Table 1.5-1. Most frequent causes of chronic cough


Accompanying signs and symptoms, cough characteristics, sputum production

Asthma or (much less often) eosinophilic bronchitis

Attack of cough may be triggered by exposure to specific or nonspecific factors, such as allergens, cold air, exercise; cough often occurring at night; accompanied by dyspnea and wheezing; good response to bronchodilators and inhaled glucocorticoids; mucous sputum, may be yellowish (high eosinophil content)

Gastroesophageal reflux

Most often accompanied by heartburn and other dyspeptic symptoms, but GI symptoms may be absent; sometimes accompanied by hoarseness or dysphonia; improved by PPI and H2 antagonist treatment (2-month treatment recommended)

Postnasal drip

Chronic rhinitis with postnasal drip; often history of allergy; concomitant chronic sinusitis; most frequently mucous sputum; “cobblestone” pattern of posterior pharyngeal mucosa

Chronic bronchitis or COPD

History of smoking and frequent respiratory tract infections; most severe in the morning and immediately after waking up; often resolves on expectoration of mucous secretions


Copious amounts of expectorated sputum (especially in the morning), often purulent, yellow and green


Dry cough resolving after drug discontinuation, although in some cases may persist for several months

Pneumonia, lung abscess, tuberculosis, sarcoidosis, tumors

Manifestations of underlying condition depending on its severity

Left ventricular failure, mitral stenosis, aortic aneurysm compressing trachea or bronchi

Usually attacks of dry cough at night; may be accompanied by wheezing; pink frothy secretions in patients with pulmonary edema; considerably enlarged left atrium or dilated pulmonary artery may compress recurrent laryngeal nerve and cause hoarseness

Chronic idiopathic cough

No cause identified but attributed to cough hypersensitivity syndrome; commonly triggered by strong smells, perfumes, aerosols, change in temperature, talking, laughing, and singing; symptoms of irritation of throat and chest

ACEI, angiotensin-converting enzyme inhibitor; COPD, chronic obstructive pulmonary disease; GI, gastrointestinal; PPI, proton pump inhibitor.