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