The Chest Clinic
Persistent cough
When to get help
Seek medical advice if a cough lasts more than three weeks. Seek urgent help for coughing up blood, chest pain, significant breathing difficulty or feeling very unwell. Call 999 for severe breathing difficulty. Do not wait for a routine appointment if symptoms are urgent.
What can cause a persistent cough?
Cough protects the airways, but a cough lasting more than eight weeks is called chronic cough in adults. Causes and contributing factors include airway inflammation, smoking, infection, nasal disease and some medicines. An overly sensitive cough reflex can also be important. More than one factor may be involved.
How is it assessed?
Your clinician asks about duration, sputum, triggers, medicines, smoking, nasal symptoms and reflux. Initial investigations for chronic cough generally include a chest X-ray, full blood count and spirometry, with FeNO where available.
CT scans and bronchoscopy are selected for a specific clinical reason rather than used routinely for every cough. Persistent productive cough, for example, may need investigation for bronchiectasis. A normal chest X-ray does not remove the need for reassessment when symptoms persist or concerning features develop.
We explain the findings, treat contributing conditions and review the response. Read about lung function tests, FeNO and bronchoscopy.
How is it treated?
Treatment targets identified causes. Inhalers, antibiotics and acid-suppressing medicines are not suitable for every cough. A productive cough may need airway-clearance support.
We work with specialist Speech and Language Therapists for cough-control therapy. This may include techniques to manage the urge to cough, breathing strategies and voice or throat care. Persistent cough hypersensitivity may also benefit from selected medicines after specialist assessment.
Gefapixant for refractory or unexplained chronic cough
Gefapixant (Lyfnua) acts on cough-reflex signalling and may be discussed for selected adults whose chronic cough persists despite assessment and treatment of identified causes. Benefit varies. Altered, reduced or lost taste is a common side effect and can make treatment difficult to tolerate.
At The Chest Clinic, gefapixant is currently available only on a self-pay basis. We discuss suitability, costs and follow-up before prescribing. NICE's appraisal was terminated without a recommendation on NHS use.
NICE: gefapixant | Patient leaflet | ERS chronic cough patient guide | All respiratory symptoms
Prepare for your consultation
Bring a medication list, previous results and a note of when the cough occurs. Tell us about coughing blood, weight loss, swallowing problems or episodes of fainting.
Routine appointment contacts | Clinic locations
Guidance and further information
BTS Clinical Statement on Chronic Cough in Adults
General information for adults; investigation and treatment are tailored to you.