sensitive and inflamed. A cough that persists following a viral upper respiratory infection is called a post-viral cough.

A more serious respiratory tract infection is pneumonia, which can be caused by bacteria or viruses. A cough, often producing a greenish or rust-colored mucus, is one of the characteristic symptoms of the illness, along with fever, chills, chest pain, weakness, fatigue, and nausea, per the CDC. These symptoms may present differently depending on your age; older adults may not experience a fever, for instance, or they may have a cough but no mucus.

Pneumonia is treated with antibiotics and generally clears up within two or three weeks. Pneumonia would typically not lead to a cough lasting longer than eight weeks, however, as patients generally seek help from their healthcare provider prior to eight weeks of symptoms and/or get better on their own before this.

Other chronic pneumonia-related causes of prolonged coughing include fungal infection, tuberculosis, or other bacterial infection.

People who have COPD can be more susceptible to such respiratory tract infections and may experience exacerbations—episodes of potentially life-threatening shortness of breath—when they catch a cold or breathe in air pollution or other irritants.

5. Air Pollution

Various pollutants and irritants in the air can cause a persistent cough. Even short-term exposure to fumes (such as diesel exhaust) can result in cough, phlegm, and lung irritation. Fumes can also exacerbate the symptoms of allergies or asthma.

Similarly, mold spores found in and around homes can cause wheezing and coughing when inhaled. In the wake of Hurricane Katrina, New Orleans reported a sudden spike in persistent cough complaints among returning residents. According to a 2011 study published in Public Health Reports, this so-called "Katrina cough" was believed to stem from the mold caused by the flooding, as well as by dry weather and the construction dust in the city.

6. ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are widely used to treat heart failure and hypertension (high blood pressure) and often cause a persistent dry cough, according to the AAAAI. According to a January 2019 study published in the Turkish Thoracic Journal, one out of five patients discontinues their use of ACE inhibitors due to side effects, the main one being chronic cough. However, the reason why these drugs lead to cough is not yet well understood.

You should never stop taking prescribed medication without consulting with your healthcare provider, and ACE inhibitors are important medications for lowering blood pressure (a more serious condition than a cough). If you think your chronic cough is linked to a drug you're taking, check in with your healthcare provider and see if you have other options.

7. Pertussis

Also known as whooping cough, pertussis is a highly contagious respiratory illness caused by the bacterium Bordetella pertussis, according to the CDC. Common symptoms include a slight fever, a runny nose, and, most notably, a violent cough that can make breathing difficult. Attempting to inhale air into the lungs between coughs can produce a distinctive, high-pitched whooping sound. After the initial stage, many people do not have a fever, but the cough that accompanies pertussis can persist for several weeks.

The best way to protect against pertussis is by getting vaccinated, says the CDC. Although the vaccine isn't 100% effective (no vaccine is), if you get the illness after being vaccinated, it's usually not as bad.

8. Chronic Smoking

People who smoke often develop a cough caused by the body's natural response to get rid of the chemicals that enter the airways and lungs via tobacco use. In this case, a chronic cough is often known as smoker's cough, says the CDC. It may begin as a dry cough but can eventually produce phlegm.

A 2016 study published in the journal Medicine looked at the prevalence of chronic cough and possible causes in the general population. The study, which was based on the Korean National Health and Nutrition Examination Survey and included 119,280 adults aged over 40 years, found that 47.7% of participants with chronic cough were current smokers.

According to the CDC, smoking is the number one cause of lung cancer. If you are experiencing additional symptoms such as coughing that gets worse or doesn't go away, chest pain, shortness of breath, wheezing, or coughing up blood, talk to your healthcare provider so they can conduct screenings as needed.

Naturally, the easiest way to get rid of a smoker's cough is to quit smoking, and if you need help with that, your healthcare provider can point you in the right direction.

Chronic cough can be annoying. But it can also be a symptom of a much more serious medical condition. If you have symptoms of a chronic cough, it's important to get it checked out. Only your healthcare provider can truly tell for sure what's going on with an incessant cough.

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