Why You Can’t Stop Coughing

Common Reasons for a Cough That Lasts for Weeks

There can literally be dozens of reasons why you can't stop coughing, a condition referred to as a chronic cough. Moreover, the cough itself can vary based on the underlying cause with some being "wet" or productive (meaning that you're coughing up phlegm or mucus) and others being "dry" or non-productive (meaning that you're coughing up nothing).

The main causes of a chronic cough can be broadly categorized as being either infectious (caused by a virus or other disease-causing organism), immunological (such as an allergy), pulmonary (related to the lungs), or gastroesophageal (related to the upper digestive tract), Less common causes include heart failure and cancer.

Most chronic coughs are not serious but should be checked out by a healthcare provider nevertheless, especially if they are painful, worsening, or accompanied by symptoms such as fever, difficulty breathing, or blood-tinged saliva or mucus.

This article describes some of the common and uncommon causes of a chronic cough. It also explains how the cough might be diagnosed and treated and which symptoms warrant an immediate call to your healthcare provider.

Common Causes of Constant Coughing

Verywell / JR Bee

Symptoms of a Chronic Cough

A chronic cough is technically one that persists (or recurs frequently) for more than eight weeks. The features of the cough can differ based on the underlying cause and may be described in different ways.

Wet (productive) coughs are typically those described as being:

  • Loose
  • Congested
  • Chesty
  • Rattling
  • Phlegmy

Dry (non-productive) coughs are more commonly described as being:

  • Hacking
  • Hoarse
  • Barking or "croupy"
  • Brassy or "metallic"
  • Throaty, ticklish, or itchy

A cough may have other descriptive features, such as being:

  • Painful
  • Wheezy or "whistling"
  • Spastic or paroxysmal (occurring in fits or attacks)

Accompanying symptoms may include fatigue, shortness of breath (dyspnea), heartburn, nausea, fever, and nasal congestion. These and other features can give your health provider a clue as to the cause and nature of your cough.

Common Causes of Chronic Cough

Causes of a chronic cough can range from those that are a nuisance to those that are potentially life-threatening. Even so, the greater likelihood is that the cause is not serious or, at the very least, manageable with proper treatment.

The causes of a chronic cough can be broken down by category.

Common Causes
  • Allergies

  • Asthma

  • Bronchitis

  • Chronic obstructive pulmonary disease (COPD)

  • Emphysema

  • Gastrointestinal reflux disease (GERD)

  • Hiatal hernia

  • Lung infections

  • Medications

  • Pneumonia

  • Postnasal drip

  • Whooping cough

Less Common Causes
  • Congestive heart failure

  • Collapsed lung

  • Fungal infections

  • Lung cancer

  • Pulmonary edema

  • Tuberculosis

Infectious Causes

Infectious causes of a chronic cough most often involve a virus or bacteria. Less common causes include fungi and parasites.

Examples include:

  • Post-viral coughs: The common cold and influenza (flu) can cause a chronic post-viral cough. This differs from a cough that arises from acute symptoms like postnasal drip or sore throat. Instead, it is due to inflammatory damage to the airways caused by the viral infection.
  • Croup: This is an infection of the upper airways including the larynx (voice box), trachea (windpipe), and bronchi (bronchial tubes). In children, croup can cause a characteristic barking cough.
  • COVID: A chronic cough is characteristic of an acute COVID-19 infection, often accompanied by fever, shortness of breath, and loss of taste or smell.
  • Pneumonia: Both viral and bacterial pneumonia can cause a chronic cough due to inflammation of the alveoli (air sacs) in one or both lungs.
  • Whooping cough: With whooping cough (pertussis), periods of unrelenting coughing are accompanied by a char "whooping" sound as a person inhales.

Immunological Causes

These are coughs that are triggered by an abnormal response of the immune system. There are three common forms:

  • Allergies: Seasonal allergies, including allergic rhinitis (hay fever), can cause a chronic cough. Environmental allergies to mold, dust mites and cat dander can also cause chronic coughing.
  • Allergic asthma: Also known as extrinsic asthma, this is a form of asthma that occurs when the immune system releases a substance called histamine in response to an allergy-causing substance. The coughing is due to both the narrowing of the airways (bronchoconstriction) and airway spasms (bronchospasm).
  • Non-allergic asthma: Also known as intrinsic asthma, this is a form of asthma that occurs when the body releases inflammatory chemicals in response to irritants like smoke, weather conditions, airway infections, food additives, and other environmental triggers. in some people, a cough is the only symptom, referred to as cough-variant asthma.

Pulmonary Causes

Chronic cough can be caused by chronic diseases directly affecting the lungs, Examples include:

  • Chronic obstructive pulmonary disease (COPD)COPD is an important cause of a chronic cough, often accompanied by shortness of breath, wheezing, and chesty cough. Smoking is both a cause of COPD and a trigger for COPD exacerbations (attacks).
  • Bronchitis: Both acute and chronic bronchitis can cause someone to cough constantly. With chronic bronchitis, a form of COPD, the cough will typically produce phlegm.
  • Emphysema: This is a more advanced form of COPD for which a chronic, productive cough is a central feature. Emphysema occurs when damage to the alveoli causes pitting in the lungs.
  • Bronchiectasis: This is a condition that occurs when the airways become damaged and widened. Causes of bronchiectasis include prior childhood infection, immune deficiency, and conditions like cystic fibrosis or connective tissue diseases.

Gastroesophageal Causes

Acid reflux, whether occasional or chronic, can cause coughing due to the backflow of stomach acid through the esophageal sphincter. This is the valve through which food passes from the esophagus (feeding tube) into the stomach.

Two common gastroesophageal causes of chronic cough include:

  • Gastroesophageal reflux disease (GERD): GERD is a chronic form of acid reflux. Chronic coughing can occur at night when lying down followed by a hoarse cough in the morning due to esophageal inflammation.
  • Hiatal hernia: This is when part of the stomach protrudes into the chest through the sheet of muscle called the diaphragm. Hiatal hernia can disrupt the normal position of the esophageal sphincter, allowing acid to backflow into the esophagus.

Pharmaceutical Causes

Medications called ACE inhibitors used to treat high blood pressure and heart failure can cause chronic coughing both during the day and at night.

ACE inhibitors associated with chronic coughs include

  • Altace (ramipril)
  • Capoten (captopril)
  • Lotensin (benazepril)
  • Prinivil (lisinopril)
  • Vasotec (enalapril)

Uncommon Causes of a Chronic Cough

Less common causes of a constant cough include:

  • Congestive heart failure: Heart failure can cause an unrelenting cough. This cough may produce pink foamy phlegm and usually worsens with lying down. It is most often accompanied by shortness of breath.
  • Collapsed lung: A pneumothorax (collapsed lung) can cause a perpetual cough that often begins suddenly. In addition to a cough, people may note shortness of breath as well as a crackling breathing sound known as crepitus.
  • Fungal infections: Fungal diseases such as coccidioidomycosis, histoplasmosis, and cryptococcosis, among others, may result in a chronic cough.
  • Lung cancer: Lung cancer is a less likely cause of a chronic cough but is important to keep in mind if you have risk factors for the disease. Roughly 50% of people with lung cancer have a cough at the time of their diagnosis.
  • Pulmonary edema: This is when fluid accumulates in the air sacs of the lungs, causing coughing and difficulty breathing. Pulmonary edema can be caused by heart failure and other conditions such as lung infections, neurological disorders, and medications.
  • Tuberculosis: While tuberculosis is fairly uncommon in the United States, it does occur. In addition to a chronic cough, weight loss and night sweats are common.

Diagnosis

When you see your healthcare provider, the first thing they will do is review your symptoms and medical history and perform a physical exam. This may include listening to lung sounds with a stethoscope.

Based on the findings, the healthcare provider may order the following tests and procedures:

  • Blood tests: A white blood cell count (WBC) may be done to look for signs of viral or bacterial infections.
  • Bronchoscopy: A bronchoscopy is a test in which a small tube with a light is inserted through your mouth and into your large airways.
  • Chest X-ray: A chest X-ray may be done to look for pneumonia and other possible causes of coughing.
  • Computerized tomography (CT) scan: A CT scan involves multiple X-ray images that are composite to create a three-dimensional image of internal structures, such as the lungs.
  • Esophageal pH testing: This is used to check for signs of acid reflux.
  • Laryngoscopy: Laryngoscopy is a procedure in which a tube is inserted through the mouth to visualize the area around your vocal cords.
  • Nasal swab: A nasal swab can check for infections such as the flu or COVID-19.
  • Spirometry: Spirometry is a test that measures how much air you can blow out of your lungs. It is commonly used to diagnose asthma or COPD.

Treatment

The treatment of a constant cough will depend on the underlying cause and may include:

  • Acid blockers: These are medications called H2 blockers used to suppress stomach acid production in people with acid reflux or GERD.
  • Antibiotics: These are drugs used to treat bacterial infections. Antibiotics can be given orally (by mouth) or intravenously (into a vein) depending on the cause and severity of the infection.
  • Antihistamines These are medications that block the effects of histamine in people with allergic asthma or respiratory allergies.
  • Inhalers: Different types are used to treat asthma or COPD, including bronchodilators that open the airways and corticosteroids that reduce inflammation.
  • Over-the-counter cough suppressants: These contain drugs like dextromethorphan that suppress coughs by reducing the sensitivity of the airways.

When to Call a Healthcare Provider

Most cases of chronic coughs are not urgent but there are certain signs and symptoms that warrant immediate emergency care.

Call 911 if your chronic coughing is accompanied by:

  • Severe chest pains
  • Choking
  • Stridor (high-pitched wheezing sounds)
  • Inability to catch your breath
  • Rapid or irregular heartbeats
  • Swelling of the face, tongue, or throat
  • Lightheadedness or fainting

Summary

A chronic cough is one that persists or recurs for more than eight weeks. There are many possible causes including infections, allergies, asthma, COPD, GERD, and even certain medications. Less common causes include tuberculosis and cancer.

The diagnosis of chronic cough may involve a physical exam, blood tests, chest X-rays, nasal swabs, or direct imaging procedures like bronchoscopy or laryngoscopy. The treatment varies by the cause.

A Word From Verywell

A chronic cough may not be serious, but it is something you should never ignore. This is especially true if you have no idea what is causing the cough or are finding no relief with over-the-counter or home remedies.

In cases like this, it is in your best interest to see your healthcare provider to identify the cause and receive the appropriate treatment. Doing so may also help you catch a more serious concern, like an infection or cancer, before the symptoms turn severe.

Frequently Asked Questions

  • Is a constant cough a sign of COVID-19?

    Yes. Along with a fever and loss of taste and smell, a persistent cough is one of the main symptoms of COVID and may linger for weeks or months after you’re infected. Talk to your healthcare provider about treating a COVID cough. Not all cough medicines are helpful with COVID, and you need to consider whether it’s safe to take a cough suppressant alongside other medication you may be using.

  • Can honey stop a coughing fit?

    It is considered a good cough remedy. Multiple studies have shown that honey can suppress a cough and help ease symptoms of an upper respiratory tract infection. 

  • When should I worry about a cough that won’t go away?

    Most causes of a cough resolve with treatment and time. But if you experience these symptoms, get emergency medical attention:

    • Severe trouble breathing
    • Swelling of the face or tongue
    • Severe chest pain
    • Coughing up blood
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."