Treatment of unexplained chronic cough

Photo: Elderly lady wrapped in a blanket in an armchair, drinking from a mug

Unexplained chronic cough can get you down and prevent you from going about your daily life. There are various strategies that can help stop your urge to cough. If you have severe symptoms, speech or physical therapy and medication can be an option.

Sometimes when you’ve got a cough it seems like it just won’t go away. A cough that lasts longer than eight weeks is classified as a chronic cough. If the doctor can’t identify a cause, even after extensive tests and examinations, they’ll diagnose you with unexplained chronic cough. This condition is also sometimes called “idiopathic cough” or “refractory cough.” It often takes quite a while for unexplained chronic cough to be diagnosed.


You’re not imagining things: Your cough is real even if the medical professionals can’t work out what’s causing it.

Unexplained chronic cough is not harmful but it can get you down. The condition often lasts several years. There are various ways to ease the symptoms.

What can I do to ease the symptoms?

Minimizing your symptoms and finding ways to cope with them better is important for your day-to-day wellbeing. Some things you can do are:

  • Keep your airways moist: This helps stop you coughing and clearing your throat. Drinking herbal tea or water on a regular basis is one way of ensuring your airways don’t dry out. Another home remedy is inhaling steam from salted water.
  • Sweets and chewing gum: Some people find it helpful to chew gum or suck sweets to stop the urge to cough.
  • Keeping busy with other things: This can help stop the urge to cough too.
  • Avoid triggers: Avoiding things that will trigger your cough (like smoke, cold air or talking for a long time) can also be useful.

Coughing can cause involuntary loss of urine – particularly in women. This can make people very anxious. So it’s a good idea to ask your doctor about ways to try to stop this problem.

What non-drug treatments are available?

Respiratory, language, speech or voice therapy can teach you various strategies and techniques for coping with your symptoms. They cover a range of exercises and components that can be combined to meet your personal needs. Examples include:

  • Psychoeducation: The first step is to learn about the condition. The aim is to understand the cough is real and not just “in your head” even if you don’t know what’s causing it.
  • Exercises to control breathing and the larynx: You will learn various techniques to identify and control the urge to cough as soon as it starts. You will also be taught special exercises for your breathing and your larynx. They can help you minimize larynx irritation and coordinate your breathing and speech better.
  • Vocal hygiene: The therapist gives tips on vocal hygiene and information about things like the role of diet and breathing through your mouth or nose. They will also discuss the hazardous effects that smoking, consuming caffeine and drinking alcohol can have on the mucus membrane lining of the larynx.
  • Other physical therapy techniques: These might include connective tissue massage, inhalation or heat therapy.

If your symptoms are severe, it could be worth trying these options. But bear in mind that they’re not offered by all speech or physical therapists. It is also best to check beforehand whether your health insurer will cover the costs.

But there have only been a few, small studies on these techniques so it’s not possible to tell how much they can help. Some of the findings indicate that voice or speech therapy can bring short-term relief for some people.

What medications can be used?

There aren’t any medications that are specifically approved for treating unexplained chronic cough. But there are a few that can be used if

  • there’s no other way of relieving the cough,
  • you specifically want to take medication, and
  • you’ve carefully considered the pros and cons with your doctor.

Medications containing codeine or noscapine have been approved for treating dry coughs. But there hasn’t been enough research done yet on using them for chronic coughs. Codeine is a weak opioid and it can cause dependency. It can only be prescribed for short periods.

Doctors can also prescribe medication containing gabapentin or a low-dose opioid containing morphine. They block the cough reflex by stopping the signals being transmitted to the brain. But they don’t stop the cause of the chronic cough – and they have multiple side effects.

In Germany, neither of these products is approved for treating unexplained chronic cough. If they’re prescribed for this condition, it’s . While you’re on them, your doctor will check regularly to see whether the pros still outweigh the cons and whether it makes sense to continue the treatment.

What do you need to bear in mind when taking morphine?

Morphine is an opioid that’s typically used to treat severe pain.

The most common side effects include:

  • Mood swings
  • Constipation
  • Tiredness
  • Headaches
  • Dizziness
  • Vomiting

A serious, but rare, side effect is extremely slow breathing (asphyxia). Experts believe the risk of serious side effects is lower when morphine is used to treat a chronic cough than when it’s used for severe pain because the dosage is lower.

It is particularly important to stick to the dosage recommended by your doctor and to follow any other instructions because a morphine overdose can be fatal.

Morphine is a very strong opioid and it can cause dependency. Over time, it can become less effective.

What about gabapentin?

Gabapentin belongs to a group of drugs that are normally used to treat epilepsy and long-lasting pain.

Common side effects include:

  • Vision problems
  • Dizziness
  • Drowsiness / Sleepiness
  • Disorientation
  • Dry mouth

In rare cases, gabapentin can cause loss of consciousness, extremely slow and shallow breathing (hypoventilation) and severe allergic reactions.

Gabapentin can lead to dependency too but experts consider the risk lower than with opioids.

If morphine and gabapentin are used to treat a chronic cough, it is considered to be non-approved (“off-label”) use, for which special regulations apply. These drugs can have some serious side effects, which is why they’re only considered if other treatments haven’t brought any relief and the person is suffering badly. Another point to keep in mind is that the cough can come back as soon as you stop taking them.

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Akuter und chronischer Husten (S3-Leitlinie). AWMF-Registernr.: 053-013. 2021.

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). Diagnostik und Therapie von erwachsenen Patienten mit Husten (S2k-Leitlinie). AWMF-Registernr.: 020-003. 2019.

Gehrke-Beck SH, F. Abklärung und Behandlung von chronischem und refraktärem Husten. Arzneiverordnung in der Praxis 2017; 44(1): 2-10.

Gibson P, Wang G, McGarvey L et al. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report. Chest 2016; 149(1): 27-44.

Morice AH, Millqvist E, Bieksiene K et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55(1): 1901136.

Ribeiro VV, Casmerides MCB, da Silva Reis ZMC et al. Efficacy of Speech-language Pathology Therapy in Chronic Cough: Systematic Review With Meta-analysis. J Voice 2021 [Epub ahead of print]; S0892-1997(21): 00408-00402.

Ryan NM, Vertigan AE, Birring SS. An update and systematic review on drug therapies for the treatment of refractory chronic cough. Expert Opin Pharmacother 2018; 19(7): 687-711.

Shi G, Shen Q, Zhang C et al. Efficacy and Safety of Gabapentin in the Treatment of Chronic Cough: A Systematic Review. Tuberc Respir Dis (Seoul) 2018; 81(3): 167-174.

Slinger C, Mehdi SB, Milan SJ et al. Speech and language therapy for management of chronic cough. Cochrane Database Syst Rev 2019; (7): CD013067.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on January 31, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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