Chronic cough
A chronic cough is defined as a cough lasting more than 8 weeks in adults. While many coughs resolve after infections, a persistent cough can be distressing, disruptive, and sometimes a sign of an underlying condition that requires specialist evaluation.
Dr Ricardo José is a Consultant Respiratory Physician in London with expertise in diagnosing and managing chronic cough. His approach focuses on identifying the underlying cause and providing targeted, evidence-based treatment.
What is Chronic Cough?
A chronic cough is a cough that continues for longer than 8 weeks in adults. It may be:
• Dry and irritating
• Productive (bringing up sputum)
• Worse at night
• Triggered by talking, cold air, or exercise
Although many people worry about serious disease, most chronic coughs are caused by treatable conditions
Common Symptoms Associated With Chronic Cough
In addition to persistent coughing, patients may experience:
• A tickling sensation in the throat
• Chest tightness or wheeze
• Breathlessness
• Frequent throat clearing
• Hoarseness
• Acid reflux symptoms
• Post-nasal drip
Understanding associated symptoms helps guide diagnosis.
What Causes Chronic Cough?
The most common causes include:
Asthma and eosinophilic airway inflammation
Cough may be the only symptom of asthma in some patients. This is known as cough-variant asthma.
Gastro-oesophageal reflux disease (GORD) / Laryngopharangeal reflux (LPR)
Reflux can irritate the airway and trigger coughing, even without heartburn. The reflux can be acidic or non-acidic.
Upper airway cough syndrome
Chronic rhinitis or sinus inflammation may stimulate cough reflex pathways.
Smoking-related airway disease
Chronic bronchitis or early COPD may present with persistent cough.
Medication side effects
Some medications have cough as an adverse effect. ACE inhibitors commonly used to treat hypertension can cause a dry cough.
Less common causes include bronchiectasis, interstitial lung disease, or lung cancer.
Part of specialist assessment is ensuring serious causes are appropriately excluded.
The Modern Understanding of Chronic Cough
Over the past decade, research has shown that many cases of chronic cough are related to a condition known as cough hypersensitivity syndrome.
In this condition, the nerves that control the cough reflex become overly sensitive. As a result, everyday triggers that would not normally cause coughing can provoke repeated coughing episodes.
Patients with cough hypersensitivity often notice triggers such as:
• talking for prolonged periods
• laughing
• cold air
• strong smells such as perfumes or cleaning products
• throat irritation or a tickling sensation
Many people describe a persistent urge to cough or a sensation of irritation in the throat.
Cough hypersensitivity may develop after respiratory infections, airway inflammation, or long-standing irritation of the airways. Even when the original trigger has resolved, the cough reflex can remain overly active.
Understanding this mechanism is important because treatment may involve therapies aimed at reducing cough reflex sensitivity, in addition to addressing underlying causes or triggers.
As part of his specialist assessment, Dr Ricardo José evaluates whether cough hypersensitivity may be contributing to persistent symptoms and develops an individualised treatment plan accordingly including novel therapies.
When Should You See a Chest Specialist?
You should seek specialist assessment if:
• Your cough lasts more than 8 weeks
• It is worsening or unexplained
• You cough up blood
• You experience unexplained weight loss
• Initial treatment from your GP has not worked
Early specialist review can provide reassurance and faster resolution.
How Dr Ricardo José Diagnoses Chronic Cough
Dr Ricardo Jose takes a structured, evidence-based approach. His assessment includes:
Detailed medical history
Triggers, environmental exposures, medications, occupational factors, reflux symptoms, and allergy history are carefully explored.
Comprehensive respiratory examination
A focused clinical examination helps identify signs of airway disease.
Lung function testing
Assesses for airflow obstruction
FeNO testing (where appropriate)
Measures airway inflammation linked to eosinophilic asthma.
Imaging
Chest X-ray or CT scan if clinically indicated.
Allergy or reflux assessment
Depending on clinical suspicion.
The aim is to identify the exact mechanism driving the cough rather than simply suppressing symptoms.
How Dr Ricardo José Treats Chronic Cough
Treatment depends on the underlying diagnosis. Dr Ricardo Jose creates an individualised management plan that may include:
Inhaled therapy
For asthma or eosinophilic bronchitis.
Anti-reflux therapy
Lifestyle advice and medication if reflux is contributing.
Nasal treatments
For post-nasal drip or rhinitis.
Smoking cessation support
Smoking is a cause of chronic bronchitis and exacerbates airway inflammation.
Specialist cough suppression therapy
In selected cases where cough hypersensitivity syndrome is diagnosed non-pharmacologic and pharmacologic treatments are available.
Regular follow-up ensures treatment is effective and adjusted as needed.
Why Choose Dr Ricardo José for Chronic Cough in London
• Consultant Respiratory Physician with specialist interest in cough
• Expertise in complex airway disease and respiratory infections
• Access to advanced diagnostic testing
• Individualised, evidence-based treatment plans
• Private consultations in London or remote via video
Patients benefit from a clear diagnosis, reassurance, and a structured management pathway.
Frequently Asked Questions
How long is too long for a cough?
Any cough lasting more than 8 weeks in adults is considered chronic and should be evaluated.
Is chronic cough serious?
Most cases are due to treatable causes. However, persistent symptoms should be assessed to exclude more serious conditions such as lung cancer.
Can reflux cause coughing without heartburn?
Yes. Many patients with reflux-related cough do not experience typical acid symptoms and treatment of acid-reflux isn’t helpful in these cases.
Will I need scans?
Imaging tests are arranged when clinically appropriate after your assessment. In most cases, a chest CT scan is not required initially. However, a chest X-ray is usually recommended as an important first step to rule out significant underlying lung disease.
Does Dr Ricardo José collaborate with other specialists?
Yes, when need Dr José collaborates with expert colleagues in ENT, gastroenterology and speech and language therapy to provide holistic assessments and treatment for people suffering with chronic cough.
If you are experiencing a persistent cough specialist assessment can help identify the cause and guide effective therapy.
Consultations with Dr Ricardo José are available in London for both UK and international patients seeking expert respiratory care.