Is a Lingering Cough Normal?

Last week, you had a miserable cold. Thankfully, this week, you feel much better. Your sneezing, stuffy nose, congestion and fatigue have gone away, but you just can’t seem to shake the cough. Considering it’s been almost two weeks since the start of your cold, you call the doctor to get an antibiotic. After all, the cough should be gone by now, shouldn’t it?

Not so fast. According to new research released in the Annals of Family Medicine, that lingering cough is actually quite normal, and most people’s perception of how long the cough should last is way off base.

In their study, researchers from the University of Georgia performed a systematic review of existing data that showed how long acute coughs normally last in people who had no bacterial infections. In addition, they polled 493 adults to learn their expectations on how long an acute cough should last if they are not taking any medicine.

In their analysis of existing research, they found that the average duration of an acute cough was 17.8 days. In contrast, the people polled stated that they expected a cough to last, on average, 7.2 to 9.3 days.

So clearly, there is a mismatch between what is normal in terms of cough duration and what people think is normal.

Why is this a big deal? Well, while many people are aware of the dangerous implications of antibiotic misuse, a large part of the population still wants a “quick fix” for their bothersome symptoms. As a result, antibiotics are being prescribed for coughs, even though these medications are usually unnecessary.

Furthermore, as the authors of the study noted in their report, “the mismatch between patients’ expectations and reality for the natural history of acute cough illness has important implications for antibiotic prescribing.” By this, they mean that if a patient believes that his cough should go away in 7 to 9 days (as the poll stated) and it hasn’t, he is more likely to go to the doctor to get a 10-day course of antibiotics. He begins feeling better after four days on the medication and the cough is fully resolved after 10 days. But is it really the antibiotic that made the cough go away, or was it just that the cough went through its natural duration period—17 to 18 days—and resolved itself? According to the researchers, it is likely the latter.

The researchers stress that physicians need to do a better job of explaining the natural duration of an acute cough so that patients understand that it’s perfectly normal for a cough to be present a few weeks after its initial onset. Doing so will reduce the needless prescribing of antibiotics and reduce the risk of antibiotic resistance.

Caveat: If your cough is accompanied by high fever, shortness of breath or bloody sputum, you should seek your doctor’s counsel. These additional symptoms actually could signal a bacterial infection, and an antibiotic would be warranted in these cases.

So next time you have a cold and feel like you just can’t shake that cough, give it another week or two. More likely than not, you’ll notice it will disappear on its own, no medication needed.

Source:

Ebell MH, et al. How long does a cough last? Comparing patient’s expectations with data from a systematic review of the literature. Ann Fam Med. 2013 Jan;11(1):5-13.