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When should you start worrying about that lingering cough?
Give it time.
By Jill U. Adams
December 23, 2013
You probably don’t need reminding that cold and flu season is
upon us. If, like me, you’ve already had your first bout of one of
these nasty bugs, you may be wondering: When will my symptoms
go away? Even as my sore throat and stuffy nose have cleared up,
my cough has lingered into a second week. It has disrupted my
sleep and kept me away from social events.
Two-plus weeks of coughing is quite common in most cases of
viral respiratory infections such as mine, says Matthew Mintz, an
internist with George Washington Medical Faculty Associates. The
average duration of cough, according to a recent study, is 18 days.
If you think that seems like a long time, you’re not alone. A
telephone survey by the same researchers found most people
expected a cough to last seven to nine days.
That dissonance between how long people expect cough to last
and how long it really does sends a lot of people to the doctor.
Cough is the most common patient complaint to primary-care
physicians and accounts for more than 30 million doctor’s visits
annually, according to the Centers for Disease Control and
Prevention.
Many people come seeking antibiotics. But if your cough began, as
mine did, with a cold and is dry and accompanied by fatigue and
muscle aches, then it is most likely related to that cold virus, and
antibiotics won’t help clear it up, says Christian Merlo, a Johns
Hopkins pulmonologist.
What about over-the-counter cough medicine? Mintz describes
two kinds of cough that linger after a cold.
One is a postnasal drip or mucus cough, in which your body’s
attack on the cold virus collects in your throat, triggering your
cough. Over-the-counter cough and cold medicines can help
lessen your symptoms by drying up the mucus and suppressing
the cough reflex. But they won’t make it go away completely — or
kill the virus that led to it.
The second kind of post-cold cough is called post-inflammatory
bronchospasm, and it resembles asthma. “It’s a tightening of the
airways that restricts air flow and is accompanied by cough and
wheezing,” Mintz says. It’s not asthma, which is a chronic
condition, but it’s similar enough that a short course (up to four
weeks) of asthma medicines — bronchodilators and/or steroids —
can help, he says. You might suspect that this is the problem if it’s
worse at night, if you’re wheezing and if you experience shortness
of breath, especially during exercise.
Home remedies such as hot water with honey and lemon or taking
a hot steamy shower can sometimes help alleviate coughing. But
there’s little clinical evidence demonstrating the effectiveness of
these approaches. Nor is there much risk in trying. “If it makes
you feel better, go for it,” Mintz says.
So when should you worry about cough? If it appears out of the
blue and takes hold of you for a couple weeks — and you are not a
smoker — or if post-cold coughing continues beyond three or four
weeks. Officially, chronic cough is defined as cough lasting for at
least eight weeks. In addition to the three problems below, cough
can occur with much more serious conditions, such as some
cancers and tuberculosis.
More than 90 percent of chronic cough cases are caused by one or
more of these three things: allergies, true asthma and reflux
disease. After taking a full history and perhaps a lung X-ray,
doctors will diagnose the problem step by step.
Merlo says that first he’ll recommend antihistamines, to address
allergies and resultant postnasal drip. If there’s no improvement
after a week or two, the next step is an inhaler for asthma. If the
patient still doesn’t improve, the next step is lifestyle changes and
reflux medications such as Prilosec or Nexium. That treatment
takes the longest to evaluate — up to six months.
While this three-step plan produces a diagnosis for the vast
majority of patients, an unfortunate minority is still left coughing.
Many of them have a puzzling condition called chronic cough
hypersensitivity syndrome, an overresponsive cough reflex. As its
name suggests, the condition causes people to cough more readily
than most and in response to triggers that others easily breathe
through. Peter Dicpinigaitis, a professor of medicine at the Albert
Einstein College of Medicine in New York, who sees many people
with the condition, says that “most of my patients have been
coughing for more than a year. Or 10 or 20 years” and that there’s
little effective treatment beyond prescription antitussives such as
codeine, which have unpleasant side effects.
For me, time was the cure. By the time I finished this article, my
cough was gone.
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