Cough lasting longer than 8 weeks is "chronic." It's one of the most common reasons patients see a pulmonologist — and one of the most frustrating, because most patients have already tried OTC medications, antibiotics, and tincture of time without resolution.
In most patients with chronic cough and a normal chest X-ray who don't smoke, the cause is one of three common conditions — and treating those three accounts for 80–90% of cures.
In nonsmokers with a normal chest X-ray and not on an ACE inhibitor: UACS, asthma, or GERD (alone or in combination). The remaining 10–20% includes eosinophilic bronchitis, refractory cough, and rarer causes.
Persistent cough, usually dry but sometimes productive, sometimes worse at specific times of day, sometimes associated with throat clearing, hoarseness, heartburn, or post-nasal drip. Many patients describe sleep disruption for themselves or partners, urinary incontinence with hard coughs, cracked ribs from coughing, or simply social embarrassment.
Sequential. We start by asking three questions: (1) Are you taking an ACE inhibitor? ACE inhibitors cause dry cough in ~10% of patients — stop the drug, the cough usually resolves in 4–8 weeks. (2) Do you smoke? If so, stop. (3) Is your chest X-ray normal? If all three are addressed and the cough persists, we work through Upper Airway Cough Syndrome (UACS — postnasal drip), Cough-Variant Asthma, and GERD. If empirical treatment doesn't resolve it, we expand the differential to eosinophilic bronchitis, aspiration, vocal cord dysfunction, ILD, infection, or refractory chronic cough — for which a new generation of drugs targets the cough reflex itself.
Treatment follows diagnosis. Trial-of-therapy is often the diagnosis: we treat empirically for UACS, then asthma, then GERD, and the one that works confirms the cause.
This page is general medical information, not personalized medical advice. If you have questions about your specific health, talk with your Nimbus clinician.
