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You may think your cough ought to last no more than a week, but the actual duration of a typical cough is nearly 18 days, and could be more than three weeks, a study finds.
If you’re a victim of this year’s terrible flu, or any of the other nasty bugs causing general respiratory distress, Dr. Mark Ebell sends his sympathies.
But if you’re tempted to head to the doctor to demand drugs for the hacking cough that came with your illness, he’s got another message: Wait a little longer.
A new study shows that although most people think a cough ought to last no more than a week or so, the duration of the most annoying symptom of winter illness is about 18 days -- and could be more than three weeks.
Taking antibiotics in the interim is not only ineffective, it could also prompt dangerous side effects -- and contribute to the country’s growing problem with bugs becoming resistant to the drugs used to treat them.
That’s according to a new study by Ebell, an associate professor at the University of Georgia College of Public Health, which sought to define the gulf between public perception and reality when it comes to coughing.
“A lot of times patients will come to me and they’ve been coughing for four or five days and they’re not getting any better, so they ask for an antibiotic,” he said. “After eight or nine days, they’re still not feeling better, so they ask for an even stronger antibiotic. Then they’ll say, ‘The only thing that really works for me is this really strong antibiotic.’”
The trouble is, antibiotics aren’t actually the solution for most of the 3 million outpatient cases in the U.S. each year in which cough is the chief complaint, or for the more than 4.5 million outpatient cases diagnosed as acute bronchitis or bronchiolitis. More than 90 percent of such cases are viral, not bacterial, which means they won’t respond to the drugs most folks request, according to the Centers for Disease Control and Prevention.
Ebell decided to pursue the study, published Monday in the journal Annals of Family Medicine, after noticing the disconnect between how long people thought coughs should last and how long they actually lingered.
When he surveyed nearly 500 Georgia residents by phone, he found that they predicted that a cough would last between five days and nine days, but generally about a week, depending on the scenario.
A review of 19 published medical studies, however, revealed that the mean duration of any cough was 17.8 days, with a range of 15.3 to 28.6 days.
If a person demanded -- and received -- an antibiotic after he or she had been sick for a week, the condition might improve several days later -- but not because of the drug, Ebell said.
“Although this outcome may reinforce the mistaken idea that the antibiotic worked, it is merely a reflection of the natural history of acute cough,” he said.
Convincing people of that fact is tough. In Ebell’s study, a quarter of participants thought that antibiotics were "always helpful" and about 44 percent said they were "always or usually" helpful.
That ignores the reality that antibiotics won't affect viral infections, and also that they can cause harmful side effects, including allergic reactions and the life-threatening gut condition called C. difficile, Ebell said. Plus, overuse of antibiotics is contributing to conditions such as drug-resistant pneumonia and other infections.
Crystal Thompson, a 34-year-old kindergarten teacher in Fort Worth, Texas, says that she’d start to become concerned if a cough lasted more than a few days.
“I would think no longer than a week,” said Thompson, whose family is just now getting over this year’s severe flu. “If it lasted longer than a week, I’d be in to the doctor.”
But Thompson said she also understands the difference between a viral infection and a bacterial one and that she’d follow her doctor’s advice about antibiotics.
In general, Ebell said he tells patients that they likely don’t need an antibiotic unless symptoms turn serious, with shortness of breath, high fever or bloody or rusty phlegm.
It’s important to get the message out about the actual duration of a normal cough, said Dr. Gustavo Ferrer, director of the new cough clinic at the Cleveland Clinic’s Weston, Fla., site. Ferrer, who was not involved with Ebell’s study, praised it as “beautiful” way to remind the public that there’s not a drug solution for every symptom.
“We have come to the conclusion as a population that we don’t want to be sick for one hour,” he said. "In reality, people want those symptoms to go away right away."
Still, cough docs know that patients come for some relief. Ferrer said that antihistamines such as Benadryl can help dry up airways, reduce coughing and help people sleep. Cough drops – especially those with honey and herbs – can help during the day, he added.
Ebell said he and other docs have come up with a range of ways to discourage demand for antibiotics. They’ll call the infection a “chest cold” instead of acute bronchitis. They’ll agree to write an antibiotic prescription -- but then tell patients to wait.
“If you feel that you’re really not going to get them out of the office without a prescription, give them one and say ‘Don’t fill it for a few days,’” he said. “About half never fill it at all.”
Related stories:
- 5 things do to (and 5 not to do) when you have the flu
- Flu spreads to 47 states, but may be waning
- Flu jab isn't perfect by a long shot, health officials admit
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The cough medicines sold over-the-counter are absolutely worthless. When I get a cold, none of them are effective at suppressing a cough - maybe because they use the same worthless "active" ingredient. I really don't understand how they ever got approval for any of them. Instead you have to pay for a doctor visit to get a prescription for something that can actually suppress a cough.
Buying over-the-counter stuff, both in liquid and capsule form, was a total waste of my money.
I've been sick since before Christmas, and am now about a week over the 18-day advice given by the article. I was diagnosed with bronchitis last week and given Albuterol inhalers, cough syrup with codeine, steroids and antibiotics, though about all they did was clear up the overall congestion--the rattling cough remains. They also gave me nebulizer treatments with Albuterol and some other drug.
Given that I don't smoke (anything) and there are people out there sucking in nicotine and marijuana with their healthier lungs, I do find myself resentful when walking past the smoking areas these days, since I can't even draw in a full breath of air.
Maybe instead of giving these patients unneeded antibiotics just to get them to go away, the doctors need to take responsibility for what they are doing and stand their ground if the patient does not need the drugs. Maybe giving the person a prescription cough syrup with codeine in it would be more appropriate and would also actually help stop the cough. Any doctor who is writing prescriptions for antibiotics when they are not called for just because the patient is pressing for them and they want to get the patient off their back should have their license revoked. Doctors should not be writing inappropriate prescriptions simply because some patient was demanding it. The doctor is supposed to be the professional that tells the patient what they need, not the other way around.
As a RN, it's been my experience that a good physician will order a sputum sample and have it cultured for bacteria that may be the cause of the cough. In the interim, a prescription cough syrup should help until the lab results come back. MD's should not be routinely prescribing antibiotics for most coughs.
My 85 year old mother has it and I am trying my best to keep her from coughing to hard. I then got it from her. Been to the doctors office twice in 7 days with her just to make sure she isn't getting pneumonia. Will go back there on Thursday so the doc can give a listen to her chest again.
Stopping the coughing can set you up for pneumonia. If you don't get the flem and all cleared from your respitory system you will have bigger problems.
The big problem is that the ONE and ONLY ingredient that effectively suppresses a cough is CODINE. PERIOD! Unfortunately, with all of the publicity around prescription drug abuse, doctors are becoming more and more reluctant to prescribe medications that are based on narcotic ingredients. I've had to insist on this medicine armed with a printout of a recent article that declared all other cough medicine worthless (if not harmful). If I've been hacking so bad that my airway has become inflamed, I also insist on a long acting steroid injection. It pisses me off that I have to instruct my Dr. on proper treatment of an elementary illness.
Actually, menthol cough drops work quite well for me, at least, esp Halls. I have idiot co-workers who think they need to run to the dr. to get antibiotics when they're sick, not understanding that most respiratory illnesses/symptoms are actually viruses, or increasingly, allergies, on which antibiotics have no effect. I just keep my mouth shut, though, as I don't have enough energy anymore to counter the stupidity. We'll all be coughing more with climate change, as the atmosphere warms, plants crank out pollen, molds grow.
Hippocrates put it best: "First do no harm". Great study here and important message for patients and health care providers alike. We, as health care providers, need to give patients the right information, and in many cases, may mean TLC, education, and no prescriptions. Check out the Choosing Wisely campaign too.
-Ben Green, MD
Well said on saying no medicines for many issues! It's easier to hand out pills and liquids when they either don't help or do harm. I know many people who felt bad, got prescriptions, and then really ended up sick. Or they end up with several toxic medicines that when taken together are basically poison.
And you are right on the TLC. I am fine with a compassionate and educated doctor telling me to wait something out if s/he understands I will let someone know if something feels off, and I appreciate being treated with respect and not shoved out the door with a pile of toxic pills that may make me worse anyway. I'm not saying that medicines are never the answer, but our bodies are often able to heal if we treat them well and listen to them. It's too bad that many doctors have lost the TLC part of the equation, and I am glad you added it to your post. Education, compassion, and really listening to patients goes a long way toward being an effective healer.
If your doc say's you don't need antibiotics, LISTEN TO HIM/HER! They have the degree, you don't.
I am sure those recent flu victims that died of pnemonia would argue. One place, they sent a kid home from the ER with tylenol. Thats why they call it practicing medicine. They get to practice on you, if you die its a shrug of the shoulders. OOps I made a mistake - no skin off my me. A lot of stup id people have degrees including a lot of st up id doctors who won the lottery and got into med school.
My guess would be that, since the flu is a virus, the pneumonia was viral, as well. If that was the case, antibiotics STILL would be unwarranted and ineffective against a virus. Exactly what do you think the ER should have sent the child home with? We've already ruled out antibiotics, and tamiflu wouldn't be an option if the flu symptoms began more than 3 days before.
Many people die of a secondary bacterial infection so the pneumonia could possibly be bacterial.
I chew cloves. A lot of cloves. Almost about 200 of them. It scrapes off the top of my tongue but my cough is gone in 2 days with few symptoms during the time i am chewing the cloves. And it does not come back for 2-3 years. Why we continue using a cough syrup, i dont know.
Well, if I chewed cloves I would throw up..lol. I can't stand even a sniff of the scent of them. I would rather cough. I'm glad they work for you, though:)
Reminds me of poison ivy. If you go to the store and get one of those creams, the rash is gone in about 14 days. But if you do nothing, it takes a couple of weeks for it to fade away.
Get SuperIvyDry. It's awesome for poison ivy/sumac/oak.
I had poison ivy all over my body two summers ago. I thought I was immune. WRONG! I used baking soda, hot and cold water, Caladryl, and oatmeal over three weeks. I had to go to my OBGYN (I was pregnant at the time) to get on steroids. Soon after that, I miscarried :/
I am 63, and as a child, I remember my family doctor (who made house calls believe it or not) said that a cold will last 21 days, or three weeks...whichever is the shortest. Dr. Boysen was wise!
This is why we are seeing antibiotic resistant bugs now. Over prescribed antibiotics for viral infections for which they are completely ineffective.
I had a cough that was so terrible I would vomit from the coughing & I refused to go to the dr b/c I felt it was just a cough from a head cold & it would go away. after almost 3 weeks of listening to me the hubby said go to the dr I'm sick of listening to you lol...my fear was I'd let it go to pneumonia or bronchitis & of course they gave me an antibiotic & inhaler...I hate taking antibiotics & honestly I think the inhaler did much more for me. & yes OTC cough syrup is pretty worthless.
We all know what it's like trying to disabuse an ignorant person of something they know to be true. It's too bad doctors can't prescribe sugar pills like priests prescribe prayer.
On my 16th day of coughing
Absolutely 100% disagree, even with the physicians. Just because they have a medical degree doesn't mean they know the best advice. In other countries, antibiotics are freely available. I used to think this way- the wait and see approach- since I rarely take any medicine. However, one day my eight-months pregnant wife and I both got the real flu - at the same time. One doctor said we didn't need tamiflu since i tested neg. We got another doctor, got tamiflu, and it made a difference right away. It was absolutely most horrendous illness we ever had. Next, with antibiotics - they work like a miracle for me and my kids. RIght away the infection retreats. There's no sense in waiting- for the last few years I've hit it right away with the medicine and my life has been immensely healthier. This year, my son and wife and I got flu-ish at the same time. I took tamiflu again and the headache and fever were gone the next day. Whoever tells me I'm wrong can call me in ten years to see if I died from this medicine- it's never happened to absolutely anyone I'ver known or read about- not a single person has died from antibiotics or tamiflu. Also, it's a complete farce that we're creating superbugs. There are all sorts of other influences on bacteria that will spawn them to mutate. To think it's only antibiotics is ridiculous- it's an influence, sure, but more of an influence is just keeping yourself clean. For those of us working parents who have kids in school and jobs- don't wait- you'll be miserable and you'll be weaker. Being sick is anomaly to the human condition- it's nothing to wait for around for.
Well, glad you cleared up decades of medical research by people with years of training. Good thing we've got you to tell us the real truth.
Tamiflu worked for the flu because it isn't an antibiotic. It's antiviral medication. Antibiotics won't do a thing for the flu, but they might kill some of your useful digestive bacteria, or help create superbugs. But you know, your single anecdote I'm sure overcomes decades of scientific research and education.
Really? Decades? How long have we have had tamiflu? Invented in 1996. How long for antibiotics? Invented in the 1940's- probably widespread in the 1960s. So they have decades of research? I don't think so- my parents and grandparents have just as much experience. But you know why I make this point- not once - maybe perhaps a time or two - has a physician ever followed up with me on medication. Rarely if ever do they follow up with you to see if it works - there is no feedback loop- and that is a real problem.
Here's the thing, Bart, about your "feedback loop" idea: it should not be your doctor's responsibility to call you (a presumed adult, since you reference having a wife and children) to see if a medication is working. By not hearing back from you after taking a medication, that IS your feedback to your doctor. I would dare say the vast majority of us would call the doctor if something wasn't working, so the doctor shouldn't have to follow after us like a mother hen. My children's pediatrician, for instance, will make rounds on his patients at the hospital, come see patients until 6-7 at night, then make rounds again on his hospital patients. Many, many doctors do this. When do suppose he should call all the parents to check and see if little Jimmy is responding to the amoxicillin? If it's necessary, he tells us to make a follow-up appt in 2 days (or however long he wants to give the situation before re-evaluating). He has never once called me to check on whether a medication is working - want to know why? Because I call him if it isn't, that's why. And I will put him up against any pediatrician on this planet in terms of his clinical skills - as long as he's practicing, my children will be his patients.
Acupuncture is quite effective in treating cough. The common cold is also treatable w/ acupuncture, which shortens the duration of the cold and alleviates the symptoms, with no side-effects. Best results in treating the cold are obtained within the first few days of onset.
I have treated many people, including myself, for cough and common cold, and obtain consistent results.
danielg-886915-thank you! Eastern medicine has so many wonderful applications for any symptom whether cold or trauma. Me and several of my friends have been involved in medicine for years and have tried to teach everyone the benefit of "alternative" therapies only to be dismissed. I've witnessed how it works first hand and couldn't be happier with the results. For those of you who are skeptical, try it. Western medicine is so hell bent on treating symptoms rather than the cause. Throw a pill at it and it'll go away. I truly believe there needs to be a balance between eastern and western medical philosophies if you want to do what's best for your patients.
With acupuncture, your cold is gone within 7 days!
Without acupuncture, it may take you as long as a week to get rid of it.
There was one cough syrup that works pretty well if you can find it. It is called "creomulsion." It tastes horrible and was probably invented a hundred years ago, but it worked better than any other. During one flu I had, I'd soak in a really hot bath, head in water; and the hot water would help melt the mucous so I could cough and blow it out easier. Try that once a day. It helps clear it out faster.
All the warnings on the OTC medications for cold, flu and cough "See your doctor in seven days if symptoms worsen, tend to reacur, or are accompanied by a fever" is what sends people to the doctor if they aren't completely better. Wonder how many OTC drugs parent companies produce the more expensive prescription "cures."
Got a nasty headcold in December, and the cough will take 30 days to go away altogether, due to the dry air and all the germs, viruses, and other irratants that air contains, whether I go to the Dr. and get even the only cough capsules that really work(in 30 days), but are expensive and have nasty side effects, or not. Go through this every few years when we have a dry winter and the air is filled with viruses, germs and 2 out of 3 people have some stage of a nasty cold or flu virus. And no, I don't smoke or live with a smoker.
I've had terrible coughs, and so did my children, but one can usually sleep at night with a simle humidifier.
When I was a kid you simply dealt with it. Running the doctor to get have a cough looked at is ridiculous. Failure to eat and drink? Doctor. Uncontrolled vomiting and high fever? Doctor. Fever that last for several days and doesn't respond to over-the-counter drugs? Doctor. All else ... get your butt in bed and sleep it off.
Where has the common sense gone these days? Oh, I know. Down the toilet with the vomit.
The article states that antibiotics are useless for the cold and flu, and may cause dangerous side effects, and contribute to the development of antibiotic resistant "super bugs." That is all true, except for a few points.-
Although it won't help with the cold or flu, often the worse lingering effect for me is the opportunistic bacterial sinus infection that invariably follows a cold or flu. Antibiotics will stop that dead in it's tracks. The signs of this kind of infection are pretty well known to most of us, but if you have yellow or green thick nasal discharge, it is a sure sign.
The antibiotic resistant "super bugs" are caused by people not taking the full course of antibiotics. If you only take them until you feel better, then you are contributing to the problem. Take the full course, and you are not. If the doctor says take them for two weeks, then do it, even if you feel fine in three days.
Occasionally there are dangerous side effects to antibiotics, but those are rare, and usually appear immediately. If you have any side effect, such as a rash, itching, shortness of breath, severe nausea, or vomiting, stop taking it AND call your doctor. You will be fine if you do this.
You don't have to live with the cough. Have your doctor prescribe a narcotic cough suppressant, and take it at bedtime. You need the rest, at you will recover more quickly if you get it.
I am an advanced practice RN, and I know what I am talking about.
I support everything you stated. I got the Flu 4 weeks ago, two days of fever (viral), then 4 days of my lungs, throat and sinuses filling up with the infection that lingered on from the weakening of my system from the Flu. 6 days in was struggling to draw a half breath so went to Urgent care to get amoxacillian. After 13 days felt like I was breathing out water from my lungs so ended going back to Dr. to get Eryothromyacin to take alongside the Amox. After 18th day my lungs have finally cleared up, my sinuses are opening and draining, the hacking wakes me up only 2-3 times a night. If not for the antibiotics I would have not been able to combat the bacterial infections in my lungs and sinuses.
Each case is different, so a general catchall cure doesn't apply. The antibiotics did not cure the Flu, but they have helped me heal from these subsequent rounds of sickness. If you are struggling to breath after the Flu finishes consider going to the Dr. Most of the deaths that occur happen when the Flu weakens the body then pneumonia or infection sets in, particularly in those that are already weak, and in the really young that don't know how to describe the suffocating feeling of pneumonia.
Take Nyquil or Mucinex. The cough will be gone in two days.
I've found those two, aspirin and ventolin to be the only medicines worth anything. Especially mucinex, taken as directed and it gets anything out of my chest in a couple days.
I developed sinus infection and a sore throat that lasted a few days and cough that's lasted 17 days. It seems to be disappearing and so may meet the average in the article. Nevertheless, knowing it's tough to get a quick appointment with my doctor (I see his P.A. for emergencies, but she seldom prescribes strong stuff), I scheduled an appointment with my family doctor for 8 days from now. I can cancel it if I recover but going on a 4th week is too much: I'll want antibiotics if it's bacterial. When I was a teacher of gifted and talented chemistry and physics classes, I couldn't afford to wait: my doctor gave me a shot and antibiotic prescription as soon as I had severe symptoms - and the P.A. would slip a note to the doc if I had to see her. There was no one qualified to take my place and teach those courses. But now that I'm retired I'm holding back on antibiotics as we all should if we're otherwise healthy.
Dear nbcnews:
Why don't you update the article and fix that really stupid caption under the photo?
Might be a good idea.
Ha! I didn't notice that caption. "the actual duration of a typical cough is nearly 18 days, and could be up to two weeks, a study finds." Perhaps they meant to say 'up to three weeks'.
I got the flu shot just like they recommended and it worked because I have the flu. I have been coughing since before Christmas and it is showing no signs of slowing. I also got a lovely parting gift from the medical assistant that gave me the shot, a know that lasted about 6 weeks at the injection site. I think I would have been better off missing that appointment.
Or...
you could mix up z batch of liposomal vitamin c. Vitamin C is water soluble, and it is normally cleared from the blood in about 10 minutes.
Liposomal vitamin c is vitamin c encapsulated in tiny spheres of oil (e.g. lecithin) which can be absorbed into the cells and used, not cleared from the blood.
Best of all, it's easy to make. Just search for it on Youtube, or google it.
I have been using it myself and I love it.
-Ken
So this Ebell guy knows that the antibiotics don't work but gives them to his patients anyway? Maybe the problem isn't educating the people, it's finding better doctors who don't give medicine to their patients that they don't need.
It depends on what is causing the cough. I've had lingering coughs that just needed time, lots of fluids and maybe some cough syrup at night to help me sleep, but I felt well and didn't feel sick or weak. This year I had bacterial bronchitis as a secondary infection after the flu. I felt sick and what I was coughing up was obviously infected. I would not have gotten better without antibiotics this time.
Opiates are great for suppressing coughs at night, especially the dry hacking type. At least you can sleep. Of course don't overdo it. You know the drill.