•Persistent dry or productive cough lasting more than 8 weeks
•Cough that worsens at night or on lying down
•Feeling of mucus dripping down the back of the throat (post-nasal drip)
•Hoarse voice or throat-clearing habit
•Coughing triggered by cold air, perfumes, smoke, or exercise
•Heartburn or sour taste in mouth (suggesting acid reflux component)
•Nasal congestion or facial pressure alongside cough
•Breathlessness or wheeze with coughing episodes
Causes & Triggers
In Mumbai, the three most common causes of chronic cough together account for over 90% of cases: upper airway cough syndrome (UACS) from allergic rhinitis driven by HDM, cockroach, and mould allergens; cough-variant asthma triggered by the same aeroallergens plus Mumbai's high pollution load; and gastro-oesophageal reflux disease (GORD), exacerbated by Mumbai's spice-rich diet, late-night eating habits, and occupational stress. Exposure to outdoor air pollution, indoor biomass smoke, and occupational irritants in textile, chemical, and construction industries adds a significant irritant cough burden. Chronic sinusitis - prevalent during and after the monsoon - perpetuates post-nasal drip and is a frequently overlooked driver.
How We Test
Evaluation follows a stepwise anatomical protocol: a chest X-ray and spirometry exclude obvious lung pathology and asthma first. If spirometry is normal, a methacholine challenge or FeNO test can detect cough-variant asthma. Nasal endoscopy and a sinus CT scan evaluate post-nasal drip and sinusitis, while skin prick testing identifies allergic triggers. A 24-hour oesophageal pH-impedance study is the gold standard for diagnosing GORD-related cough. Blood eosinophil count and sputum eosinophilia point toward eosinophilic bronchitis.
Treatment is directed at the underlying cause: UACS is treated with intranasal corticosteroids, saline nasal irrigation, and allergen immunotherapy for relevant sensitisers. Cough-variant asthma responds to inhaled corticosteroids, often with rapid improvement within 2–4 weeks. GORD-related cough is managed with proton pump inhibitors, dietary modification (reducing spicy food, late meals, caffeine), and elevation of the head of the bed. Refractory chronic cough unresponsive to all three treatments may benefit from speech therapy (cough suppression) or the newer neuromodulator agent gefapixant.
See a doctor promptly if your cough has lasted more than 8 weeks, is accompanied by blood-streaked sputum, unexplained weight loss, or fever, or is significantly disrupting sleep and daily activities.
Frequently Asked Questions
Most chronic coughs (lasting over 8 weeks) in non-smokers are caused by allergic post-nasal drip, cough-variant asthma, or acid reflux - not infection. Antibiotics are ineffective against these conditions. An allergist can run the right tests to identify your specific cause and prescribe targeted treatment, which typically resolves the cough within 4–8 weeks.
Yes. Chronic exposure to PM2.5, ozone, and NO₂ at Mumbai's levels can cause airway neurogenic sensitisation - a heightened cough reflex - even without classical allergy. It can also unmask or worsen underlying asthma and rhinitis. Wearing a mask during high-pollution commutes and using HEPA air purifiers at home reduce this burden.
Spicy food - a staple of Mumbai diets - can worsen cough through two mechanisms: it relaxes the lower oesophageal sphincter, promoting acid reflux, and capsaicin directly sensitises airway cough receptors. If your cough worsens after spicy meals or on lying down, a GORD component is likely. Reducing spicy, fried, and acidic foods, especially at dinner, often provides noticeable relief.
Cough-variant asthma (CVA) is a form of asthma where cough - rather than wheeze - is the predominant symptom. Diagnosis is confirmed by a methacholine bronchial provocation test or FeNO measurement, combined with a therapeutic trial of inhaled corticosteroids. CVA is very responsive to standard asthma treatment and identifying it early prevents progression to classic wheezing asthma.
Lying down increases post-nasal drip from nasal allergies and promotes acid reflux from the stomach - both common triggers for a chronic night-time cough. If symptoms are worst on waking, dust mite exposure from the mattress and pillows is a likely contributor. Your allergist will assess all three mechanisms to identify the primary driver.
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Living with chronic cough? Let’s find your trigger.
