Cough - Myth Busting

Common cold and flu are viral illnesses affecting the upper respiratory tract causing blocked and runny nose, sneezing, sore throat, coughing and sometimes temperatures, headaches and muscle aches.

Adults can expect 2-4 colds a year, while nursery age children can have up to 12 a year, each lasting for up to two weeks. It feels like they are always ill.

Most people know how to treat themselves by resting, drinking fluids and using over the counter medication to ease the symptoms.

However there are some “red flags” that could be signs of serious underlying illness and might need medical intervention. If you have these symptoms, please seek medical attention promptly. The reg flags for cough are:

• SHORTNESS OF BREATH (meaning that you are breathless when not coughing)
• COUGHING UP BLOOD (especially if is is not only a few specks of blood mixed with mucus)
• FEVER FOR LONGER THAN 5 DAYS (higher than 38.5 at least once a day)
• CHEST PAIN ON THE SIDE (especially if it is worse on breathing in)
• UNDERLYING ILLNESS (mainly asthma, COPD, weak immune system, frail, elderly)
  NB: an elderly person with temperature always needs to be seen ASAP, regardless of any other symptoms
• COUGH LASTING LONGER THAN 6 WEEKS

Paracetamol and ibuprofen are needed to treat respiratory infections with fever.
Mums often call us panicking that their child’s temperature is high with a respiratory tract infection, but they refuse to take medicine like Calpol or Nurofen. Please don't panic, the temperature has the tendency to go up and then to come down on its own. If we know that the illness is a viral upper respiratory tract infection, we don't need to worry about the temperature, it is part of the immune response. Calpol and Neurophen are not known to shorten the illness duration or reduce hospital admission rate. They just make the child feel a little bit less poorly. If your child refuses, you don't need to force them to take the medicine, they will get better regardless. We have a separate chapter on high temperature, you might want to check that one out.

Cold and flu last only for a couple of days.
Patients call us saying that they are better from the initial temperature, but after 5 (or 7 or 10) days they still have the cough. This is quite normal. It is the temperature that settles first, then you feel better in yourself, but the cough can linger around for up to 3 weeks because this is how long it takes for the airway lining to recover. Please contact your GP if the cough lasts longer than 6 weeks, you need to be investigated.
Similarly, a real flu can make you ill and pin you to bed for a good two weeks before you get better. Unfortunately there is no quick fix for that, just take the time and rest if you don't have the any of red flags we discussed above.

Coughing up green mucus is a sign of bacterial infection.
You might start with a dry cough that changes to phlegmy, chesty cough with different colours of sputum, before it resolves. If there is no underlying lung condition like COPD, the colour or the mucus is not an indication of a bacterial infection.
Your GP is not mean by not giving you the antibiotics, it simply does not work. Antibiotics are not “let’s try anyway” or “I want to get better sooner as I am fed up with this cough”  or “I need to go back to work, give me something strong” type of medication as we used to look at them. We need to change this view and see antibiotics as life saving drugs that are very precious and preserved for serious bacterial infections. Otherwise we lose them all soon.

With cold and flu I need to take cough medicine.
Cough medicine for young children contains no active ingredients, most times they are just sweet syrups with or without glycerol that can moisturise the throat when swallowed. However the cough is coming mainly from the deeper level of the throat, so the medicine helps only for a few minutes or not at all. Cough syrups for older children and for adults might contain cough suppressants. They are marketed for dry cough and can work to some extent, however most times the viral infection causes a chesty cough with mucus that needs to clear, so suppressing the cough is not a good idea. It is a defence mechanism stopping the infection spreading deeper. Cough is tough, but it is useful.

Using ibuprofen is better than paracetamol as it is an anti inflammatory.
There is no evidence that ibuprofen would be more effective than paracetamol, but some people might find that one or the other works better for them.

Steam inhalation shortens the disease.
I would love to say this is the case, as patients often hear this advice from us, but unfortunately there is no evidence that steam inhalation makes you better quicker, but it might provide symptom relief temporarily.

My throat is so sore that I need antibiotics.
Sore throat is one the worst symptoms of an upper respiratory tract infection. I can't blame you for wanting to get it fixed ASAP. Antibiotics seem to be the quick fix, as if they work, they work pretty quickly, within 24-48 hours. However, antibiotics only work for bacteria, not for viruses. The level of pain is not an indication of the nature of the infection. You can have pain like razor blades from a viral infection. To see the signs and symptoms of a bacterial throat infection, when you might benefit from antibiotics, please check out our “tonsillitis” chapter.

If it spreads to the chest I will need antibiotics.
Yes, it can happen that the virus spreads on the chest, causing inflammation of the lining of the lower airways, called bronchitis. The bronchitis cough can cause pain behind the breastbone and with bronchitis, you feel more poorly compared to a simple cold. Also it could last longer.

However most of the time this is still the very same virus that has given you the cold, and antibiotics still would not work against it.
There is a separate topic about “chest infection”, if you are worried about that possibility, please check that chapter out.

I hope you have found this informative and will help you to decide when you need to seek medical advice.

For further information, please consider visiting https://www.nhs.uk/conditions/cough/

https://www.nhs.uk/conditions/common-cold/
https://patient.info/chest-lungs/cough-leaflet/common-cold-upper-respiratory-tract-infections
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/
https://www.bmj.com/content/347/bmj.f6041