When your cough won’t stop

You may have gotten past the sniffles and aches of a cold or flu weeks ago, but the cough continues and shows no signs of letting up. It might even get in the way your sleep or exercise, keeping you from a full recovery. Here’s a look at what might be going on, how to manage and minimize symptoms, and when to see your doctor.

Why we cough

First, it helps to understand that we cough for a reason: It helps clear any irritants and mucus from your airways — also known as your bronchial tubes. Coughing also can prevent things from descending into your lungs, where they could cause an infection. Coughing is usually a good sign, as it shows that your body is functioning the way it’s meant to. Still, a lasting cough can be annoying and worrisome.

Why a cough may linger after other symptoms have gone away

There are several reasons a cough may remain after your initial infection has begun to subside:

Your nerves are working overtime. Some coughs stick around after a cold or flu resolves — for up to 2 weeks or more — because your bronchial nerves are recalibrating.

They may have been sensitized by the initial infection to react to the slightest stimuli. So even a very minor irritant such as dust could set off a reaction, says Omid Mehdizadeh, MD. He’s an otolaryngologist and laryngologist at Providence Saint John’s Health Center in Santa Monica, California.

This is called post-viral neuropathy, and it may affect other nerves in the head, neck and inner ear as well. Post-viral neuropathy can cause feelings of tingling, weakness, numbness or pain. When it affects the throat and voice box, it can be bothersome, but it’s usually not serious, says Dr. Mehdizadeh.

Mucus production is still winding down. Just as your bronchial nerves take time to desensitize after a cold, your body’s mucus-producing function (a healthy response to an infection) may still be returning to normal. This can cause some postnasal drip that triggers a cough.

You may have other issues unrelated to the cold that are coming into play. You could be dealing with asthma, acid reflux or postnasal drip from allergies, all of which can cause you to cough.

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When to consult a doctor for a cough

A cough that persists for longer than 8 weeks is considered chronic. At that point, you should consult a doctor to figure out what is causing it. Even if the cough doesn’t seem like a big deal and just feels like an annoyance, having it assessed is important.

Chronic coughing can put you at a higher risk of issues such as sleep deprivation, which has a ripple effect on your health. And severe cases of chronic coughing can cause vomiting, lightheadedness and even rib fractures.

But don’t wait 8 weeks if you’re struggling with exhaustion or everyday activities, says Dr. Mehdizadeh. “In fact, I would not recommend anyone wait more than 1 to 2 weeks with a cough," he says. "And if other symptoms are present, including shortness of breath, chest pain or fever, then care should be sought out.”

Another possibility is that you might be dealing with sinusitis, an infection of the sinuses. While many sinus infections are viral and will run their course, a few may be bacterial and need antibiotics.

It’s also possible that you may have an underlying infection such as pneumonia or bronchitis, says Tabitha Cranie, MD. She’s a family practice doctor in St. Petersburg, Florida.

Respiratory infections such as bronchitis (an inflammation of the bronchial tubes) can often cause lingering coughs. And while many cases resolve on their own, it’s still a good idea to get assessed in case the cause is bacterial and requires antibiotics.

Pneumonia, in which the large air sacs in your lungs become filled with fluid, can be serious and needs immediate attention.

If a cough is accompanied by other symptoms such as a fever or shortness of breath, make it a priority to get seen by a doctor. And if chest pain is involved, experts recommend that you get seen right away.

Managing a lingering cough with OTC products

If your cough hasn’t yet reached the chronic stage and you just want to focus on knocking it out, you can try over-the-counter (OTC) products designed to ease symptoms.

“OTC products such as cough suppressants are well-tolerated in adults and may help by generally altering the cough center in our brain or the cough sensory pathway in the lungs,” says Dr. Mehdizadeh. “As with all medications, be sure to carefully read and follow the instructions.”

Here are some OTC helpers to consider:

• Cough suppressants. These often contain dextromethorphan, a medication that affects the signals in the brain that trigger the cough reflex. This is especially helpful if you’re waking up a lot due to coughing. (Don’t take this medication if you’re on a monoamine oxidase inhibitor.) Some pharmacies keep these products behind the counter, since dextromethorphan “can be abused as a psychedelic substance,” says Dr. Mehdizadeh.
   
• Expectorants. If you’re producing a lot of mucus with your cough, an expectorant can help thin the mucus and make it easier to cough up. (Check with your doctor before taking an expectorant if you have asthma or chronic obstructive pulmonary disease.)
   
• Lozenges. Sucking on cough drops or even hard candies can ease a dry cough and soothe an irritated throat, says Dr. Cranie. The stickiness can coat the throat and help ease irritated bronchial nerves.

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Managing a lingering cough with a natural approach

There are also all-natural ways to help your cough run its course:

• Drink water. A major way to ease a cough is to make sure you’re hydrated, says Dr. Cranie. When you don’t drink enough water, excessive mucus can build up in the respiratory system and irritate the tissues, including your throat and sinuses.

  Your body will want to cough to try to clear the buildup. Fluids help thin the mucus in your throat, which can quell the cough reflex, Dr. Cranie says.

• Sip tea with honey. Putting honey in tea can have the same effect as a lozenge, says Dr. Cranie.

• Get steamy. Standing in the bathroom with a hot shower going can be helpful for clearing mucus, since the steam can moisturize the air you’re breathing.

You may need to try a few strategies at once, but that multi-pronged approach can often tame a cough that has stuck around for too long.

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Additional sources
Cough overview: American Lung Association (2021). "Learn About Cough"
Sinus infection overview: Centers for Disease Control and Prevention (2019). "Sinus Infection (Sinusitis)"
Bronchitis: Mayo Clinic (2017). "Bronchitis"
Pneumonia: American Lung Association (2021). "Pneumonia Symptoms and Diagnosis"