Dear Pamela: Can't shake lingering cough

Dear Pamela, 

I have had a chronic cough this spring that lingers in spite of taking more than one round of antibiotics.  I was diagnosed as having bronchitis a month or so ago. I’ve improved some; but I still cough much more than normal, and it interferes with my sleep. 

I’m hoping you can recommend more natural, plant-based things I can use to complement my conventional treatment. I am interested in approaches that might reduce inflammation and the frequency of my coughing. 

Any suggestions you have are very much appreciated. 

Sincerely,
Maxed Out on Meds

Dear Maxed Out on Meds,

Thank you so much for your question. Many of us in Southwest Virginia have been dealing with a chronic cough after an infection seems to have resolved, or medication regimen has been completed.  I appreciate your desire to complement your medical provider’s regimen with natural or plant-based options. Before you try any regimen, whether it is natural, plant-based, herbal, alternative, over-the-counter, etc, please check with your medical provider to ensure there is no risk of adverse reactions or interactions with your other medications.

Some suggestions that I commonly recommend to help reduce airway inflammation, loosen mucus, soothe cough reflexes, and improve sleep are plant-based, and I have listed below. Use these alongside (not instead of) your prescribed treatment and check with your provider if symptoms persist, worsen, or you have fever, difficulty breathing, or cough up blood.

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Herbal teas and hot drinks:

• Licorice root tea (If you have reflux try DGL or deglycyrrhizinated licorice — licorice root with the glycyrrhizin removed): acts as an anti-inflammatory and demulcent (a substance that soothes and protects irritated mucous membranes by forming a protective, mucous-like film). Limit prolonged use if you have high blood pressure.
• Marshmallow root tea: soothes irritated mucous membranes.
• Slippery elm tea: similarly demulcent for throat irritation.
• Ginger tea: anti-inflammatory and bronchodilator, you can add honey and lemon for extra soothing.
• Peppermint tea: mild antitussive and helps clear nasal congestion (avoid if reflux worsens).
• Green tea: contains antioxidant EGCG (Epigallocatechin-3-gallate) which is the most abundant and active catechin (a type of flavonoid) in green tea that reduces inflammation.

Steam, humidification, inhalation:

• A humidifier at night (set to 40 -50% humidity) to reduce airway drying and throat irritation.
• Steam inhalation (hot water + two to three drops of eucalyptus or peppermint oil) for short sessions — avoid oils if you have asthma or increased airway reactivity.
• Warm showers before bed can reduce nocturnal cough by loosening secretions.

Mucus-thinning and expectorant botanicals:

• NAC (N-acetylcysteine) supplement of foods that support glutathione (sulfur vegetables). NAC is not plant-based, but it is commonly used, please check with your provider first.
• Pelargonium sidoides (a South African medicinal plant which is a type of geranium used as an herbal remedy and is often sold as Umckaloabo) has been widely studied for acute bronchitis to help loosen mucus and reduce cough duration in some trials, as it may have antiviral, antibacterial, expectorant and immunomodulatory effects. It is generally well tolerated for short-term use, but possible side effects include gastrointestinal upset and rare allergic reactions or increase in liver enzymes, so this would need to be stopped if you develop a rash, dark urine, jaundice, or severe abdominal pain. Check with your provider before use if you have liver disease, are pregnant, breastfeeding, or take other medications. 
• Thyme (Thymus vulgaris) extract + ivy (Hedera helix) combos are commonly utilized in Europe as expectorants to loosen mucus, reduce cough, and ease bronchial spasms. It is appropriate for productive coughs, but less helpful for dry non-productive coughs, or coughing from uncontrolled asthma. Some possible concerns are around reflux or allergic reactions, especially people with allergies to plants in the Araliaceae family. And always avoid essential oil inhalation of thyme in young children and people with reactive airways.

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Soothing agents and cough suppressants:

• Honey: take 1-2 teaspoons before bed (NOT SAFE for children younger than 1-year-old). Effective for nocturnal cough suppression.
• Licorice, marshmallow, slippery elm (see above as lozenges or syrups to soothe the cough reflex).

Anti-inflammatory dietary choices:

• Increase omega-3 rich plant foods: chia, flaxseed, walnuts.
• Eat colorful fruits and vegetables (berries, leafy greens) for antioxidants.
• Minimize foods that increase inflammation such as processed foods and foods high in sugar or trans-fats. Also avoid intake of excessive dairy items if it causes thick mucus. 

Breathing exercises and physical measures:

• Diaphragmatic (belly) breathing and pursed-lip breathing exercises can improve airway mechanics and reduce cough triggers. 
• Controlled coughing and huffing techniques can clear mucus more effectively than just coughing when a spasm occurs. Chest physiotherapy techniques for bronchitis can help loosen/clear mucus, improve ventilation, and reduce cough frequency.
  • Active cycle of breathing techniques (ACBT)
    • Breathing control: gentle diaphragmatic breathing for 20 – 30 seconds to relax airways.
    • Thoracic expansion exercises: 3-4 deep breaths in, with 2 - 3 second breath-hold, and passive exhale.
    • Forced expiratory technique (huff): one or two huffs from mid to low- lung volumes (“huff” like fogging a mirror) to move mucus towards your larger airways. Repeat this cycle 3-4 times, and finish with huffs and a controlled cough if needed.

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Allergy and reflux checks:

• Consider whether postnasal drip or allergic rhinitis is contributing to your cough. You may try nasal saline irrigation and talk to your provider about nasal steroid sprays or antihistamines to help reduce cough. 
• If cough is worse at night or with meals, consider reflux management such as avoid eating within 4 hours before bedtime, cut down on caffeine, alcohol, spicy foods, etc.

Lifestyle supports:

• Avoid smoke, strong perfumes, cleaning chemicals, and cold dry air.
• Maintain good hydration (aim for clear or light-colored urine) to thin secretions.
• Address sleep hygiene and nasal breathing at night.

Safety and interactions:

• Tell your medical provider about herbal supplements since some of them like licorice, large doses of herbs, thyme/ivy extracts have drug interactions or side effects. 
• Stop any new herb if you develop rash, increased heart rate, dizziness, or worsening breathing.
• If you take blood thinners, immunosuppressants, or have cardiovascular  disease, are pregnant, or have severe hypertension, check with your provider before using supplements like licorice, high-dose ginger, or herbals with anticoagulant properties. 

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Supplements and adjuncts (optional, choose 1–2, and discuss with provider)

• NAC 600 mg once or twice daily (ask provider).
• Pelargonium sidoides per label.
• Omega3 (plant sources daily: flax, chia, walnuts).

Quick symptom-management tools

• Honey 1 tsp at bedtime for nocturnal cough.
• Slippery elm/marshmallow lozenges for throat soothing.
• Nasal saline rinse for postnasal drip before bed if relevant.

Safety reminders

• Stop licorice (nonDGL) if you have high blood pressure, low potassium, or take a diuretic or water pill.
• Check herb-drug interactions (anticoagulants, immunosuppressants,  heart meds).

When to seek urgent care:

• Worsening shortness of breath, fever, bloody sputum, chest pain, or cough lasting more than 8 weeks — see your clinician or urgent care.

Very truly yours,

Disclaimer: The information provided in this article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider.