Dr Matt

Coughs can be ir­ri­tat­ing when they per­sist – but when do they be­come a se­ri­ous prob­lem? DR MATT PICCAVER ex­plains

EDP Norfolk - - Inside - Dr Matt Piccaver

It’s a glamour-filled life for our hard-work­ing GP

I’VE BEEN im­mersed in a ca­coph­ony of coughs just re­cently. The win­ter months bring a fa­mil­iar sea of af­fected pa­tients, with the hope that spring will see the tide go out on this pool of af­flic­tions.

Cough­ing is the sound­track of my life. Con­sul­ta­tions are punc­tu­ated by hacks, grunts, and oc­ca­sion­ally of­fer­ings of green, sticky mu­cus in a hanky.

“I thought you might want to see this doc­tor?” A tis­sue is peeled open to re­veal a but­ter­fly of spu­tum. Ours is a glam­orous ca­reer. As much as I want to say no, it is oc­ca­sion­ally use­ful to have a sam­ple of spu­tum. Not all the time, I has­ten to add, but in cer­tain cir­cum­stances a sam­ple for the mi­cro­bi­ol­ogy lab­o­ra­tory can be very use­ful.

For most of us a cough might last a week or two, then grad­u­ally set­tle. It might be in the con­text of a cold or flu-like ill­ness; a sore throat, runny or blocked nose, sneez­ing, to­gether with a cough and the com­mon cold is prob­a­bly your likely cul­prit.

I of­ten get peo­ple wor­ried that they need an­tibi­otics be­cause they cough up a bit of ‘phlegm’. For the most part, the green or yel­low spu­tum is prob­a­bly not too much to worry about. It is pretty com­mon, and doesn’t nec­es­sar­ily mean we need to treat it with any­thing more than time and over-the-counter med­i­ca­tions. Red or brown spu­tum? Pos­si­bly blood, so it’s prob­a­bly worth get­ting in touch.

Many cases of cough will set­tle within about three weeks. We call this acute cough, and more of­ten than not it is down to an in­fec­tion, usu­ally a self­lim­it­ing, vi­ral ill­ness that doesn’t need much in the way of treat­ment. Over 12 weeks and we re­fer to chronic cough. Chronic refers to the time scale, not the sever­ity. Be­tween that is the sub-acute cough.

Acute coughs don’t al­ways need treat­ment, but if you’re cough­ing up blood, have a high fever, are short of breath or get­ting sicker in gen­eral, you prob­a­bly need see­ing. Peo­ple with un­der­ly­ing dis­eases such as chronic ob­struc­tive pul­monary dis­ease or asthma may need see­ing in case this rep­re­sents their ex­ist­ing con­di­tion caus­ing prob­lems. Smok­ers usu­ally come off worse, even with a cold, so there’s a good rea­son to stop smok­ing.

Chronic cough could be due to a mul­ti­tude of causes, any­where from asthma, chronic ob­struc­tive pul­monary dis­ease, prob­lems with al­lergy and nasal mu­cus, acid re­flux, or in some un­for­tu­nate cases, lung can­cer. The posters tell us to get a cough checked out if we’ve had it more than three weeks. For many of us in the trade this feels a bit too soon, but it is prob­a­bly a good idea none­the­less.

If you get to three weeks and you’re still cough­ing, what can you ex­pect to hap­pen if you visit your doc­tor? We’ll talk about the symp­toms and get an idea of the his­tory of the prob­lem. We will most likely ex­am­ine your chest, and we may or­der spe­cial tests such as a chest x-ray or even blood tests. Treat­ment de­pends very much on what we find.

So when should we worry about a cough? A cough of more than three weeks, par­tic­u­larly in a cur­rent or ex-smoker, should be ad­dressed, as should cough­ing up blood, high fevers and short­ness of breath. Un­in­ten­tional weight loss, in con­junc­tion with a cough which in­cludes cough­ing up blood ,might be a sign of lung can­cer, and needs to be ad­dressed rapidly.

For most of us, a cough may go as quickly as it comes. For oth­ers, it may be the har­bin­ger of more se­ri­ous ill­ness. If in doubt, get checked out.

Till next time.

For most of us, a cough may go as quickly as it comes

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