Why Can’t I Stop Coughing, and How Do I Stop?

There are many possible reasons why you can't stop coughing. The most common include a viral infection, allergies, asthma, chronic bronchitis, and gastroesophageal reflux disease. Treatment with certain medications such as ACE inhibitors can also contribute to a chronic cough.

A chronic cough (also called nagging or nonstop cough) is one that lasts for eight weeks or longer. Most chronic coughs aren't serious and will resolve over time. In the meantime, you can treat a chronic cough with over-the-counter remedies like cough drops and cough suppressants or home remedies like steam and honey.

This article describes some of the common and uncommon causes of a nonstop cough. It also explains how a chronic cough is diagnosed and treated and when you should see a healthcare provider.

Common Causes of Chronic Cough

Causes of a chronic cough can range from those that are a nuisance to those that are potentially life-threatening. Even so, the greater likelihood is that the cause is not serious or, at the very least, manageable with proper treatment.

Respiratory Infections

One of the most common causes of uncontrollable coughing is an infection with a virus or bacteria. Less common causes include fungi and parasites.

Examples include:

• Post-viral coughs: The common cold and influenza (flu) can cause a chronic post-viral cough. This differs from a cough that arises from acute symptoms like postnasal drip or sore throat. Instead, it is due to inflammatory damage to the airways caused by the viral infection.
• Croup: This is an infection of the upper airways including the larynx (voice box), trachea (windpipe), and bronchi (bronchial tubes). In children, croup can cause a characteristic barking cough.
  
• COVID: A chronic cough is characteristic of an acute COVID-19 infection, often accompanied by fever, shortness of breath, and loss of taste or smell. A cough can linger for weeks or months after you’re infected.
• Pneumonia: Both viral and bacterial pneumonia can cause a chronic cough due to inflammation of the alveoli (air sacs) in one or both lungs.
  
• Whooping cough: With whooping cough (pertussis), periods of unrelenting coughing are accompanied by a characteristic "whooping" sound as a person inhales.
• Acute bronchitis: This is a form of bronchitis that is usually caused by a virus or bacteria.
  

Allergies

Coughs can be triggered by an abnormal response of the immune system.

Seasonal allergies, including allergic rhinitis (hay fever), can cause a chronic cough. Environmental allergies to mold exposure, dust mites, and cat dander can also cause chronic coughing.

Asthma

Asthma is a chronic condition that causes the airways to swell. Asthma can make it difficult to breathe, which can trigger coughing.

• Non-allergic asthma: Also known as intrinsic asthma, this is a form of asthma that occurs when the body releases inflammatory chemicals in response to irritants like smoke, weather conditions, airway infections, food additives, and other environmental triggers. In some people, a cough is the only symptom, referred to as cough-variant asthma.
• Allergic asthma: Also known as extrinsic asthma, this is a form of asthma that occurs when the immune system releases a substance called histamine in response to an allergy-causing substance. The coughing is due to both the narrowing of the airways (bronchoconstriction) and airway spasms (bronchospasm).

Chronic Obstructive Pulmonary Disease (COPD)

COPD is an important cause of a chronic cough, often accompanied by shortness of breath, wheezing cough, and chesty cough. Smoking is both a cause of COPD and a trigger for COPD exacerbations (attacks).

• Chronic Bronchitis: With chronic bronchitis, a form of COPD, the cough will typically produce phlegm.
• Emphysema: This is a more advanced form of COPD for which a chronic, productive cough is a central feature. Emphysema occurs when damage to the alveoli causes pitting in the lungs.

Bronchiectasis

This is a condition that occurs when the airways become damaged and widened. Causes of bronchiectasis include prior childhood infection, immune deficiency, and conditions like cystic fibrosis or connective tissue diseases.

Gastroesophageal Reflux Disease (GERD)

Acid reflux, whether occasional or chronic, can cause coughing due to the backflow of stomach acid through the esophageal sphincter. This is the valve through which food passes from the esophagus (feeding tube) into the stomach.

GERD is a chronic form of acid reflux. Chronic coughing can occur at night when lying down. It's followed by a hoarse cough in the morning due to esophageal inflammation.

Hiatal Hernia

Hiatal hernia is when part of the stomach protrudes into the chest through the sheet of muscle called the diaphragm. Hiatal hernia can disrupt the normal position of the esophageal sphincter, allowing acid to backflow into the esophagus.

Medication

Medications called ACE inhibitors used to treat high blood pressure and heart failure can cause chronic coughing both during the day and at night.

ACE inhibitors associated with chronic coughs include

• Altace (ramipril)
• Capoten (captopril)
• Lotensin (benazepril)
• Prinivil (lisinopril)
• Vasotec (enalapril)
  

Uncommon Causes of a Chronic Cough

Less common causes of a constant cough include:

• Congestive heart failure: Heart failure can cause an unrelenting cough. This cough may produce pink foamy phlegm and usually worsens with lying down. It is most often accompanied by shortness of breath.
  
• Collapsed lung: A pneumothorax (collapsed lung) can cause a perpetual cough that often begins suddenly. In addition to a cough, people may note shortness of breath as well as a crackling breathing sound known as crepitus.
• Fungal infections: Fungal diseases such as coccidioidomycosis, histoplasmosis, and cryptococcosis, among others, may result in a chronic cough.
• Lung cancer: Lung cancer is a less likely cause of a chronic cough but is important to keep in mind if you have risk factors for the disease. Roughly 50% of people with lung cancer have a cough at the time of their diagnosis.
• Pulmonary edema: This is when fluid accumulates in the air sacs of the lungs, causing coughing and difficulty breathing. Pulmonary edema can be caused by heart failure and other conditions such as lung infections, neurological disorders, and medications.
• Tuberculosis: While tuberculosis is fairly uncommon in the United States, it does occur. In addition to a chronic cough, weight loss and night sweats are common.
  

Nonstop Cough Relief

The underlying cause of a nonstop cough must be diagnosed before it can be successfully treated and cured. However, there are also things you can do to relieve the symptoms of a cough temporarily.

Here are some home remedies, over-the-counter medications, and prescription medications that can soothe or cure a cough.

Home Remedies

• Steam: Breathing in steam from a pot or bowl can help break up mucus in the lungs and may relieve a cough. Adding eucalyptus oil or Vicks VapoRub to the steam can improve the effect.
• Humidifier: Using a humidifier puts extra moisture in the air, reducing irritation from dry air. A humidifier may help reduce coughing by relieving the irritation in your airways.
• Honey: Multiple studies have shown that honey can suppress a cough and help ease symptoms of an upper respiratory tract infection. 
• Drinking fluids: Water and other fluids can help thin mucus, making it easier to cough up.

Over-the-Counter Cough Medications

• Over-the-counter cough suppressants: These contain drugs like dextromethorphan that suppress coughs by reducing the sensitivity of the airways. If a cough is keeping you up at night, Nyquil, a cough medicine with a mildly sedating antihistamine, can help you sleep.
• Cough drops and lozenges: Throat lozenges or cough drops may relieve coughs temporarily. Those containing menthol may be particularly effective as menthol acts as a mild anesthetic.
• Vaporizing ointment: Vicks VapoRub is a mentholated ointment meant to be rubbed on the chest. The ointment releases vapors that provide a cooling sensation and can quiet a cough.
• Antihistamines: Antihistamines are used to manage symptoms (including coughing) of allergic asthma or respiratory allergies.
• Expectorants: These medications help loosen mucus, which makes it easier to cough.
• Pseudoephedrine: This decongestant medication can help dry out your nasal passages, which reduces postnasal drip and reduces the need to cough.
  

Prescription Cough Medications

• Acid blockers: H2 blockers are used to suppress a cough caused by stomach acid production in people with acid reflux or GERD.
• Antibiotics: Antibiotics are used up to clear a bacterial infection that may be responsible for a cough, as with bacterial pneumonia. They will not work on an infection caused by a virus.
  
• Inhalers: Different types of inhalers are used to treat asthma or COPD, including bronchodilators that open the airways and corticosteroids that reduce inflammation.

Nonstop Cough Relief for Children

Over-the-counter cough medicines are not recommended for children under the age of two. This is because there is a much higher risk of serious, potentially life-threatening side effects in very young children. If in doubt, check the manufacturer's label.

Home remedies can help ease your child's cough. Some of these include:

• Make sure they drink plenty of fluids
• Put a cool-mist humidifier in their bedroom
• Use a saline nose spray to help reduce congestion
• Try having them breath warm vapors, such as from a shower
• Have them gargle with salt water
• For a child over the age of 2, make sure their head is elevated when they're asleep
• For a child over the age of 1, give a spoonful of honey

You should not give honey to a child under the age of 1 year. This is because of the risk of botulism, a dangerous bacterial infection.

Can't Stop Coughing? When to Worry

Most causes of a cough resolve with treatment and time, but see a healthcare provider if you are still coughing after eight weeks and you're also experiencing symptoms such as:

• Chest pain that seems unrelated to the cough
• Weight loss and/or poor appetite
• Fatigue
• Wheezing
• Night sweats

If you experience these symptoms, get emergency medical attention:

• Severe chest pains
• Choking
• Stridor (high-pitched wheezing sounds)
• Inability to catch your breath
• Rapid or irregular heartbeats
• Swelling of the face, tongue, or throat
• Lightheadedness or fainting
• Severe trouble breathing
• Swelling of the face or tongue
• Coughing up blood-tinged saliva or mucus
  

How Are Coughs Diagnosed?

When you see your healthcare provider, the first thing they will do is review your symptoms and medical history and perform a physical exam. This may include listening to lung sounds with a stethoscope.

Accompanying symptoms may include fatigue, shortness of breath (dyspnea), heartburn, nausea, fever, and nasal congestion. These and other features can give your health provider a clue as to the cause and nature of your cough.

Based on the findings, the healthcare provider may order the following tests and procedures:

• Blood tests: A white blood cell count (WBC) may be done to look for signs of viral or bacterial infections.
• Bronchoscopy: A bronchoscopy is a test in which a small tube with a light is inserted through your mouth and into your large airways.
• Chest X-ray: A chest X-ray may be done to look for pneumonia and other possible causes of coughing.
• Computerized tomography (CT) scan: A CT scan involves multiple X-ray images that are composite to create a three-dimensional image of internal structures, such as the lungs.
• Esophageal pH testing: This is used to check for signs of acid reflux.
• Laryngoscopy: Laryngoscopy is a procedure in which a tube is inserted through the mouth to visualize the area around your vocal cords.
• Nasal swab: A nasal swab can check for infections such as the flu or COVID-19.
• Spirometry: Spirometry is a test that measures how much air you can blow out of your lungs. It is commonly used to diagnose asthma or COPD.

Summary

A chronic cough is one that persists or recurs for more than eight weeks. There are many possible causes including infections, allergies, asthma, COPD, GERD, and even certain medications. Less common causes include tuberculosis and cancer.

The diagnosis of chronic cough may involve a physical exam, blood tests, chest X-rays, nasal swabs, or direct imaging procedures like bronchoscopy or laryngoscopy. The treatment varies by the cause.