Chronic cough?

Dr David Evans, a respiratory consultant (chest physician) at Spire Harpenden, writes about one of the common symptoms he sees:

"I frequently see patients who are concerned about a cough. Often coughing can be intrusive, especially when it disturbs sleep.

"Patients who come to me with a cough that won’t go away are often concerned given the recent media suggestion that this problem can be a symptom of something sinister - such as lung cancer. Although a tumour is a possible explanation for a chronic cough (particularly in smokers), fortunately coughing is not usually due to cancer but often caused by inflammation of the tubes (airways) in the chest.

"This often happens after colds and chest infections. It can also be a sign of asthma. Many people think (incorrectly) that asthma is a childhood condition and don’t consider it as a cause of coughing.

"Actually, a diagnosis of asthma causing a cough in adults is quite common. This explanation is a relief and it is rewarding to treat. Medication is often very effective to stop the cough and to control the symptom for the future."

What can trigger adult asthma?

"Unrecognised allergy can trigger asthma - many sufferers have reactions to pollens or dust. Low levels of allergy in the bronchial tubes in the chest can also cause an increased vulnerability for picking up other respiratory infections (‘colds going to the chest’).

"If this happens, coughing can get a lot worse - sometimes for many weeks at a time. Newly diagnosed adult asthma patients can often recall cycles of infections and coughing episodes over many years."

What is an asthma cough like?

"As a rule, asthma cough in adults is a dry cough (or only small amounts of sputum). You may get coughing spasms which can be triggered by exercise, talking for periods of time and being in smoky or strongly perfumed areas.

"The cough can be troublesome at night and it isn’t particularly helped by either antibiotics or blue inhalers (taken on their own)."

How do you diagnose adult asthma?

"I carry out a careful review of a patient’s clinical history and allergies as well as a chest X-ray and basic measures of lung function. This allows me to make a diagnosis. Often I prescribe an inhaler (perhaps a low dose of inhaled steroid) which usually allows a quick and good recovery of inflammation in the bronchial tubes and stops the coughing. Any associated wheezing or breathlessness will also go away.

"At the time of assessment, it is also possible to do specific tests to try and understand what is causing the reaction i.e. allergy to any of pollens (grass/tree), pets (cat/dog), moulds/spores or house dust. In doing this, it is possible to work out if these triggers can be avoided to minimise the risk of recurrent coughing in the future."


"Cough is an important symptom, although usually not caused by anything worrying. However it is always worth getting it checked out, especially if you have symptoms for more than a couple of weeks. The results of a clinical assessment and X-ray are usually very reassuring and treatment for asthma can quickly treat the symptoms."

Dr David Evans


Dr David Evans is a consultant chest physician at Spire Harpenden and Bushey Hospitals as well as a consultant at Hemel Hempstead, St Albans and Watford Hospitals. He also works at The Royal Brompton and Harefield Foundation NHS Trust. He is an Honorary Senior Lecturer at the National Heart & Lung Institute, London. His research relates to the diagnosis and treatment of airways disease including asthma and respiratory infection.


Clinics at Spire Harpenden are on Wednesday evening and Thursday afternoons as well as on Monday evening at Spire Bushey.

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