🫁 Men's Health

Chronic Cough — Causes in Nigeria

A cough lasting more than 8 weeks always needs a diagnosis.

Chronic cough — lasting more than 8 weeks — is one of the most common reasons Nigerians visit a GP. The most common causes are post-nasal drip, asthma, acid reflux (GERD), and ACE inhibitor medication. Less commonly, TB, lung cancer, or heart failure are responsible. Every chronic cough deserves a proper diagnosis.

Signs and Symptoms

✓ Cough lasting more than 8 weeks — by definition chronic

✓ Post-nasal drip cough: tickling sensation at the back of the throat, worse lying down

✓ Asthma cough: often dry, episodic, worse at night, possibly with wheeze

✓ GERD cough: worse after eating, lying down, or in the morning; may have heartburn

✓ ACE inhibitor cough (lisinopril, perindopril): dry, persistent, starts weeks after starting medication

✓ TB cough: productive cough for weeks, night sweats, weight loss, blood in sputum

✓ Productive cough with coloured sputum — may indicate infection or bronchiectasis

✓ Blood-streaked sputum (haemoptysis) — requires urgent investigation

Risk Factors

Smoking or exposure to secondhand smoke
Occupational exposures — dust, chemicals, fumes
Living with someone with TB
Taking an ACE inhibitor (lisinopril, perindopril, enalapril)
History of asthma, allergic rhinitis, or eczema
Obesity — worsens GERD and increases cough
Recent respiratory infection that did not fully resolve
HIV — increases susceptibility to opportunistic respiratory infections

When to Seek Help

NowCoughing blood (haemoptysis), significant breathlessness, or cough in someone with known HIV or cancer — these require urgent assessment.

SoonCough lasting more than 8 weeks, or a productive cough with fever and night sweats — TB must be excluded.

SoonCough that starts or worsens after beginning a new blood pressure medication (likely ACE inhibitor-induced cough).

RoutineDry cough lasting 4–8 weeks after a respiratory infection — often post-infectious cough; may need treatment if persistent.

Tests & Diagnosis

🧪 Chest X-ray

First-line investigation for chronic cough — identifies TB, pneumonia, lung masses, heart failure, and pleural effusion.

🧪 Sputum Microscopy, Culture and AFB

For productive cough with risk factors for TB — acid-fast bacilli smear and culture diagnose pulmonary tuberculosis.

🧪 Spirometry

To diagnose asthma or COPD as a cause of chronic cough.

🧪 Full Blood Count and ESR

Elevated ESR and low haemoglobin may support TB or chronic infection.

🧪 GeneXpert MTB/RIF Test

Rapid molecular test for TB — results within hours, also detects rifampicin resistance. Preferred over AFB smear in people with HIV.

🧪 pH-Metry or Empirical GERD Trial

If GERD is suspected — a 4-week trial of proton pump inhibitors (omeprazole) that resolves the cough confirms the diagnosis.

Treatment Options

Treat the Underlying Cause

Chronic cough management requires identifying and treating the specific cause — not just coughing suppressants. The treatment depends entirely on the diagnosis.

Post-Nasal Drip / Rhinitis

Intranasal corticosteroid sprays (fluticasone, mometasone), antihistamines, and saline nasal irrigation.

Asthma-Related Cough

Inhaled corticosteroids — cough-variant asthma responds well within 4–8 weeks.

GERD-Related Cough

Proton pump inhibitors (omeprazole 20–40mg) for 4–12 weeks, lifestyle changes (avoid lying down after eating, elevate head of bed, reduce spicy food and alcohol).

ACE Inhibitor Cough

Switch to an ARB (losartan, valsartan) — same cardiovascular benefits, without the cough. Cough resolves within 1–4 weeks.

TB Treatment

Standard 6-month rifampicin-based regimen under the Nigerian DOTS programme. Essential to complete the full course.

Frequently Asked Questions

Can a cough be a sign of TB?

Yes — TB should be considered in any cough lasting more than 3 weeks in Nigeria, especially with night sweats, weight loss, or contact with a known TB patient. A chest X-ray and sputum test are needed.

My blood pressure medication is making me cough — what should I do?

ACE inhibitors (lisinopril, perindopril, enalapril) cause a dry persistent cough in 10–20% of people — more common in African populations. Do not just stop your medication — ask your doctor to switch to an ARB. The cough resolves within weeks.

Is a productive cough more serious than a dry cough?

Not necessarily — post-nasal drip and TB both cause productive coughs; acid reflux causes a dry cough. The colour, amount, and duration of sputum, plus associated symptoms, guide investigation rather than the type of cough alone.

Can I use cough suppressants from a pharmacy?

Over-the-counter cough medicines treat symptoms but not causes. They are appropriate for short-term viral coughs. For a cough lasting more than 8 weeks, a diagnosis is needed — cough suppressants alone are not the answer.

How long after a chest infection does the cough last?

Post-infectious cough can last 4–8 weeks after a chest infection — this is normal and usually due to airway hyperreactivity. If it persists beyond 8 weeks, further investigation is warranted.