Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
We all get coughs and colds – 3-4 times a year for the average adult. Most settle without treatment but there are certain “red flags” that need checking out.
For instance, a cough with sharp, stabbing chest pain when you breathe (not cough), coughing up blood or a sudden increase in shortness of breath could signal pneumonia or a clot on the lung. Don’t delay in getting these checked.
Far more worrying for most is a chronic cough. Many of my patients use the term “chronic” to mean a condition is severe; for doctors, it’s all about how long it has gone on for. If you’ve had a cough constantly for more than 8 weeks, your doctor will describe it as chronic, and they’re likely to be looking for other causes than a cold.
Smoking is top of every doctor’s list as the culprit for chronic cough. The long term lung condition COPD, which causes cough, shortness of breath and wheeze, is usually but not always down to smoking. If you have given up, you could still develop COPD – but your risk is reduced and if you do get it, symptoms will be less severe. If you have a chronic cough, have ever smoked and are over 35, your GP may well arrange a spirometry test to look at your total breathing capacity and how fast you can blow out. If COPD is diagnosed, they’ll probably prescribe inhalers – and stopping smoking! One group of medicines called ACE inhibitors, used for high blood pressure (their names all end with -pril, like rami-pril) can cause a persistent tickly cough. This
COUGHING UP COLOURED PHLEGM DOESN’T MEAN YOU NEED ANTIBIOTICS IF YOU DON’T HAVE “RED FLAGS”– VIRUSINFECTIONS CAUSE THIS TOO.
can develop weeks or even months after you start taking the medication regularly. Changing to a related blood pressure tablet should solve the problem.
Asthma usually starts in childhood, but can occur, or come back, later. Although the most common symptoms are shortness of breath and wheeze, it can occasionally be to blame for a cough with no other symptoms. Unlike COPD, people with asthma have normal breathing some of the time. If you have a chronic cough and were diagnosed with asthma in childhood, let your GP know even if you haven’t had symptoms for years. It can be brought on by something you are allergic to at work – socalled occupational asthma. Cough, breathlessness or wheeze that eases at weekends or on holiday is a clue.
Next on the list is a cause that’s nothing to do with your lungs. Heartburn or a hiatus hernia can cause acid to reflux into the back of your throat, irritating the voice box. It’s more likely if you suffer from burning pain behind your breastbone or at the top of your tummy, but cough may be the only symptom you get. It’s often worse during or after eating. If your doctor suspects this, they’re likely to prescribe medicine that suppresses acid production in your stomach.
Less likely is “postnasal drip” – mucus related to sinusitis, nasal polyps or allergies. Less common still are whooping cough, which causes spasms of intense coughing that can last several months; heart failure, usually accompanied by breathlessness on lying flat or exercising and swollen ankles; and rarer lung diseases like bronchiectasis.
Everyone fears cancer as a cause of cough. This is unlikely if you’re otherwise well. But if you have a cough with loss of appetite, unexplained weight loss, tiredness, chest pain or coughing up blood, do see your GP. Next issue: IBS – What’s The Latest?
IF YOU’RE OVER 65 OR HAVE A LONG TERM CONDITION, GET YOUR FLU AND PNEUMOCOCCAL VACCINE TO PROTECT AGAINST CHEST COMPLICATIONS.
SMOKING IS AT THE TOP OF EVERY DOCTOR’S LIST AS THE CULPRIT FOR CHRONIC COUGH’’