When should I see my doctor about that cough?

Coughs are one of the most common presentations we deal with as GP’s. Many patients are unsure about what is causing their cough or when to consult their doctor, so here is a guide. This explains some of the most common causes of cough, it does not replace seeing your doctor.

What is the most common cause of cough?


The most common cause of cough is acute bronchitis. This is a viral illness that tends to start with a sore throat (“pharyngitis” rather than “tonsillitis”). You could also feel fatigued and have a fever. Pharyngitis is often accompanied by “laryngitis”, which occurs when the vocal cords become swollen and can’t vibrate properly causing your voice to become hoarse. Anecdotally, I find the hoarse voice tends to be at its worst just as you start feeling better in yourself. The cough, or “bronchitis”, originates from the large airways in your chest (the “bronchi”) and can vary in severity. It often hurts and you may cough up coloured sputum. The fever and sore throat should settle within a few days to a week. The cough tends to linger longer, often for some weeks. This occurs because while the body has cleared the virus, the airways still remain sensitive and irritable for some time. Regular followers of my blog would understand that being a virus, antibiotics are not indicated and are likely to do more harm than good (antibiotic resistance). During the recovery phase you should be feeling well in yourself with the cough slowly tapering off over time, otherwise you should see your doctor.


What sorts of coughs require antibiotics?

If your cough persists for more than a week and particularly if your fever doesn’t settle and you continue to feel miserable, pneumonia may have developed as a “secondary” bacterial infection. Not all pneumonia requires hospital treatment and some can be managed with antibiotics at home. It depends on how sick you are and the type of pneumonia. The infection is diagnosed by the doctor listening to your chest with a stethoscope. Pneumonia changes the way air flows in and out of your lungs resulting in certain noises being audible to the doctor. This process is not infallible and sometimes a chest X-Ray is used to confirm the diagnosis. If you feel particularly unwell at the onset of your illness, don’t hesitate to see the doctor straight away as pneumonia can also be a primary infection.


What is whooping cough?


There are too many causes of cough to address them all in this guide but another important infection is whooping cough (or “pertussis”). This infection is quite common and I see many cases every year. Whooping cough causes a cough that can last for up to three months and can be life threatening to newborns and infants, which is why all new parents are immunised. The classic presentation of coughing fits with an inspiratory “whooping’ noise (sometimes resulting in a vomit) is rarely seen in our society as many of us are at least partially immune. Nevertheless, having a cough for such a long time is enough of a burden for me to recommend my patients receive a booster vaccination every 10 years.


Why are smokers more prone to cough?


Smokers are more prone to cough and chest infections. Even a small amount of smoking will damage the delicate ‘cilia’ in your airways. These are like fine hairs that gently move mucous from the bottom of your lungs. Cilia prevent secretions pooling in your airways so if they are damaged this encourages infection (How to quit smoking).


Can a chest infection worsen my asthma?


Those of you who suffer asthma will be aware chest infections will sometimes exacerbate your condition. Asthma rarely causes cough. It mostly results in wheeze and shortness of breath and can be triggered by a chest infection. All asthmatics should be aware of how to manage an exacerbation and may require assessment and extra treatment from their doctor if their usual puffers are not controlling their symptoms. You should always have an “asthma action plan” in place and review it at least annually with your doctor. If you frequently need to use your asthma reliever, you should see your GP to consider a preventer.


How are coughs spread?


Coughs are spread through the air or by touching contaminated surfaces. You are most contagious to others in the early part of your illness. Stay home and cover your cough by using your elbow rather than your hand to minimise the spread of infection to others. Coughing into your hand and then touching a surface can spread the germs.


Should I go to work (or school) if I have a cough?


When you’re unwell, it’s important to stay home and rest as this will help speed up your recovery. Staying home also benefits your colleagues. Although it may be difficult for you to take time off, think about the lack of productivity if your illness spreads through your workplace (or school) when you inevitably pass it on to numerous others causing a domino effect. According to this ABC podcast on ‘presenteeism’;the act of attending work while sick, costs the Australian economy approximately $34.1 billion per annum.


What is the best treatment for a cough?


Time and rest are the best treatment for coughs caused by a virus. Simple analgesia like paracetamol will help with fever and that viral feeling. Antihistamines can help dry nasal secretions if a “post-nasal drip” is causing an annoying tickle in the back of your throat, as can rinsing your sinuses with saline. Throat lozenges or a teaspoon of honey can also be useful. There is some evidence for the use of menthol-based chest rubs (such as ‘Vicks Vaporub’) but there is very little evidence to support the use of over-the-counter cough medicines. Only codeine syrup has been proven to suppress a cough effectively but it is rarely used except in cancer patients, as it is strongly addictive.


When will my cough go away?


The good news is that most people will be over the worst of their virus within a few days to a week; once your fever settles and you feel better in yourself you can return to work or school without starting an epidemic. As mentioned above the airways can remain sensitive for some time after the virus has cleared so most coughs don’t completely go away for at least 2-3 weeks despite feeling better in yourself. There are causes of cough that can persist much longer like whooping cough.


Can I exercise with a cough?


Here’s a good guide to when you can recommence exercise.


See your doctor about your cough


This article serves as an educational guide, and does not replace being fully assessed by your GP if you have any concerns about your cough.


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