Just Wondering: Is a Lingering Cough After a Cold Something to Worry About?

For one, you could have leftover irritation in your airways. Or you could have a postnasal drip that keeps that ticklish feeling in the back of your throat going. Most of the reasons for your lingering cough are nothing to worry about, but it's still an irritating side effect that you likely want relieved—especially if all your other cold symptoms are gone.

Here, we break down the top reasons why that post-cold cough happens, and what to do to get rid of it for good.

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What causes a lingering cough after a cold

While most run-of-mill coughs clear up after a week or two, some stubborn ones insist on overstaying their welcome. The following issues may be to blame for a cough that won’t budge.

1. Postnasal drip

Among the many possible reasons for a lingering cough, postnasal drip tops the list, says Nima Majlesi, DO, director of medical toxicology at Northwell Staten Island University Hospital. Postnasal drip happens when mucus accumulates and drips down the back of your throat. You tend to produce more mucus (which helps fight infections) during a cold. But even after, you might still have residual sinus congestion, which can cause the irritating drip, Dr. Majlesi says.

One clue your cough is related to postnasal drip: It bothers you mostly at night, says Wayne Altman, MD, FAAFP, professor and chair of family medicine at Tufts University School of Medicine. Other signs of postnasal drip to look out for include the following, per the Cleveland Clinic:

• Sore throat
• Feeling like there’s a lump in the back of your throat
• A feeling of mucus draining into your throat
• Frequent swallowing
• Gurgling or hoarseness
• Urge to clear your throat
• Bad breath (halitosis)
• Nausea and vomiting from excess mucus draining to your stomach

2. Bronchial irritation

“Bronchial irritation can also occasionally linger after the acute phase of infection,” Dr. Majlesi says. Your bronchial tubes are the airways that carry air to and from your lungs. When they become irritated, mucus builds up.

This irritation is often caused by prolonged inflammation from your cold. “The original viral infection initiates the body’s inflammatory response, which is the way the body fights off the infection,” says William Schaffner, MD, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center. “Sometimes, even after the cold virus is gone, the inflammatory response continues, irritating the mucus membranes and producing a cough.”

3. Lack of rest

In Dr. Altman’s opinion, this is the most likely cause for a cough that won’t quit. And it makes a lot of sense: when you’re sick, lack of sleep can slow down your recovery time. “When you have a viral infection, antibiotics do not help,” he says. “You are at the mercy of your immune system, which is powered up by getting more rest.”

As you snooze, your immune system “powers up” by releasing cytokines—a type of protein that helps protect you against infection and inflammation, according to the Mayo Clinic. Without enough sleep, you won’t have as many cytokines (or infection-fighting antibodies and cells) to fend off a virus, and your cold symptoms, including cough, will last longer.

4. Over-the-counter cold medicines

Hate to break it to you, but the medicines you take to alleviate cold symptoms—like antihistamines and decongestants—could be prolonging your cough. “I find that these medications dry up secretions, which may give some mild short-term relief from congestion and runny nose, but they often cause secretions to thicken, making them harder to drain,” says Dr. Altman. If thick mucus builds up, it can cause problems like postnasal drip, which, as we know, can trigger a cough.

5. Another underlying condition

A chronic cough could be a sign of other health issues. For example, allergies are infamous for triggering a tickle in your throat. If you also have sneezing, itchy eyes, runny nose, and watery eyes, chances are allergies are behind your persistent cough.

Similarly, silent reflux (also known as laryngopharyngeal reflux) can irritate your vocal cords and make you cough, according to UT Southwestern Medical Center. Silent reflux happens when stomach acid travels up your esophagus into your voice box and throat. It’s called “silent” because it doesn’t cause your run-of-the-mill acid reflux symptoms like heartburn.

On top of a chronic cough, other signs of silent reflux may include the following, per UT Southwestern Medical Center:

• Asthma
• Bitter taste in the throat
• Excessive throat clearing
• Difficulty swallowing
• Hoarseness
• Postnasal drip
• Sensation of a lump in the throat
• Sore or burning sensation in the throat

A cough that lasts longer than four weeks could also be due to reactive airway disease (RAD), Dr. Altman says. RAD describes a collection of breathing symptoms (that are similar to asthma) that develop when your bronchial tubes swell. Researchers aren’t clear on the cause of RAD, but people who have it tend to get chronic cough, shortness of breath, difficulty breathing, wheezing, and chest tightness, according to the Cleveland Clinic.

If your cough lags for longer than two weeks, see your doctor. They can examine you, take a history of your symptoms, and help rule out (or identify) any underlying medical conditions that might be causing your chronic cough.

6. Your immune system is weakened

When your immune system isn’t working at its best, it won’t be able to fend off a cold like it should. That means symptoms, like cough, can stick around. If you’re immunocompromised due to an underlying condition, older than 65, or a smoker, you’re more likely to have a persistent cough, according to UnityPoint Health.

7. Other medications

“If you have a dry cough that you cannot shake,” the culprit might be in your pillbox, Dr. Altman says. A chronic, pesky cough can be a side effect of some medications. For example, certain kinds of blood pressure drugs, such as lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, can cause a dry cough, he says.

If you suspect your medicine is making you cough, don’t stop taking it. First, talk to your doctor who may be able to give you a different drug or a lower dose.

How long does a cough usually last?

Typically, a week. However, “a residual cough after a viral upper respiratory infection can occasionally last as long as two weeks,” Dr. Majlesi says. Sometimes it can stretch on longer than that. “A cough after a chest cold can be a bother for some time, even up to several weeks,” Dr. Schaffner says.

If a cough persists for more than eight weeks, it’s considered chronic, per UnityPoint Health.

How to treat a chronic cough

If you have a lingering cough, your symptoms could stick around for a few weeks. That doesn't mean you have to feel like crap. The following strategies might help you feel better.

1. Get enough sleep

“I offer my patients the #3NightChallenge: get eight to 10 hours of sleep for three nights in a row while taking it easy during the day,” Dr. Altman says. “This almost always results in an improvement or resolution of cold symptoms.”

2. Try saline nose spray

“If congestion is the issue, a saline nasal spray may effectively assist in drying out sinuses,” Dr. Majlesi says.

3. Hydrate

Keep a water bottle within reach and sip on warm fluids like soups, which can help loosen mucus, Dr. Altman says. “You know that you are adequately hydrated when your pee is clear,” he adds. On the flip side, steer clear of caffeinated drinks and alcohol that can lead to dehydration.

4. Try honey

A cup of herbal tea with a drizzle of honey can help soothe a sore, hoarse throat due to chronic cough and postnasal drip, Dr. Altman says.

5. Sleep with an extra pillow

If your cough is related to postnasal drip, try elevating your head when you sleep, Dr. Altman says. This can help prevent mucus from running down your throat. Plus, if you’re more comfortable at night, you’ll sleep better. Quality sleep equals a stronger immune system.

6. Prescription medications

While home remedies may help, in some cases, they may not cut it. You might need to see your doctor, who can prescribe stronger medications like the following, per Dr. Majlesi:

• Benzonatate: a cough suppressant that may help for postnasal drip
• An albuterol inhaler (similar to what is used in people with asthma): may help relieve the bronchial spasm that happens during the coughing episodes
• Corticosteroids (such as prednisone): can help with lingering inflammation

When to see a doctor

While inconvenient, it’s not uncommon for a cough to lag on after a cold. In most cases, you can wait it out and treat your symptoms with home remedies to keep you more comfortable.

But if your cough doesn’t show any sign of letting up after two weeks, it might be time to check in with your doctor. You might have a bacterial infection (like acute bronchitis) or a secondary viral infection (like a sinus infection or pneumonia), according to UnityPoint Health.

Other red flags to keep an eye out for include the following, per Drs. Majlesi and Schaffner:

• You’re coughing up blood
• Your mucus changes to a thick green, brown, or blood-tinged color
• You have chest pain
• You have difficulty breathing or shortness of breath
• You have fatigue
• You have loss of appetite
• You have persistent fever
• You have weight loss

“Also, if the prolonged cough comes in distinctive episodes of several coughs close together (cough seizures) that interrupt work, eating, or even sleeping, and if there is associated vomiting, you may have whooping cough (pertussis),” Dr. Altman says. This respiratory illness is caused by a type of bacteria called Bordetella pertussis, which can damage the cilia (tiny, hair-like extensions in upper respiratory system) and cause the airways to swell, according to the Centers for Disease Control and Prevention (CDC).

As the name implies, cough is the signature symptom, and it can go on for weeks. Whooping cough can develop into a more serious infection if you’re immunocompromised or you have asthma, so don’t wait to seek medical attention if you have symptoms.

Final takeaway

In most cases, a residual cough after a cold is nothing to worry about. Usually, it’s a sign that your body needs a little extra time and help to recharge and recover. “Think of fighting off a cough/cold as a tug-of-war with your immune system on one side and the virus on the other,” Dr. Altman says. “Power up your immune system by getting rest, eating healthy, and managing your stress effectively. When you do that, your coughs and colds will be fewer and shorter in duration."