A cough that won’t go away – when should I seek help?
While we think of coughs as troublesome, they’re actually your body’s way of protecting your airways, getting rid of foreign bodies including germs. Coughs lasting under three weeks are most commonly down to viral infections, but when should you seek medical help?
Coughs, like taxes, are a fact of life. Kids get them more often than healthy adults (with up to eight a year) because their bodies are still building up immunity to the germs that cause them. But there are over 200 different viruses that can cause coughs and colds, so nobody is ever immune to all of them.
Most coughs that accompany a cold will settle in one to two weeks. It’s not uncommon to be infected with more than one virus at the same time, so symptoms may overlap and last longer from start to finish. They’re almost all caused by viruses, so antibiotics don’t do any good at all. In fact, we can’t ‘cure’ them, but there are a lot of things that you can do to help relieve the symptoms.
Your pharmacist is the expert here – they can advise you on all sorts of remedies, depending on what combination of symptoms you have. For instance, with a chesty cough you bring up yellow or green phlegm or mucus, while a dry, tickly cough usually doesn’t come with any sputum. You’ll get best results from cough mixtures designed for the kind of cough you have. You may also find that your cough gets worse at night – this is because when you’re upright during the day, the mucus from your nose trickles down the back of your throat and you swallow it. At night when you’re lying down, it trickles on to your soft palate and stimulates your cough reflex. If you’re kept awake by coughing when you lie flat, make a nest of pillows so you’re propped up. Being cold for long periods may increase the chance of illnesses like chest infections – so don’t sleep with the window open! However, there’s no reason to avoid going out entirely if you have a cold, as long as you’re well wrapped up.
What is a chronic cough?
About one in 10 people have a chronic cough (lasting over three weeks). This can be down to an allergy like hay fever, which is closely linked with asthma. Asthma usually causes breathlessness and wheezing, but cough can be a sign.
Chronic obstructive pulmonary disease (COPD) is a chronic lung condition, usually (but not always) caused by smoking. One of the early symptoms is usually a chronic cough with sputum, which often comes and goes at first and then becomes persistent. In the early stages you may get breathless just when you exercise, but this will get worse without treatment. If you’re over 35, have ever smoked and have a chronic cough, you should see your GP to get a breathing test called spirometry. Inhaled medicines will help, but the most effective way to stop it getting worse is to stop smoking – there’s lots of help available.
If you have COPD, you’re more prone to bacterial chest infections which can make your breathing worse. If you start coughing up more sputum or it changes colour, your GP is likely to give you antibiotics and, if your breathing worsens, a course of steroid tablets. She or he may recommend you keep a supply at home to start straightaway.
Chronic cough can also be caused by reflux, where acid from your stomach leaks upwards into your gullet. It can also cause heartburn and a nasty acid taste in your mouth, but sometimes the main symptom is a dry, tickly cough. Do mention to your doctor if you have any other symptoms of heartburn accompanying your cough – often a course of acid suppressant tablets can relieve symptoms.
Sinusitis – inflammation of the lining of the sinuses around your nose – can give rise to a blocked nose, pain over the sinuses and mucus dripping down the back of the throat. This can lead to chronic cough.
At least once a week, I have a patient in who’s worried their cough is due to cancer. It rarely is – other causes are much more likely. However, always see a doctor if your cough is accompanied by coughing up blood or rusty-coloured sputum; wheeziness or difficulty in breathing; or sharp stabbing chest pain when you breathe (rather than when you cough).
The National Institute for Health and Care Excellence (NICE) has brought out new guidelines on when cancer should be suspected. They recommend you should have a chest X-ray within two weeks if you’re over 40 and have two symptoms out of cough, shortness of breath, tiredness, chest pain, weight loss or loss of appetite. If you’re over 40 and have ever smoked, just one of these symptoms should trigger a referral for chest X-ray. However, be aware that the proviso is that the symptoms should be unexplained – so a cough for a week or two accompanied by other symptoms of infection with a virus (runny nose, fever etc) doesn’t raise the same alarm bells.
With thanks to ‘My Weekly’ where this article was originally published.