How Long Have You Been Coughing????

No one really likes coughing, it's probably safe to say.  A cough of course is one of those 'tip of the iceberg' type symptoms, being caused by any one of a number of maladies highly variable in the direness of their consequences, and virtually everyone will have a cough in their lifetime.  But this week on PodMed we talk about the garden variety cough, the one that develops with a cold or even the flu, and how long such a cough should last before concern should be raised.  Our discussion is focused on a study in the current issue of Annals of Family Medicine, a journal we admit we have never covered before.  Mea culpa!  Seems unbelievable in almost 8 years of broadcasting, but there it is. 

This study is very timely, of course, as the CDC is reporting national data on widespread flu outbreaks, while here at Johns Hopkins we're also seeing a nasty URI associated with persistent cough.  The study included two datasets: a meta-analysis of 19 studies with between 23 and 1230 patients each evaluating cough severity, duration and other characteristics but excluding underlying causes such as asthma, cancer, and COPD, and the other results from a telephone survey of 493 adults residing in Georgia on their expectations regarding cough resolution after an acute illness with cough as a symptom.  Here's what the researchers showed:  the average duration of a cough is 17.8 days, yes, that's right, almost three weeks, yet most adults expect a cough to resolve in about 8 days.    Can you spell disparate expectations, anyone?

The most likely consequence of this expectation mismatch is a visit to a primary care practitioner with a request for antibiotics.  Then lo and behold! after a week or so the cough resolves, thus reinforcing this strategy for next time.  Meanwhile, the authors report, a distressingly large number of prescriptions are written for azithromycin and respiratory quinolones, with potential adverse consequences relative to the development of bacterial strains resistant to these heavy hitters in our armamentarium. 

Rick relates his own clinical experience by revealing that he, too, would have predicted cough resolution after about a week or ten days, so concludes that both clinicians and patients need to modify their expectations with regard to cough duration.  As one of my children is fond of intoning, chillax, dude.  That cough will most likely ultimately resolve on its own, no chemical help needed.  When is a visit indicated?  If a fever persists or recurs, if sputum is bloody or rusty, or if shortness of breath occurs, it is prudent to seek evaluation.  But the authors conclude that even beyond three weeks duration, cough alone is insufficient to prompt treatment when there's a history of acute illness with cough. 

Other topics this week include fecal infusion for Clostridium difficile infection in NEJM, another study in Annals of Family Medicine on using a questionnaire to screen for alcohol abuse, and the best anatomic site for immunizations in kids in Pediatrics.  Until next week, y'all live well.

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8 Comments

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http://tinyurl.com/lxthu8r November 22, 2013 at 11:12 am

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Steve in Alabama April 11, 2013 at 7:22 pm

Hey, I just wanted to say thanks for providing this post. A cough that doesn't go away could be a signal of something much more serious, and it is something that you definitely want to have checked out. In fact, this could be an early symptom of lung cancer, especially if you were prior smoker. Then again, it could be something like an irritated voice box.

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Peter February 24, 2013 at 8:31 am

Hi Elizabeth,

was just catching up on missed episodes of the podcast, when I heard the report from NEJM about using fecal infusion to treat C Diff.
I have heard similar reports before, and the therapy has quite a catchy name. It's called a "transpoosion". 😉

Regards,

P.

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Elizabeth Tracey February 28, 2013 at 12:30 pm

okay, I laughed out loud! we've heard some very good ones related to this issue, thanks.

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Blanca February 23, 2013 at 6:57 pm

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