Three weeks is the threshold. Beyond that, a cough is a symptom rather than a leftover.
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These combinations warrant an urgent chest X-ray, which your NHS GP can arrange on an urgent pathway. We will write to them the same day.
A cough after a viral illness commonly lasts two to three weeks and occasionally longer — that is normal and not a sign of anything wrong.
Three weeks is the useful threshold. Beyond that, a cough stops being the tail end of something and becomes a symptom in its own right, and it is worth knowing which of a fairly short list is causing it.
The big three, accounting for most chronic cough
Other causes — COPD; ACE inhibitor blood pressure medication, which causes a dry cough in around one in ten people and is entirely reversible by switching; smoking; whooping cough, which is commoner in adults than most people think; and post-infectious cough.
Needing exclusion — lung cancer and tuberculosis. Both uncommon, both the reason the three-week rule exists.
If you take ramipril, lisinopril, perindopril or any other ACE inhibitor for blood pressure, that is very possibly your cough.
It affects a substantial minority of people taking these drugs, it is a dry tickly cough with no other symptoms, and — the part that catches people out — it can start months or even years after beginning the medicine, so the connection is rarely made. It is one of the commonest reasons for a chronic cough being investigated at length when a simple medication switch would have resolved it.
Do not stop it yourself. Raise it, and an alternative that does not cause cough can usually be substituted. The cough then settles over a few weeks.
These three — asthma, reflux and post-nasal drip — account for the large majority of chronic coughs in non-smokers with a normal chest X-ray.
The pattern narrows it substantially — dry or productive, worse at night or on waking, seasonal, related to exercise or cold air, and crucially what medication you take. Stopping an ACE inhibitor resolves a surprising number of chronic coughs and is the first thing worth checking.
We arrange chest X-ray where the cough has lasted beyond three weeks or has any concerning feature, plus blood count and allergy testing where relevant. For suspected asthma we arrange spirometry.
Treatment is targeted at the cause rather than the cough. Cough suppressants treat the symptom and leave the reason in place.
Longer than most people expect. A cough after a viral infection commonly lasts three to eight weeks, and that is normal rather than a sign of anything sinister — the airways stay irritable long after the virus has gone. Beyond eight weeks it counts as a chronic cough and should be assessed properly.
The exception is anyone over 40 who smokes or used to: three weeks is the threshold there, and a chest X-ray is warranted.
Quite possibly, and this is the most easily fixed cause on the list. ACE inhibitors — ramipril, lisinopril, perindopril, enalapril and others ending in "-pril" — cause a persistent dry cough in a significant minority of users. It can begin months or years into taking them, which is exactly why the link gets missed and people end up with X-rays and inhalers instead of a prescription change. Raise it; do not stop the tablet unilaterally.
Urgent — get it assessed this week, even if it was a single small streak and even if it has not happened again. Most causes turn out to be a burst small vessel from forceful coughing or a chest infection, but coughing up blood is a recognised presenting symptom of lung cancer and of TB, and it is never watched and waited on.
Almost certainly not. The overwhelming majority of coughs — including ones that produce green or yellow phlegm, which people find hard to believe — are viral. Colour tells you very little about whether an infection is bacterial. Antibiotics for a viral cough cause side effects and drive resistance without shortening the illness by a day.
Reasonable for a cough lasting more than three weeks in a current or former smoker, for anyone over 40 with a new persistent cough, and for anyone coughing up blood, losing weight, or having night sweats. A normal chest X-ray does not end the enquiry — the common causes of chronic cough do not show up on one — but it is the right starting point.
Yes — cough-variant asthma is exactly that: asthma where cough is the only symptom. Suspect it if the cough is worse at night, after exercise, in cold air, or around dust and animals. It is diagnosed with breathing tests and often confirmed by a trial of inhaled treatment.
It is not just a childhood illness, and it is very much still around — including in vaccinated adults, whose immunity wanes. The pattern is a cough lasting weeks to months in violent bouts, sometimes ending in vomiting or a sharp intake of breath, and it is known as the hundred-day cough for good reason. Worth considering in any adult with a prolonged paroxysmal cough, particularly if they have been around a child with one.
Occasionally, yes. TB has been rising in the UK, and the pattern to know is a cough lasting more than three weeks alongside fever, drenching night sweats and weight loss. It is more likely with a history of living in or travelling to a high-prevalence country, or close contact with someone who has had it. It is entirely curable, and it needs identifying rather than treating as a chest infection.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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