Dry Cough: Causes and Treatments

Dry Cough: Causes and Treatments


Coughing is your body’s way of protecting your lungs from irritants. This reflex helps remove or eject harmful substances from your airways, preventing them from entering your lungs. Everybody coughs sometimes—but a frequent dry cough can be a sign of a health condition that needs treatment.

A dry cough can be either acute (lasting up to three weeks), subacute (lasting 3-8 weeks), or chronic (lasting more than eight weeks). Coughing is one of the most common reasons people visit their healthcare providers. In fact, up to 12% of the world population lives with chronic cough. That said, several treatment options are available to help improve your cough and any accompanying symptoms.

Several health conditions and environmental factors can cause a dry cough. Inhaling dust or dry air are common triggers for an acute cough, while health conditions such as acid reflux, asthma, and COVID-19 can cause a chronic cough. If your cough has lasted a long time, seeing a healthcare provider is essential to getting the treatment you need.

Coughs can be wet (productive) or dry (nonproductive). A wet cough brings up mucus (phlegm) or other liquid from the throat. Wet coughs often result from health conditions that increase mucus production in the throat. A dry cough, however, does not cause any mucus. Depending on its cause, a dry cough can come on suddenly and go away quickly or develop slowly and linger for a long time.

There are several possible causes of dry cough, ranging from health conditions causing irritation or swelling in your throat to an environmental irritant that’s triggering your symptoms. Some causes of a dry cough are more serious than others, so it’s always important to seek advice from a healthcare provider to learn about the exact cause of your cough.

Allergies

Environmental allergies are a common cause of dry cough. An allergic reaction happens when your body’s immune system mistakes a harmless substance for a dangerous one and tries to fight it off. 

Common environmental allergens include tree pollen, pet dander, and mold. Allergies to these substances may worsen during certain seasons, called seasonal allergies or hay fever. Other symptoms of seasonal allergies include sneezing, stuffy nose, and itchy eyes.

Asthma

People with asthma experience swelling and a feeling of tightness in their airways. Coughing is one of the most common symptoms of asthma. Wheezing and shortness of breath often occur alongside a dry cough. However, some people have a type of asthma called cough-variant asthma. For those with this condition, coughing is the only symptom.

Asthma-related dry cough often occurs at night, and other triggers for this type of cough include::

  • Inhaling irritants or allergens
  • Certain medications
  • Food additives
  • Exercise
  • Extreme weather, such as very cold air or hot and humid air

Acid Reflux

Acid reflux happens when acid flows backward from your stomach into your esophagus. It is medically known as gastroesophageal reflux (GER). Symptoms of GER can occur in anyone occasionally, but severe or long-lasting GER is called gastroesophageal reflux disease—commonly known as GERD. About 20% of people in the United States live with GERD.

A similar condition to GER and GERD is laryngopharyngeal reflux (LPR), which occurs when acid backs up into your esophagus and in your voice box (larynx). Both GERD and LPR can cause dry cough because the stomach acid that flows back into your throat can irritate the lining of your esophagus. This can trigger coughing. Other symptoms of GERD and LPR can cause you to cough, including:

  • Stomach contents flowing back into the throat (known as regurgitation or microaspiration)
  • The sensation that something is stuck in your throat
  • Burning or sore throat
  • Trouble breathing or swallowing
  • Hoarse voice

Respiratory Infections

A dry cough that is particularly hard to shake can be a symptom of respiratory tract infections.

  • Upper respiratory infections are usually caused by viruses like COVID-19, the common cold, flu, and respiratory syncytial virus (RSV).
  • Lower respiratory infections can be caused by viruses or bacteria, which tend to be more serious. Pneumonia and bronchitis are examples of lower respiratory infections. COVID-19 can also spread to the lower tract in some cases.

During the active infection, your cough may be wet. You may also have other symptoms, such as fever, runny nose, and sore throat. However, a dry cough can linger for several weeks after the infection passes. This is called a postinfectious cough.

Pertussis (whooping cough) is another respiratory infection that can cause extreme coughing. The main symptom is severe coughing fits that sometimes end with a “whoop” sound. These coughing episodes can last up to three months and tend to worsen at night.

Lung Disease

A cough can also be a symptom of lung disease, such as chronic obstructive pulmonary disease (COPD). In COPD, the walls of your airways and the air sacs in your lungs are damaged. This reduces your ability to take in air when you breathe. Oftentimes, a COPD-related cough is dry but sometimes can be wet. Shortness of breath is one of the most common symptoms that occurs alongside coughing.

Smoking is the primary risk factor for COPD, but high exposure to other toxins in the air can raise your chances of developing COPD. These toxins include secondhand smoke, chemical fumes, and air pollution.

Poor Air Quality

Even if you do not develop lung disease, exposure to pollutants or irritants in the air around you can lead to a dry cough. For example, living in a large city with high levels of air pollution or inhaling secondhand smoke can trigger a cough. This is because the irritants in the air trigger inflammation in the airways. People with asthma are especially prone to these irritants.

Less Common Causes

There are a number of other possible causes of acute or chronic dry cough, including:

  • Non-asthmatic eosinophilic bronchitis (NAEB): A condition that causes inflammation in the respiratory tract and dry cough but not other asthma symptoms, like wheezing and chest tightness
  • Certain medications: Prescription drugs such as ACE inhibitors can cause dry cough as a side effect
  • Lung cancer: While cancer is not a common cause of dry cough, more than half of people with lung cancer experience chronic cough
  • Heart problems: Heart failure can lead to pulmonary edema, which causes too much fluid to build up in your lungs and creates swelling in the airways to trigger coughing
  • Unknown causes: Sometimes, people live with a chronic cough with no discernible cause, which healthcare providers call chronic idiopathic cough, chronic refractory cough, or cough hypersensitivity syndrome

A dry cough is usually not a cause for concern, and an acute (short-term) cough usually goes away on its own. However, if your cough is severe, produces mucus or blood, or lasts longer than two weeks, contact your healthcare provider. You may also want to contact your provider immediately if your cough occurs alongside symptoms like trouble breathing or swallowing, swelling in your legs, or fever. They can help you understand the cause of your cough and recommend treatment options.

A primary healthcare provider, allergist, or pulmonologist (lung specialist) can diagnose the cause of a dry cough. Your provider will likely also perform tests to determine why you are coughing, such as:

  • Physical exam to listen to your lungs, check your vital signs, and look at your ears, nose, and throat
  • Chest imaging, such as an X-ray or computed tomography (CT) scan
  • Lung function tests such as spirometry
  • Barium swallow test to assess for GERD
  • Blood tests

If your dry cough requires treatment, the goal of treatment is to target the underlying cause of your coughing. Generally, medications are available to help manage the symptoms of many conditions that can cause a dry cough, including:

  • Environmental allergies: Over-the-counter (OTC) antihistamines or allergy shots (immunotherapy)
  • Asthma and COPD: Inhaled corticosteroids or fast-acting bronchodilators to open the airways
  • GERD or LPR: Antacids, H2 blockers, and proton-pump inhibitors
  • Respiratory infections: Antibiotics (for bacterial infections), antivirals (for viral infections, or over-the-counter cold medicines

A range of lifestyle changes can also improve symptoms. If you smoke tobacco, your healthcare provider will encourage you to quit smoking, as smoke can significantly affect your breathing and the health of your airways. Other remedies like sucking on cough drops and using a humidifier in your home can also improve your coughing.

While coughing is a symptom that everyone experiences at least once, there are several things you can do to prevent a dry cough or reduce the severity of your symptoms. The exact prevention strategy will depend on the underlying cause of your cough. Consider the following strategies:

  • Treat underlying health conditions, including GERD and asthma, as your healthcare provider prescribes
  • Take recommended OTC medications for environmental allergies and acid reflux
  • Get vaccinated for respiratory infections such as COVID-19, RSV, and the flu
  • Limit acidic, spicy, and fatty foods, and avoid caffeine and alcohol if you have GERD
  • Avoid triggers like environmental toxins or secondhand smoke if you have asthma or lung disease
  • Close the windows and stay inside (if possible) if pollen levels are too high to prevent allergy attacks

Each cause of a dry cough can lead to its own set of complications. The following complications may especially arise if you don’t receive treatment for an underlying condition:

  • GERD and LPR can damage tooth enamel and vocal cords, leading to inflammation, sores, and bleeding in your esophagus. It can also cause trouble swallowing.
  • Asthma can reduce lung function and disrupt sleep.
  • Respiratory infections can worsen conditions like asthma and COPD. They can cause more serious infections like pneumonia and spread to other organs, which can become life-threatening.

A severe dry cough itself also can cause complications, such as:

  • Lightheadedness
  • Fainting
  • Fatigue
  • Vomiting
  • Nosebleeds
  • Cracked ribs
  • Hernia
  • Collapsed lung
  • Encephalopathy (brain dysfunction)

Common causes of dry cough include allergies, asthma, acid reflux, and respiratory infections like the common cold and COVID-19. Environmental factors like smoke or pollution can also trigger a dry cough. 

Coughing helps protect your lungs by pushing out irritants, but frequent coughing can indicate a health issue that needs treatment. Home remedies and medications can help alleviate symptoms and reduce the risk of complications.

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