Based on PubMed | Is cough a symptom of Crohn’s disease, and what might cause it in someone with Crohn’s?

Cough is not considered a typical symptom of Crohn’s disease, which mainly affects the digestive tract with problems like diarrhea, abdominal pain, weight loss, and fatigue. ^{[1] [2]} However, cough can occur in people with Crohn’s for several reasons, including rare lung involvement from the disease itself and side effects or infections related to medications used to treat Crohn’s. ^{[3] [4]}

What is typical for Crohn’s

• The most common symptoms are diarrhea, abdominal cramping or pain, and weight loss. ^[1]
• Other recognized symptoms can include fatigue, fever, mouth sores, and blood in the stool. ^[2]
• These core features reflect inflammation in the digestive tract rather than the lungs. ^[5]

When cough can be related to Crohn’s

Cough is usually unrelated to intestinal inflammation, but there are important exceptions to be aware of:

• Pulmonary (lung) manifestations of IBD: Inflammatory bowel diseases, including Crohn’s, can occasionally involve the airways and lung tissue. Typical pulmonary symptoms in these cases include a productive cough, chest pain, and shortness of breath. ^[6] Such lung involvement is uncommon but recognized as an “extraintestinal manifestation” of Crohn’s. ^[3]
• Airway disease and bronchiectasis: The most frequent lung manifestation reported in Crohn’s is bronchial inflammation and suppuration (pus-forming airway inflammation), sometimes with bronchiectasis, which often presents with chronic cough and sputum production. ^[3]
• Interstitial lung disease (ILD): Rarely, Crohn’s is associated with ILD (inflammation/scarring of lung tissue), which can cause cough and progressive breathlessness. ^[7]

Medication-related causes of cough in Crohn’s

Many people with Crohn’s take immune-modulating medications, which can themselves cause respiratory side effects:

• Methotrexate: This medicine can cause lung toxicity; an early warning sign is dry, nonproductive cough, which requires stopping the drug and prompt evaluation. ^[8]
• Anti-TNF biologics (e.g., infliximab, adalimumab, certolizumab): These increase susceptibility to lung infections, which can present with cough, fever, and breathing issues. ^{[9] [4]} Rarely, anti-TNF therapy has been associated with noninfectious interstitial lung disease; reported cases improved after stopping the drug and using steroids. ^[10]
• 5-ASA drugs (mesalamine/sulfasalazine) and azathioprine: Noninfectious lung reactions have been described with these agents, though they are uncommon. ^{[7] [3]}

How common is lung involvement in Crohn’s?

• Lung problems are rare compared to intestinal symptoms, but they span a wide range from subtle changes to airway disease, parenchymal (tissue) disease, pleural inflammation, and medication-related issues. ^{[11] [3]}
• In many people, lung symptoms may parallel Crohn’s activity, but they can also occur at different times and may be overlooked. ^{[6] [3]}

What to do if you have cough and Crohn’s

• Assess for common causes first: Viral colds, seasonal allergies, asthma, GERD (acid reflux), and smoking are far more frequent causes of cough than Crohn’s itself. (No citation)
• Consider medication side effects: If you are on methotrexate and develop a new dry cough, seek medical evaluation promptly, as methotrexate lung toxicity can be serious. ^[8] If you are on anti-TNF therapy and develop cough, fever, or shortness of breath, you should be evaluated for possible lung infection. ^[4]
• Screen for rare Crohn’s-related lung disease: If cough is persistent, productive, or accompanied by chest pain or progressive breathlessness, clinicians may consider chest imaging (CT) and bronchoscopy to check for airway inflammation or other pulmonary manifestations. Early work-up is recommended because some cases can progress quickly. ^[6]
• Treatment options: When lung disease is linked to Crohn’s activity, steroids (inhaled or systemic) are commonly used and can be effective; choice depends on the specific pattern (airway vs. interstitial). ^[3] For drug-induced ILD, stopping the offending medication and treating inflammation (often with steroids) is standard. ^[10]

Key takeaways

• Cough is not a typical Crohn’s symptom, but people with Crohn’s can develop cough from rare lung involvement, medication side effects, or infections related to immunosuppressive therapy. ^{[1] [3]}
• Medication vigilance matters: A new, unexplained dry cough on methotrexate needs prompt attention, and cough with fever on anti-TNF therapy warrants evaluation for infection. ^{[8] [4]}
• Don’t ignore persistent respiratory symptoms: Inflammatory airway disease associated with Crohn’s can present with productive cough and may require imaging and targeted treatment. ^{[6] [3]}

If you’d like, I can help you review your current Crohn’s medications and recent symptoms to narrow down the most likely cause of your cough?