The Cough That Will Not Go Away
It has been weeks – maybe months – and you are still coughing. It disrupts your sleep, embarrasses you in meetings, and worries you. A chronic cough (lasting more than eight weeks) is never normal, and while serious causes are uncommon, identifying the reason is important for effective treatment and peace of mind.
At our practice in Zürich Seefeld, I approach chronic cough systematically, because the three most common causes account for the vast majority of cases – and all are treatable.
The Big Three Causes of Chronic Cough
Upper airway cough syndrome (post-nasal drip): Mucus dripping from the sinuses or nasopharynx triggers cough receptors in the throat. Often accompanied by throat clearing, nasal congestion, and the sensation of something dripping down the back of the throat. Common in allergic rhinitis and chronic sinusitis.
Asthma (cough-variant asthma): Some patients have asthma that presents only or predominantly as cough – without the classic wheezing or breathlessness. The cough may be worse at night, with exercise, or after cold air exposure.
Gastro-oesophageal reflux (GERD): Acid reflux can trigger cough through direct aspiration of gastric contents into the airways or through vagal nerve-mediated reflex. Notably, reflux-related cough can occur without typical heartburn symptoms (silent reflux).
Other Important Causes
Medication-induced: ACE inhibitors (a class of blood pressure medication) cause chronic dry cough in up to 15% of users. This is the first thing I check in any patient on these medications.
Chronic bronchitis: Particularly in smokers or former smokers, chronic airway inflammation produces a productive cough.
Post-infectious cough: Following a respiratory infection, airway inflammation and heightened cough sensitivity can persist for weeks to months.
Eosinophilic bronchitis: Airway eosinophilia without the bronchospasm of asthma, causing chronic cough responsive to inhaled corticosteroids.
Serious causes to exclude: Lung cancer (particularly in smokers over 40), tuberculosis, interstitial lung disease, bronchiectasis, and foreign body aspiration.
When to Seek Evaluation
Any cough lasting more than eight weeks warrants investigation. Seek urgent evaluation if the cough is accompanied by blood (haemoptysis), significant weight loss, progressive breathlessness, fever persisting beyond a few days, or if you are a smoker over 40 with a new or changed cough pattern.
Our Diagnostic Approach
I follow an evidence-based, stepwise approach: detailed history (timing, triggers, associated symptoms, medications), physical examination, chest X-ray if indicated, spirometry to assess for asthma, FeNO measurement, trial treatments based on clinical suspicion, and further investigation (CT scan, bronchoscopy, pH monitoring) if the cough does not respond to initial treatment.
What We Do: Silencing the Cough
Target the cause: Intranasal corticosteroids and antihistamines for upper airway cough syndrome; inhaled corticosteroids for asthma; proton pump inhibitors and lifestyle modifications for reflux-related cough.
Medication review: Switching ACE inhibitors to alternative blood pressure medications when they are the cause.
Post-infectious cough management: Reassurance, time, and sometimes inhaled corticosteroids or honey-based remedies while the airway heals.
Smoking cessation support: For smoking-related chronic cough, structured cessation support is the most effective intervention.
Cough hypersensitivity management: For patients with cough that persists despite treating identifiable causes, emerging treatments for cough hypersensitivity syndrome may be appropriate.
Conclusion
A chronic cough always has a cause, and that cause is almost always treatable. If you have been coughing for more than eight weeks, book an evaluation at our practice in Zürich Seefeld – relief is usually achievable once we identify what is driving your cough.
