The cough that will not go away

An acute cough commonly takes around three to four weeks to settle completely

Dr Tendai Zuze
Health Matters
IF you have recently had the flu, you may have noticed something rather frustrating; everything else seems to have settled, but the cough has decided to stay behind.
This is actually quite common. A cough can outlast the fever, body aches, blocked nose and tiredness by several weeks.
After a viral infection such as flu, the breathing tubes can remain irritated and sensitive for a while. Even when the virus is gone, the airways may still react to cold air, dust, smoke, perfumes or simply talking and laughing.
So, a cough that continues for a couple of weeks after the flu does not automatically mean that the flu is still there or that you need an antibiotic.
An acute cough commonly takes around three to four weeks to settle completely.
But not every cough is the same. A dry, irritating cough is particularly common after a viral infection. There may be little or no mucus, but the person feels an almost constant urge to clear the throat or cough. This is often due to irritation of the airways and can be particularly troublesome at night.
A wet or productive cough is different. There is mucus or phlegm being brought up. This can occur with viral bronchitis and other respiratory infections. The colour of the mucus on its own, however, does not always tell us whether the infection is bacterial. Green or yellow phlegm does not automatically mean that antibiotics are required.
Then there is the cough associated with post-nasal drip. The person may feel mucus running down the back of the throat, with frequent throat clearing and coughing, particularly when lying down.
Some people develop a cough because the viral infection has temporarily made their airways more sensitive. This can be especially noticeable in people who have asthma or who are prone to wheezing. A cough that comes with wheezing, chest tightness or shortness of breath deserves a proper assessment rather than simply being treated as a flu hangover.
There are also coughs that have nothing to do with the recent flu. Acid reflux can cause a persistent cough, sometimes without obvious heartburn. Certain blood-pressure medicines can cause a dry cough.
Smoking and exposure to cigarette smoke, dust and other irritants can keep a cough going. And in Zimbabwe, a cough that persists for several weeks should also make us think about tuberculosis, particularly when there are other suggestive symptoms or relevant exposure.
A cough needs medical attention if the person is becoming increasingly unwell, develops significant difficulty breathing, has persistent or recurrent fever, develops chest pain, becomes unusually weak or confused, or is coughing up blood. It is also worth getting checked if the cough is getting worse rather than gradually improving, or if it has persisted for around three to four weeks without settling.
A cough that has lasted for weeks together with weight loss, night sweats, prolonged fever or coughing blood should not simply be blamed on the previous flu. TB and other lung conditions need to be considered.
People who are older, have asthma, significant heart or lung disease, diabetes, kidney disease or a weakened immune system should also have a lower threshold for seeking medical attention because respiratory infections can cause more serious complications in these groups.
For most uncomplicated post-viral coughs, time is probably the most important treatment. Drink plenty of fluids. This helps keep the throat moist and can make mucus easier to clear. Warm drinks can be particularly soothing. Honey can also help to calm an irritating cough in people over one year of age. It is not a miracle cure, but it can reduce troublesome cough symptoms.
Avoid cigarette smoke and other irritants. If you notice that cold air, dust, strong perfumes or smoke trigger the coughing, try to minimise exposure while the airways are recovering. Simple measures such as sucking a lozenge, drinking warm fluids and keeping the throat moist can also make the cough more bearable.
There is nothing wrong with using an appropriate over-the-counter cough preparation if it provides relief, but don’t expect cough mixtures to make the underlying illness disappear. Evidence for many cough medicines is limited, and some commonly used preparations do not provide much benefit for an ordinary acute cough.
And perhaps, most importantly, don’t automatically reach for antibiotics. Most coughs following colds and flu are caused by viruses. Even acute bronchitis is usually viral. Antibiotics generally make little difference to the duration of the cough in otherwise uncomplicated cases, while exposing people to side effects and contributing to antibiotic resistance.
That doesn’t mean antibiotics are never necessary. Someone who is genuinely very unwell, has pneumonia or is at increased risk of complications may need antibiotic treatment. The important thing is to determine which situation you are dealing with rather than treating every cough in the same way.
A cough can be surprisingly stubborn. After a bad bout of flu, it is quite possible to feel completely recovered while still coughing for another week or two. That is usually part of the normal recovery process.
But don’t ignore a cough that is progressively worsening, accompanied by breathing difficulty, chest pain, significant fever or blood, or simply refuses to improve over time.
Sometimes the lungs just need a little more time to recover. Sometimes, however, a persistent cough is the body’s way of telling us that there is something else going on.