Chronic Coughing: Is It Asthma, a Runny Nose or Acid Reflux?

December 11, 2023

A mature man coughing during a consultation with a doctor in a clinic

If you’ve ever had a lingering cough, you know the aggravation it can cause when talking, eating or sleeping. Getting to the root cause of the cough is the best way to effectively treat it and get rid of those pesky symptoms.

Causes of a Chronic Cough

A chronic cough – defined as one lasting for at least eight weeks – can have many causes. Anything that irritates the throat, esophagus, sinuses or lungs can cause chronic coughing. Aside from smoking, the most common causes of a chronic cough are asthma, postnasal drip and acid reflux. Other causes include bronchitis and medications such as ACE Inhibitors.

What’s more, an already-sensitive throat is more easily irritated by excess mucus, reflux acid, cold air, smoke, perfumes or other airborne substances, causing even more coughing.

Diagnosing a Chronic Cough

“When your cough won’t go away, it’s important to pay attention to your symptoms, find out what’s causing the cough and get the right help,” says University Hospitals ear, nose and throat specialist (ENT) Scott Howard, MD.

Diagnosis begins with a medical history and symptom check. “When addressing a chronic cough, I always consider what is most common first. Is the patient on an ACE Inhibitor? Do they smoke? Do they have asthma? Do they have reflux? Do they complain of postnasal drip or sinusitis? Most of the time, a detailed medical history, review of symptoms, physical exam, and sometimes x-rays or lab tests can rule out a few of these, so that we can treat the cause that seem most likely,” says Dr. Howard.

A Runny Nose and Chronic Cough

When a sinus infection or nasal irritant produces extra mucus that drips into your throat, it triggers the normal cough reflex to clear the mucus. If postnasal drip doesn’t go away due to a continuing infection in the sinuses, it can result in a chronic cough. Antibiotics, medications to dry nasal mucus and nasal cleansing treatments such as saline washes can resolve the runny nose and improve the cough.

“A cough that lingers after an upper respiratory infection is often neurogenic, which means it is caused by a change in throat sensation. This can be due to an overly sensitive throat or reduced sensitivity. More often we find that our patients are hypersensitive to normal amounts of mucus that is produced by the body,” says Dr. Howard.

Acid Reflux and Chronic Cough

For many, it may be a surprise to learn that chronic coughing is often triggered by gastroesophageal reflux disease (GERD), commonly called acid reflux. Acid reflux occurs when stomach acid backs up into the esophagus. When acid or other digestive enzymes irritate the throat, they often cause changes in sensation or irritation that can stimulate a cough. Even extremely small amounts of acid can irritate the voice box and throat, triggering a cough. Worse yet, coughing can aggravate GERD and fuel a vicious cycle.

Along with a medical history and symptom check, a pH test can help confirm acid reflux. If reflux is suspected as a cause of chronic cough, medication to reduce stomach acid may be prescribed.

“Along with acid-reducing medications, diet and lifestyle changes can help reduce acid and minimize coughing. Some medications can block regurgitation which may be the most important step,” Dr. Howard says.

Asthma and Chronic Cough

It’s likely that asthma or another lung issue is the underlying cause of a chronic cough if the coughing begins or gets worse:

Following a respiratory infection.
Following a change in the seasons.
If you are exposed to fragrances, smoke, chemicals or anything that makes breathing difficult.

To reduce coughing, treatment includes medication, inhalers, avoiding triggers, and learning how to improve breathing and swallowing.

Finding Answers, Getting Help

Both pulmonologists and ENTs offer evaluations for chronic coughing. An ENT is particularly well-suited to evaluate the overlap between the sinuses, the esophagus and the lungs. In addition, ENT providers are critical members of the cough team to ensure laryngeal cancer or other problems are not causing the cough. Pulmonologists frequently refer patients to an ENT provider when the symptoms don’t fit a lung disease such as asthma or COPD.

In addition to treating the cause of the cough, Speech and Language Pathologists can provide cough suppression techniques, breathing exercises, vocal hygiene, hydration tips and other counseling to help patients treat their cough.

The best news is that chronic coughing typically disappears once the underlying problem is treated.