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Male pediatrician holding a stethoscope to exam patient.

When Is a Cough More Than Just a Cough?

By Dr. Frank Chocano, Pulmonology

A cough is a simple reflex that helps clear irritants and secretions from the airways.

Sometimes a cough is just a cough, but when it lasts four weeks or more, we consider that a chronic cough that may need medical evaluation.

A chronic cough can interrupt your child’s sleep, causing exhaustion during the day. Severe cases of chronic cough can trigger vomiting, lightheadedness, and even rib fractures.

The most common causes are exposure to tobacco smoke, postnasal drip, asthma, and acid reflux. Typically, it disappears once the underlying problem is treated.

Consult your pediatrician if your child’s cough:

  • Lingers for weeks.
  • Brings up blood or sputum (saliva and mucus from the respiratory tract).
  • Disturbs sleep.
  • Interrupts school.

The following conditions, alone or in combination, cause the majority of chronic coughs:

  • Postnasal drip: When the nose or sinuses produce extra mucus it can drip down the back of the throat and trigger a cough reflex.
  • Asthma: An asthma-related cough may come and go with the seasons. It can arise after an upper respiratory tract infection or become worse when exposed to cold air or certain chemicals or fragrances.
  • Gastroesophageal reflux disease (GERD): The stomach acid flows back into the tube that connects the stomach and throat (esophagus). The constant irritation can lead to chronic coughing.
  • Infections: A cough can linger long after pneumonia, flu, a cold, or other infection of the upper respiratory tract has gone away. Pertussis, also known as whooping cough, is another cause of a chronic cough. Chronic cough can also occur with fungal infections of the lung, tuberculosis infection, or lung infection from bacterial germs.
  • Blood pressure drugs: Angiotensin-converting enzyme (ACE) inhibitors, which are commonly prescribed for high blood pressure and heart failure, can cause chronic coughing.


Your child’s pediatrician will likely start treatment for one of the common causes of chronic cough. If the treatment doesn't work, testing will be added, such as chest X-rays, CT scans, and pulmonary function testing. A pediatric pulmonologist can also perform a bronchoscopy, in which a flexible tube is inserted into the nose or mouth, down the throat to the windpipe, and into the lungs for examination.

Medications used to treat chronic cough include:

  • Antihistamines, corticosteroids, and decongestants: These drugs are standard treatment for allergies and postnasal drip.
  • Inhaled asthma drugs: The most effective treatments for asthma-related cough are corticosteroids and bronchodilators, which reduce inflammation and open up the airways.
  • Antibiotics: If a bacterial, fungal, or mycobacterial infection is causing your child’s chronic cough, a pediatrician may prescribe medications to address the infection.
  • Acid blockers: When lifestyle changes don't take care of acid reflux, medications can be prescribed to block acid production.

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About Children's Specialty Group

About Children's  Specialty Group Children's Specialty Group is the only pediatric multi-specialty practice serving southeastern Virginia and northeastern North Carolina. The physicians of Children's Specialty Group base their practices at Children's Hospital of The King's Daughters and serve as faculty in the Department of Pediatrics at Eastern Virginia Medical School. Learn more about our specialists here.