Persistent Dry Cough: Causes from Allergies to Acid Reflux

At-a-Glance

• Dry cough lasting over 3 weeks needs medical evaluation
• Common culprits: post-nasal drip, asthma, acid reflux, medications
• ACE inhibitor blood pressure meds cause chronic dry cough in up to 20% of users
• Usually not serious but can really affect your quality of life
• Treatment depends on finding and fixing the root cause

What It Feels Like

That annoying tickle in your throat that just won't quit. You cough and cough, but nothing comes up - no mucus, no relief. It's a dry, hacking cough that might make you sound like you're barking.

The worst part? It often gets worse at night when you're trying to sleep, or when you lie down. Talking, laughing, or taking a deep breath can set it off. Your chest might feel tight and sore from all the coughing. You're exhausted, and people around you are probably tired of hearing you cough too.

Common Causes

Post-Nasal Drip

This is the most common cause of chronic dry cough. Mucus from your sinuses drips down the back of your throat, irritating it and triggering coughing. You might feel like you're constantly clearing your throat or notice a tickle that won't go away.

Allergies, sinus infections, or just chronic sinus issues can all cause post-nasal drip. Treatment includes antihistamines, nasal steroid sprays, or decongestants.

Asthma

Many people with asthma don't wheeze - they just cough. This is called cough-variant asthma. The cough is usually dry and often worse at night or triggered by exercise, cold air, or allergies.

If you notice your cough gets worse with physical activity or changes in weather, asthma might be the culprit. Inhalers can make a huge difference.

Acid Reflux (GERD)

Stomach acid creeping up into your esophagus can irritate your throat and trigger coughing. You might not even have typical heartburn - sometimes a chronic cough is the only symptom.

The cough usually gets worse after eating or when lying down. Lifestyle changes (elevating your head while sleeping, avoiding trigger foods) and acid-reducing medications help.

ACE Inhibitor Medications

If you take blood pressure medication ending in "-pril" (lisinopril, enalapril, etc.), it might be causing your cough. Up to 20% of people on these medications develop a persistent dry cough. It can start weeks or months after beginning the medication.

The good news? The cough goes away within days to weeks after stopping the medication. Talk to your doctor about switching to a different blood pressure med.

Upper Respiratory Infection Aftereffects

Had a cold or flu recently? Sometimes the cough lingers for weeks after the infection clears. Your airways are still inflamed and irritated, making you cough even though you're no longer sick.

This usually resolves on its own within 8 weeks, but honey, cough suppressants, and staying hydrated can help while you wait it out.

Other Causes

Less common causes include chronic bronchitis, environmental irritants (smoke, pollution, strong odors), lung conditions, or even anxiety. Rarely, a persistent cough signals something more serious like lung cancer, especially in smokers.

What You Can Do

Stay hydrated - Drink plenty of water to keep your throat moist and thin any mucus. Warm liquids like tea with honey are especially soothing.

Use honey - A spoonful of honey before bed can coat your throat and reduce nighttime coughing. Works surprisingly well.

Try a humidifier - Especially in winter when indoor air is dry. Moist air soothes irritated airways.

Elevate your head - If your cough worsens at night, prop yourself up with extra pillows. This helps with both post-nasal drip and acid reflux.

Avoid irritants - Stay away from smoke, strong perfumes, and cold air when possible.

Over-the-counter options - Cough suppressants (dextromethorphan) can provide temporary relief. Antihistamines help if allergies or post-nasal drip are the cause.

When to See a Doctor

Make an appointment if:

• Your cough has lasted more than 3 weeks
• It's getting worse instead of better
• You're coughing up blood or colored mucus
• You have other symptoms like fever, weight loss, or night sweats
• The cough is interfering with sleep or daily activities
• You're a smoker with a new or changing cough

Your doctor will ask about your symptoms, listen to your lungs, and may order a chest X-ray, lung function tests, or other tests to identify the cause.

Common Questions

The Bottom Line

A persistent dry cough is frustrating, exhausting, and disruptive, but it's usually not dangerous. The key is identifying what's causing it - whether that's post-nasal drip, asthma, acid reflux, or medication side effects.

Don't just suffer through it. If your cough has lasted more than 3 weeks, see your doctor. Treatment targeted at the underlying cause is much more effective than just suppressing the cough with over-the-counter meds.

In most cases, once you identify and treat the root cause, your cough will improve significantly within a few weeks.