Consultant respiratory physician · London
Chronic cough specialist in London
A cough lasting more than eight weeks can be exhausting, disruptive and difficult to explain. Dr Ricardo José provides a structured specialist assessment to identify the cause and create a clear, personalised plan.
Specialist chronic cough care
Private appointments in LondonUnderstanding your symptoms
What is a chronic cough?
A chronic cough is a cough that continues for longer than 8 weeks in adults. It can be frustrating, disruptive and may affect sleep, work, exercise and everyday conversations.
Although many people worry about serious disease, most chronic coughs are caused by treatable conditions. A specialist assessment can help identify the underlying cause and guide the most appropriate treatment.
When to seek prompt assessment for a persistent cough
A persistent cough can be assessed in a planned consultation with Dr Ricardo José. Book an appointment if you have a persistent cough. particularly if it affects sleep, work or daily life, and has not improved with initial treatment, or comes with symptoms that need respiratory assessment.
A specialist consultation may be particularly appropriate if you have:
- Persistent fever, recurrent chest infections or drenching night sweats.
- Unexplained weight loss.
- Ongoing or worsening breathlessness that is not severe or sudden.
- Blood-stained phlegm when you are otherwise stable.
- Chest symptoms, hoarseness or a persistent change in your voice.
- A cough that is becoming more troublesome or difficult to explain.
Specialist chronic cough care
Why see Dr Ricardo José for a persistent cough?
Persistent cough can have more than one cause. A consultant-led assessment helps identify what is driving your symptoms and ensures treatment is focused on the right diagnosis.
- 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 remotely by video
- Practices at Royal Brompton Hospital and The London Clinic .
Patients benefit from a clear diagnosis, reassurance and a structured management pathway.
Patient feedback
What patients say about Dr Ricardo José
Patients with troublesome or persistent cough often value clear explanations, careful assessment and a structured plan for the next steps.
“More progress in half an hour than in months.”
“I felt reassured and grateful.”
“Clear information and involved patient.”
“A prompt plan and treatment.”
Understanding the cause
What causes chronic cough?
Chronic cough can have several possible causes. Identifying the underlying trigger is important because treatment depends on the diagnosis.
Asthma and eosinophilic airway inflammation
Cough may be the only symptom of asthma in some patients. This is known as cough-variant asthma.
Reflux-related cough
Gastro-oesophageal reflux disease (GORD) or laryngopharyngeal reflux (LPR) can irritate the airway and trigger coughing, even without heartburn. Reflux may be acidic or non-acidic.
Upper airway cough syndrome
Chronic rhinitis, nasal allergy or sinus inflammation may stimulate cough-reflex pathways and contribute to persistent coughing.
Smoking-related airway disease
Chronic bronchitis or early chronic obstructive pulmonary disease (COPD) may present with a persistent cough, sometimes before breathlessness becomes noticeable.
Medication side effects
Some medicines can cause cough as a side effect. ACE inhibitors, commonly prescribed for high blood pressure, can cause a persistent dry cough.
Less common causes
Less commonly, chronic cough may be related to bronchiectasis , interstitial lung disease or lung cancer. Specialist assessment helps ensure these causes are appropriately considered and excluded where needed.
A structured specialist assessment
The aim is to identify the most likely cause of your cough, arrange appropriate tests where needed, and ensure serious conditions are appropriately excluded.
A specialist explanation of persistent cough
Cough hypersensitivity syndrome
Cough hypersensitivity syndrome describes a cough reflex that has become overly sensitive. In some people, this can help explain why a cough continues even when the original trigger has improved or initial treatment has not fully solved the problem.
In this condition, the nerves that control the cough reflex react too readily. Everyday stimuli that would not normally cause coughing can then provoke repeated coughing episodes or a persistent urge to cough.
Many people describe irritation, dryness, a tickling sensation in the throat or a need to clear the throat. Symptoms can overlap with asthma, nasal inflammation, reflux or airway irritation, so a structured assessment is important.
Why can the cough persist?
Cough sensitivity may increase after a respiratory infection, airway inflammation or long-standing irritation. In some cases, the original trigger settles but the cough reflex remains overactive. Reflux or aspiration can also contribute to airway irritation, including when heartburn is not prominent.
Why does this change treatment?
Treatment is not simply about suppressing a cough. It involves identifying and treating contributing conditions, reducing avoidable triggers and considering cough-control strategies where appropriate. This can be particularly relevant when a cough has not improved with standard treatment.
Symptoms can have more than one driver, which is why treatment is tailored to the individual rather than based on a single symptom alone.
Consultant-led assessment
When a standard treatment plan has not solved the cough
Dr Ricardo José assesses whether more than one condition may be contributing, whether cough-reflex sensitivity remains active after a trigger has been treated, and whether further investigation is needed. The aim is to establish a clear working diagnosis and a practical, individualised plan.
This may include treatment of underlying causes, cough-control strategies and, for selected people with refractory or unexplained chronic cough , discussion of newer treatment options where clinically appropriate.
How Dr Ricardo José diagnoses chronic cough
A structured approach to finding the cause
Dr Ricardo José takes a thorough, evidence-based approach to identify the underlying cause of chronic cough and guide the right treatment.
Understand your cough
Your consultation begins with a detailed discussion about your cough, including how long it has been present, what triggers it and any associated symptoms such as breathlessness, reflux or nasal symptoms. Medical history, medicines and lifestyle factors are also reviewed.
Clinical assessment
A focused examination helps identify possible causes. This may include assessment of your breathing, oxygen levels where relevant, smoking history and any symptoms that may need more urgent investigation.
Arrange targeted investigations
Tests are selected according to what is most likely to be causing your cough. These may include lung-function testing , FeNO, chest X-ray or CT scan , blood tests , sputum analysis or reflux assessment, depending on your symptoms.
Review results and build your treatment plan
Findings are reviewed together to reach a working diagnosis, exclude important alternative conditions and create a personalised treatment plan. Follow-up allows treatment to be adjusted where needed.
The outcome
A clear diagnosis and a plan that works for you
The aim is to identify the cause of your cough, arrange the right tests where needed and provide an individualised management plan.
Appointments and locations
Where can I be seen for a chronic cough consultation?
Private chronic cough consultations are available at several central London locations. Video consultations may also be appropriate for some patients.
Patient symptom check-in
How is your cough affecting daily life?
Answer a few questions about your cough and its impact over the past week. Your result is a practical symptom summary, not a diagnosis.
Cough severity
How severe has your cough been during the past 24 hours?
Move the marker from 0 for no cough to 100 for the worst cough you can imagine.
Daily-life impact
Over the past 7 days, how much has your cough affected the following?
Choose one response for each question.
Duration
How long has your current cough been present?
Duration is not part of your impact score, but it helps guide the next step.
Important symptoms
Do any of these apply to you now?
These symptoms are not included in the score. Select all that apply.
Your symptom summary
Your cough impact dashboard
This website score summarises the impact of cough on everyday life. It is not a diagnostic test and does not replace a medical assessment.
Overall cough impact
Mild impact
Your reported pattern
Daily-life impact breakdown
These are your individual responses rather than a diagnostic score.
Helpful answers
Frequently asked questions about chronic cough
Find answers to common questions about persistent cough, investigations and specialist treatment.
How long is too long for a cough?
Any cough lasting more than 8 weeks in adults is considered chronic and should be assessed. A specialist review can help identify the cause and determine whether any tests or treatment are needed.
Is chronic cough serious?
Most chronic coughs are caused by treatable conditions, such as asthma, airway inflammation, reflux, rhinitis or smoking-related airway disease. However, persistent symptoms should be assessed to exclude less common but more serious causes, including lung cancer or significant lung disease.
Can reflux cause coughing without heartburn?
Yes. Some people with reflux-related cough do not experience typical symptoms such as heartburn or acid regurgitation. However, acid-suppressing medication does not help every patient, particularly where there is no clear evidence of acid reflux. Treatment is guided by the overall assessment and suspected mechanism of cough.
Will I need scans to investigate my chronic cough?
A chest X-ray is usually an important first step in assessing chronic cough and helps rule out significant underlying lung disease. A CT scan is not required initially in every case, but may be arranged where your symptoms, examination findings or initial test results indicate that more detailed imaging is needed.
When should I seek urgent medical advice for a cough?
Seek urgent medical advice if you cough up blood, develop chest pain, have unexplained weight loss, persistent fever, recurrent chest infections or worsening breathlessness . These symptoms do not always indicate a serious condition, but they should be assessed promptly.
Can a cough persist after a respiratory infection?
Yes. A cough can continue after a respiratory infection has resolved, particularly if the airways or cough reflex remain irritated. If symptoms persist beyond 8 weeks, become more severe or affect daily life, an assessment can help identify whether cough hypersensitivity or another underlying cause is contributing.
Can cough hypersensitivity be treated?
Yes. Where cough hypersensitivity is contributing to symptoms, treatment may include identifying and managing triggers, cough-control approaches and selected medication where clinically appropriate. The best approach depends on the individual and whether there are other underlying causes to address.
Does Dr Ricardo José collaborate with other specialists?
Yes. When needed, Dr Ricardo José collaborates with expert colleagues in ENT, gastroenterology and speech and language therapy to provide a coordinated assessment and treatment plan for people with chronic cough.
How can I prepare for my consultation?
It can be helpful to bring a list of your current medications, details of previous tests or scans, and notes about when the cough started, what triggers it and any associated symptoms. This helps ensure the consultation is focused and efficient.
Still have questions?
Arrange a specialist chronic cough assessment
A consultant-led assessment can help identify the cause of persistent cough and provide a clear management plan.
Clinical information on this page was reviewed by Dr Ricardo José, Consultant Respiratory Physician.
