Long-lasting cough and breathlessness
Most coughs clear up in three to four weeks. If a cough stays, or you run out of breath sooner than before, the cause has to be found. This page covers common causes, how they are assessed and the signs that cannot wait.
How long is a cough normal?
After a cold or a chest infection, a cough and phlegm can last up to three weeks. Most coughs clear up by themselves within three to four weeks. A cough lasting more than three weeks counts as persistent and should be checked.
What causes a cough or breathlessness?
The list of causes is long, and the nearest explanation is not always the right one. Some common ones:
- Asthma and chest infection
- Smoking and COPD
- Being overweight and panic attacks, for breathlessness
- Bronchiectasis, which comes with a cough with a lot of phlegm and repeated infections
- Fibrosis and interstitial disease
- Heart failure, especially if the ankles are swollen too
- Lung cancer, not the commonest cause but not one to ignore
Long-lasting breathlessness after COVID is a separate topic, covered in this article.
When should you book?
- A cough has lasted more than three weeks.
- Breathlessness has grown during usual activities or when lying down.
- Breathlessness comes with swollen ankles.
- You are losing weight for no reason.
- Your immune system is weak, for example from chemotherapy or diabetes.
How is it assessed?
The doctor first asks when it began, whether there is phlegm, whether nights or days are worse, and which medicines you take. An examination and an oxygen check follow. Depending on these, a chest X-ray, spirometry, blood tests or a phlegm sample and sometimes a CT may be requested. Not everyone needs all of these.
Keeping notes helps a lot: what time the cough is worse, what starts it, how many stairs make you breathless, and the colour of any phlegm.
Signs that cannot wait
Call 115 and do not drive yourself if:
- You are so breathless you cannot finish a sentence
- Your chest feels tight or heavy, or pain spreads to your arm, back, neck or jaw
- Your lips or skin turn very pale, blue or grey
- You are suddenly confused
- Breathlessness and chest pain came on suddenly, especially with a swollen, painful leg
- You cough up more than a few streaks of blood
Coughing up even a little blood, or a cough that is quickly getting worse, should be checked the same day. The full list is in the warning signs guide.
Frequently asked questions
Should I take antibiotics for a cough?
Antibiotics are not normally the treatment for a cough, and viral bronchitis does not benefit from them. A doctor prescribes them only if a bacterial infection is likely, and then the course should be finished.
Is cough syrup enough?
Syrups may reduce coughing but do not remove the cause. If a cough has passed three weeks, its cause needs finding, not just silencing.
Does breathlessness always come from the lungs?
No. Heart failure, being overweight and panic attacks can also cause it. That is why you should not diagnose yourself.
The first step, a calm conversation.
Go to the booking page or talk to support. Have your earlier results and scans ready.