GLP-1 Drugs Associated with 12-32% Higher Risk of Chronic Cough vs Other Diabetes Drugs | Research

The takeaway

In 427,555 matched patients, GLP-1 RA use was associated with 12% higher chronic cough risk vs other diabetes drugs, rising to 29% when excluding reflux patients, suggesting a GLP-1-specific cough mechanism.

29% higher without reflux
After excluding reflux patients, GLP-1 users still had significantly higher chronic cough risk, suggesting a direct mechanism

What the researchers found

GLP-1 RA use associated with chronic cough: aHR 1.12 vs all non-GLP-1 drugs; 1.18 vs DPP-4i; 1.32 vs sulfonylureas. After excluding GERD: aHR 1.29 vs all; 1.36 vs DPP-4i; 1.14 vs SGLT2i; 1.25 vs sulfonylureas.

Why it matters

With millions taking GLP-1 drugs, even a modest cough risk affects many patients. Identifying this association helps clinicians recognize and manage this underappreciated side effect.

How the study worked

Large multicenter cohort study using US EMR data (2005-2025, 70 organizations), propensity-matched comparisons of 427,555 GLP-1 users vs 1,614,495 other second-line diabetes drug users, with Cox regression.

What this study cannot tell us

Observational design. Cannot prove causation. Chronic cough has many potential causes. ICD coding may not perfectly capture chronic cough.

How to read the evidence

Very large propensity-matched cohort study with multiple comparator groups and sensitivity analyses. Strong observational evidence for a novel association.

When this study was published

Published in 2025 using data through April 2025.

The bigger picture

This is the first study identifying chronic cough as a GLP-1-specific adverse effect, potentially mediated through vagal nerve stimulation independent of reflux.

Questions still open

What mechanism causes GLP-1-related cough independent of reflux?
Is the cough dose-dependent or specific to certain GLP-1 agents?
Should patients with chronic unexplained cough on GLP-1 drugs consider switching?

Common questions

Can GLP-1 drugs like Ozempic cause chronic cough?

This large study found a 12-32% higher risk of chronic cough with GLP-1 drugs compared to other diabetes medications. The risk persisted even after excluding patients with acid reflux, suggesting a direct drug effect.

What should I do if I develop a cough on a GLP-1 drug?

Report persistent cough to your doctor. While the risk increase is modest, GLP-1 drugs should be considered as a potential cause of unexplained chronic cough, especially if it started after beginning the medication.

Read the original research

Glucagon-Like Peptide-1 Receptor Agonists and Chronic Cough.

JAMA otolaryngology-- head & neck surgery, 152(2), 163-171

View on PubMed ↗Publisher’s paper ↗

Citation

Gallagher, Tyler J; Razura, Diego E; Li, Albert; Kim, Ian; Vukkadala, Neelaysh; Barbu, Anca M. (2026). Glucagon-Like Peptide-1 Receptor Agonists and Chronic Cough.. JAMA otolaryngology-- head & neck surgery, 152(2), 163-171. https://doi.org/10.1001/jamaoto.2025.4181