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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
Leave a Comment:
How about creating a cough medicine that actually works. What's out there now does diddly squat. Any company that can do that will make billion$. People ask for antibiotics because they're desperate for relief. If you're coughing for weeks (or months) it's debilitating.
If your cough is caused by junk in your throat, or if you have a sore throat, try a gargle and swallow of the strongest liquor you can find. 151 proof Rum works well, as does moonshine. It will clean all the junk out, and numb your throat. And anything with codeine in it works for a cough.
Since you are the doctor, maybe you shouldn't give prescriptions unless they are necessary. How about honest healthy lifestyle advice instead?
I saw a similar study recently, and amoxicillin was shown to be no better than placebo. Initially these viral infections don't respond to antibiotics, but later bacterial sinusitis and bronchitis can set in and antibiotic response can be expected.
In my personal experience, too much time is wasted on cheaper but ineffective antibiotics- amoxicillin and Z-packs. My bronchitis responds quickly to Avelox, a late generation fluoroquinolone but unfortunately expensive.
I'll bet George H. Bush got antibiotics during his recent hospital stay for bronchitis.
My doctor tested me for flu and it was negative. But I did have strep. He said lots of people are showing up with strep and a cough. I took an antibiotic for 10 days. He gave me cough syrup with codeine in it. I coughed for 7 days. Moral of the story: Don't assume you have flu. Don't let your doctor assume you have flu. Mine took it upon himself to make sure what I had. But I haven't heard of a single other acquaintance of mine whose doctor actually tested for what they had. Everybody, including their doctors, just assumed they had the flu. And the stuff just keeps going around. Oh, one other thing-- my doctor also said to stay home until the cough was gone.
Remember Granny's cold cure on The Beverly Hillbillies? It was just moonshine. She said to drink it and wait a wek or two and your cold would be gone.
What a load of crap. I was just sick recently, the first time in 3 years. I was sick for 1 day, coughing very badly, then the next day I was fine. I stopped coughing 4 days after my sickness. Every body is different.
How about the doctors recommending pneumonia shots for teenagers and young people that have never had one. My youngest son that is 11 had the series when he was a baby. My son that is 14 did not because back then it wasn't available. It is the pneumonicocal series. Now he is 14 he can get it at Walgreens but peditricans won't give it unless in a high risk group which is total bull crap. Everyone should have pneumonia shots so they are protected. I personally got one 3 years ago in my mid 40's and they told me I am now protected until my mid 60's. Pneumonia can kill people but yet there is no frenzy in getting people innoculated with the right protection that is already available on the market. As far as doctors not giving anti-biotics, I can atest that one time my youngest son was refused because a strep test was negative in the office, but days later positive when sent off to the lab. By then he was much worse because he had not been on antibiotics. It took 3 weeks to get better and 3 weeks of hell for missing school and feeling miserable. I literally had to get a third stronger antibiotic at the end of week 2 because he could no longer walk and was as pale as a ghost. Only after raising my voice in the doctor waiting room was I given a third prescription and I was fully prepared to go the ER and I had an attorney for medical malpractice on speed dial if refused. Come to find out he had septic shock and if I had not demanded medicine he would have had to have his limbs amputated. Doctors are not as wise and smart as their degrees state and suggest. You have to do your own research and watch your children like a hawk and be your own doctor at times. Doctors push patients into their offices and then out the door to get to the next. Sometimes people that are really sick just don't have a virus but a bacterial infection that can literally kill them. Parents have to speak up and demand to be heard and also be prepared to take whatever steps are necessary when they know that something is seriously wrong with their child. I still have an attorney on speed dial just incase and I always will be prepared to make that call if needed. When a life is at stake there is no room for errors because that person once dead cannot be brought back to life. Just because someone has a title of doctor doesn't mean they cannot make mistakes or are fully listening to you or the patient. Not every case is viral and they have to treat every case as a potential bacterial infection before just assuming it's a virus. Viruses don't kill you, but if it is bacterial you better have anti-biotics prescribed. Doctors should not play God when parents know their own child the best before anyone else since they live with them 24/7.
Doctors should refuse to provide prescriptions for antibiotics for clearly viral infections. It is unethical to contribute to the weakening of antibiotics.
Also, a spoonful or two of honey for a cough will do at least as much good as an OTC cough syrup and will probably cost you less.
Keep it loose with Musinex during the first few days, especially during the day. This keeps you from getting 'cloggged and stuffy' minimizing the chance of bacterial infection. At the same time take non-drowsy antihistamine (Claratin, Allegra etc) which will minimize the fluid created by the bodies response to the virus. Toward the end and at bed time as needed to sleep add a little Benadryl type antihistamine to dry you up during the night. You can also add in a steroidal nose spray and\or a nose spray decongestant to help you sleep. I am not a doc so if you have high blood pressure or other health issues talk to him\her first.
Caught a cold last Wednesday. Started as a sore throat. By Thursday I had a cough with it. By Thursday night I bought a bottle of Whiskey. First liquor I had bought in years. First cold I have had in years.
Alcohol relaxes you. Calms you. Makes it easier to rest, to sleep. It might not actually reduce the cough but it makes it easier to live with it. I know why they took alcohol out of medicines but the medicines worked better with it. I hope I go another few years before I get a cold again. But when I get one I'll buy a bottle of whiskey to go with it.
And no. I did not drive or work while drinking. I waited until the evening, when I was home from work to have a drink. During the day I suffered through it. Once I am over my cold I will go back to where most weeks the only alcohol I have is the little cup of wine during communion at church.
Puff puff pass cough.
Puff puff pass cough.
Puff puff pass cough.
Puff puff pass cough.
Puff puff pass cough.
Yep, 18 days.......So far....
Tablespoon of honey w/cinnamon 3 times a day
I'm not searching for narcotics or anything but I hate it when my doctor prescribes junk like Tessalon (benzonatate) for a legit cough. Like what I currently have which is lingering now well into the 3rd week. Just prescribe the stuff that actually works (OTC is a waste of time). Why not? Think I'll get addicted on the 1-2 bottle(s) and my life will then be ruined and I'll sue or whatever? They are SO wary these days to give you what is good and works. And it's not like I'm going to go to a different doctor just for hydrocodone syrup cause I guess that'd be seen as doctor shopping. Still, just give me the blasted stuff and give your patient some relief.