Condition
A cough that will not settle
Most coughs clear within two or three weeks. One that carries on has a cause, and in the great majority of people it is findable and treatable. Cough syrup is not the answer to it.
What it is
A cough after a cold usually settles within two to three weeks. Between three and eight weeks it is called subacute, and beyond eight weeks, chronic. At that point it is not "just a cough" - it is a symptom with a cause, and the job is to find which one.
The common causes are few: asthma and its cough-only variant, reflux, post-nasal drip from the sinuses, a blood pressure tablet of the ACE-inhibitor family, and smoking. In this part of the country tuberculosis has to be considered and excluded early rather than late.
This page is general information about the condition, written for patients. It is not a diagnosis, and it is no substitute for being examined.
Measuring it
How we find out, rather than assume
Each of these is done on site at the Tirupati centre, which is why most patients leave the first visit with an answer.
Chest X-ray
The first test in almost every persistent cough, and the one that finds or excludes the diagnoses nobody wants to miss.
Spirometry and FeNO
Identifies the very common case where a cough with no wheeze at all turns out to be asthma, and responds to an inhaler rather than a syrup.
Sputum testing
Including for tuberculosis. It is common enough here that a cough of this length is tested rather than assumed to be something else.
HRCT chest
Where the X-ray and the breathing tests do not explain it: bronchiectasis, interstitial disease and airway problems show here.
Treatment
What care looks like
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1
Treatment follows the cause. Asthma-related cough responds to inhaled treatment, reflux to acid suppression and timing of meals, post-nasal drip to nasal treatment, and an ACE-inhibitor cough to changing the tablet in discussion with whoever prescribed it.
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2
Tuberculosis is treated on a full course under supervision, with follow-up that continues after the cough stops, and the post-tuberculosis clinic exists for the scarring and airway damage that can be left behind.
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3
A small number of coughs stay after every cause is treated. The refractory cough clinic deals with those specifically, with speech and breathing retraining alongside medication rather than an endless run of antibiotics.
Questions
Asked most often
Answered the way we would answer them in the room. If yours is not here, ring the clinic and ask.
Related services
How long is too long for a cough?
Three weeks is the point at which it is worth being examined, and eight weeks is when it is formally called chronic. Blood, weight loss, fever or breathlessness at any point bring that forward.
Why has cough syrup not worked?
Because most syrups suppress the reflex rather than treat what is causing it. If the cause is airway inflammation, reflux or infection, it carries on underneath and returns as soon as the syrup stops.
Could it be tuberculosis?
It is one of the possibilities that gets tested for rather than assumed either way, particularly with a cough of more than three weeks alongside weight loss, fever or night sweats. Testing is quick and the answer changes everything that follows.
I only cough at night. Is that different?
It is a useful clue. A cough that is worse lying down points towards reflux or post-nasal drip, and one that wakes you in the early hours points towards asthma. The pattern is worth describing in detail at the consultation.