Health condition · Clinically reviewed
Chronic cough, a cough lasting more than 8 weeks.
Three causes account for most of it: asthma, reflux and postnasal drip. A structured work-up finds the cause in the majority of patients.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced from guidance
Checked against British Thoracic Society, European Respiratory Society and NICE CKS sources you can see at the end.
- 03
Current for 2026
Reflects modern thinking on cough hypersensitivity syndrome and emerging P2X3 antagonist therapy.
Key facts
Chronic cough at a glance.
The essentials, in plain English — what counts as chronic, the causes behind most cases, and the modern thinking that is changing treatment.
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Definition
A cough lasting more than 8 weeks in adults, or more than 4 weeks in children.
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Three main causes
Asthma or eosinophilic bronchitis, gastro-oesophageal reflux disease, and upper airway cough syndrome — together they explain most cases.
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Medications matter
ACE inhibitor cough is one of the commonest medication-induced coughs — always ask about the drug list.
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Smoking and occupation
A careful smoking and occupational history is essential — both change the differential and the plan.
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Cough hypersensitivity
A modern concept — the cough reflex becomes over-sensitive, and treating the reflex itself now guides therapy.
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New pharmacotherapy
P2X3 receptor antagonists such as gefapixant are emerging as targeted treatments for refractory chronic cough.
Why this guide matters
Most chronic cough has a treatable cause.
A structured work-up finds the answer in the majority of patients — and the three points below shape everything else on this page.
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Three causes explain most cases
Asthma or eosinophilic bronchitis, gastro-oesophageal reflux, and upper airway cough syndrome — start here.
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The drug list changes the plan
ACE inhibitor cough is common, and easy to miss unless the medication list is reviewed carefully.
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Cough hypersensitivity is real
When causes are excluded, treating the reflex itself — with speech therapy or P2X3 antagonists — is the modern answer.
How the diagnosis is made
From first history to a clear diagnosis.
The steps a UK GP or respiratory clinician will normally follow, in order — so you know what to expect and why.
Phase 1 · History
Full history and chest examination
Phase 2 · Investigating
X-ray, spirometry, FeNO and PPI trial
Phase 3 · Specialist
ENT review, HRCT or bronchoscopy
- 01
History
Full history
Medications (ACE inhibitors especially), smoking history, occupational exposures and environmental triggers.
- 02
History
Chest examination
Listening for wheeze, crackles or focal signs — and looking for clubbing, lymphadenopathy or weight loss.
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Investigating
Chest X-ray
First-line imaging to exclude structural lung disease, infection or malignancy.
- 04
Investigating
Spirometry + FeNO
Lung function with a FeNO breath test to look for asthma or eosinophilic bronchitis.
- 05
Investigating
Trial of PPI for reflux
A time-limited proton-pump inhibitor trial is often used when reflux is suspected clinically.
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Specialist
ENT / sinus review
For upper airway cough syndrome — postnasal drip, chronic rhinosinusitis or laryngeal irritation.
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Specialist
Bronchoscopy or HRCT
If the diagnosis remains unclear, high-resolution CT or bronchoscopy in a respiratory clinic.
Typical timeline: 4–12 weeks of structured trials to reach a diagnosis.
Symptoms
What chronic cough actually looks like.
The pattern of the cough — dry, productive, nocturnal, reflux-driven — points strongly to the likely cause.
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Dry persistent cough
A dry, tickly cough that will not settle — often the first presentation of cough hypersensitivity.
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Productive cough
A cough bringing up phlegm — points more towards infection, bronchiectasis or chronic bronchitis.
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Nocturnal cough
Coughing that wakes you at night — classic for asthma and for reflux.
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Postnasal drip
A sensation of mucus dripping from the back of the nose into the throat — the driver of upper airway cough syndrome.
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Reflux-related
Cough triggered by meals, lying flat or bending — with or without classic heartburn.
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ACE-inhibitor cough
A dry cough starting after a blood-pressure medication ending in -pril — resolves on stopping.
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Weight loss with cough
Unintended weight loss alongside a persistent cough — always needs urgent investigation.
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Red flag
Haemoptysis, weight loss or night sweats warrant an urgent 2-week-wait respiratory pathway.
Treatment
How chronic cough is treated in the UK.
Treatment follows the cause — with time-limited trials for asthma, reflux and upper airway cough syndrome, and specialist options when needed.
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Stop ACE inhibitor
If an ACE inhibitor is implicated, swap to an angiotensin-receptor blocker — cough usually settles within weeks.
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Trial inhaled corticosteroid
For suspected asthma or eosinophilic bronchitis — a time-limited trial with clear review points.
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Trial PPI for reflux
A course of a proton-pump inhibitor with lifestyle measures when reflux is the likely driver.
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Nasal steroid for UACS
Regular intranasal corticosteroid, sometimes with an antihistamine, for upper airway cough syndrome.
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Speech and language therapy
Cough-suppression techniques delivered by a specialist SLT for cough hypersensitivity syndrome.
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Gabapentin (specialist)
Neuromodulator used off-label in specialist clinics for refractory chronic cough.
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P2X3 antagonist (specialist)
Gefapixant and related agents targeting the cough reflex — an emerging specialist option.
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Onward referral
Respiratory or ENT specialist review when first-line trials fail or red flags appear.
What this guide is based on
The sources behind every claim on this page.
UK and European guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or respiratory clinician knows your history and can tell you which parts apply to you. If in doubt, ask for a review.
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British Thoracic Society. Recommendations for the management of cough in adults.
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European Respiratory Society. Task force guideline on chronic cough.
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NICE Clinical Knowledge Summary. Cough.
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Cough Society UK. Patient information and clinician resources.
Red flags
When a cough needs urgent review.
Most chronic cough is benign — but the features below need same-week attention, and several trigger a 2-week-wait pathway.
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Haemoptysis
Coughing up blood — needs urgent respiratory review and imaging.
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Weight loss with cough
Unintended weight loss with a persistent cough — 2-week-wait pathway.
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Night sweats
Drenching night sweats alongside cough — think infection or malignancy.
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New cough in a smoker over 45
A new or changed cough in an older smoker warrants urgent chest X-ray.
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Post-radiotherapy cough
New cough after thoracic radiotherapy — needs specialist review to exclude pneumonitis or recurrence.
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Immunocompromise with cough
Cough in immunosuppressed patients — lower threshold for imaging and microbiology.
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Chest X-ray abnormality
Any unexplained finding on chest X-ray — arrange respiratory review promptly.
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Voice change (RLN palsy)
New hoarseness with cough may signal recurrent laryngeal nerve palsy — needs urgent ENT and imaging review.
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Recurrent aspiration
Coughing on food or drink — suggests swallowing dysfunction and needs speech and language assessment.
Living with it
A frustrating symptom, but almost always improvable.
Four practical things that make the biggest difference — knowing your triggers, using cough-suppression, small lifestyle changes and structured review of every trial.
A quiet reminder
A cough that will not settle deserves a plan.
If a first trial has not worked, the next step is not to give up but to escalate — to specialist review, HRCT, or targeted therapy for cough hypersensitivity.
- 01 Triggers
Know what sets it off
Cold air, perfumes, dust, laughing and eating are common triggers — noting yours helps direct treatment.
- 02 Technique
Cough-suppression works
Sipping water, controlled breathing and pausing at the urge to cough can genuinely reduce frequency over weeks.
- 03 Lifestyle
Small changes, real difference
Stopping smoking, treating rhinitis and simple reflux measures each help more than people expect.
- 04 Reviews
Time-limited trials, then review
Each treatment trial deserves a defined review point — 4 to 8 weeks — so you know whether it is working.
Frequently asked
Everything we get asked about chronic cough.
Quick answers on definitions, common causes, ACE-inhibitor cough, cough hypersensitivity, new drugs and when to worry.
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What counts as a chronic cough?
A cough lasting more than 8 weeks in adults, or more than 4 weeks in children. Anything shorter is usually classified as acute or subacute cough.
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What are the three commonest causes?
Asthma or eosinophilic bronchitis, gastro-oesophageal reflux disease, and upper airway cough syndrome (postnasal drip). A structured work-up finds the cause in the majority of patients.
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Could my blood-pressure tablet be causing it?
Very possibly. ACE inhibitors — drugs ending in -pril — commonly cause a dry cough. Swapping to an angiotensin-receptor blocker usually resolves it within weeks.
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What is cough hypersensitivity syndrome?
A modern concept describing an over-sensitive cough reflex — patients cough in response to stimuli that would not normally trigger a cough. It reframes chronic cough as a disorder of the reflex itself.
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Are there new treatments coming?
Yes. P2X3 receptor antagonists such as gefapixant target the cough reflex directly and are emerging as specialist options for refractory chronic cough.
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When should I be worried?
Coughing up blood, unintended weight loss, night sweats, a new cough in a smoker over 45, or an abnormal chest X-ray — any of these warrant urgent respiratory review, usually via a 2-week-wait pathway.
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