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Persistent cough: possible causes and when to worry

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Shortness of breath or trouble breathing
  • Chest pain
  • Coughing up blood
  • Hives with a swollen face or throat and trouble swallowing
  • Bluish lips or nails
  • A cough with high fever and feeling very unwell

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Warning signs: when to go to the ER

A persistent cough is one that hangs on for more than about three weeks. Most coughs start with a cold, flu or sinus infection and clear up before then. A cough that lasts longer may come from allergies, asthma, acid reflux or bronchitis that is slow to heal. Go to the ER if you are short of breath, have chest pain or are coughing up blood.

  • Flu (influenza) — cough with fever and body aches
  • COVID-19 — cough with fever, sore throat or loss of smell
  • Bronchitis — wet cough that lingers after a cold
  • Allergies — dry cough with sneezing and itchy nose or eyes
  • Asthma — cough with wheezing, worse at night or with exercise
  • Acid reflux — cough with heartburn, worse lying down
  • Sinus infection — postnasal drip and facial pressure

How long should a cough last?

Doctors group coughs by how long they last:

  • Acute cough: starts suddenly, usually from a cold, flu or sinus infection, and generally goes away within 3 weeks.
  • Subacute cough: lasts 3 to 8 weeks, often the cough left behind after an infection.
  • Chronic cough: lasts more than 8 weeks and always deserves a medical evaluation.

Common causes of a persistent cough

The causes table on this page sums up the usual suspects. A few clues:

  • Cough with fever and body aches: flu or COVID-19.
  • A wet cough that lingers after a cold: possibly bronchitis.
  • A dry cough with sneezing and itchy nose or eyes: possibly allergies.
  • A cough with wheezing, worse at night or with exercise: possibly asthma.
  • A cough with heartburn, worse lying down: possibly acid reflux.
  • Mucus dripping down the throat and facial pressure: possibly a sinus infection.

Dry cough or wet cough: what is the difference?

A dry cough brings nothing up and is common with allergies, asthma, reflux or the tail end of a cold. A wet (productive) cough usually goes with a respiratory infection. Mucus color alone does not tell you whether you need an antibiotic, and most viral coughs get better without one. Get checked if the mucus is bloody or foul-smelling, or if you have a fever.

Home care for a cough

For a cough from a cold or flu without warning signs:

  • Drink plenty of fluids to help loosen mucus.
  • Breathe steam from a warm shower or use a humidifier.
  • Cough drops or hard candy can ease a dry cough in adults. Never give them to children under 3, who can choke on them.
  • Stay away from cigarette smoke and vaping.
  • If you use over-the-counter cough or decongestant products, read the label, especially if you have high blood pressure or another condition.

When can a telehealth visit help with a cough?

An online doctor visit can help if your cough has lasted more than 10 to 14 days, if you have a fever and cough without shortness of breath, if you suspect allergies or reflux, or if you have known asthma and want to review your treatment while you are stable. The doctor will ask about your symptoms, listen to you cough and watch how you breathe. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.

Some causes need a chest X-ray, a test or someone listening to your chest in person. If so, the doctor will tell you and, if appropriate, can give you a lab order. A visit costs US$79 and you must be in Puerto Rico.

When do you need the ER or an in-person visit?

Call 911 if you are short of breath or struggling to breathe, or have hives with a swollen face or throat and trouble swallowing. Go to the ER if you cough up blood or have chest pain. Get seen in person soon if a cough comes with a high fever, a high-pitched sound when breathing or foul-smelling mucus, gets worse lying down and you have a heart condition, or if you may have been exposed to tuberculosis. See when to go to the ER.

Cough in children

Children follow different rules: over-the-counter cough and cold medicines are not recommended under age 4, and honey must not be given under 12 months. Read cough and cold in children.

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Frequently asked questions

When should I worry about a cough that won't go away?
Get a medical evaluation if a cough lasts more than 10 to 14 days. A cough lasting more than 8 weeks is chronic, and its cause should always be looked into. If you are short of breath, have chest pain or cough up blood, go to the ER.
Does green mucus mean I need an antibiotic?
Not necessarily. Mucus color alone does not mean a bacterial infection, and most viral coughs improve without antibiotics. The doctor will assess whether your situation needs treatment.
Can a doctor assess a cough over video?
Often, yes. The doctor can go through your symptoms, hear your cough and watch how you breathe. If you need an X-ray, a test or an in-person chest exam, the doctor will tell you.

Sources

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