Patience is a virtue with that nagging cough

8:41am Friday 9th May 2008

This has been an odd month. In the surgery we expect the winter load of extra coughs and colds to subside gradually through April, leaving us with a relatively easy early May.

This year that hasn't happened.

Certainly we have had to deal with many severe chest infections in the past two weeks, some of which have needed prolonged courses of antibiotics to help settle them.

It isn't easy to justify prescribing an antibiotic for a routine chest infection, as most of them are thought to be viral and will settle on their own without the need for a prescription. It seems that this infection, however, has left the lungs susceptible to added bacterial infections, leading to bronchitis in some people.

Usually you can predict the people who are most susceptible to such exacerbations' of bronchitis - they are known to have lung problems, such as asthma or tobacco damage - and we tend to be quicker to prescribe antibiotics for them, to prevent any possible further structural damage.

However, many of the people coming to us with bad chests' recently have not been smokers and don't have asthma. That tends to suggest that we are in the middle of an outbreak of a new virus infection that hasn't before spread among the general population. Hopefully, this will be both its first appearance and its swansong. Now that most of us will be immune to it, it won't affect us again.

Now it seems to be subsiding, it has left us to deal with one problem - a persistent cough.

Many chest infections still cause us to cough for weeks after the germ has disappeared from our throats and lungs. That's because it leaves the delicate tissues raw and irritated as the slow process of healing takes place.

There isn't really anything we can do to make it disappear faster: cough medicines soothe the irritated areas for a while, and paracetamol or aspirin dulls the sensation in the throat, but they don't work for very long. There is no really satisfactory treatment for these chronic coughs, except to have patience. Maybe that's why we still call you patients', despite all the efforts of various authorities to call you clients'.

There are guidelines, however (the same authorities love guidelines), on the management and treatment of persistent coughs, and it's useful to repeat them here. I'd hate readers to gain the impression that because most coughs disappear on their own they shouldn't bother their doctors with them. There are coughs that we do need to know about.

We want to see you whenever the cough becomes so persistent and so distressing that it is affecting your quality of life. We want to know if it is productive' (with phlegm, of whatever colour) or dry' (in other words, the product of irritation, rather than a need to clear the chest of mucus). We want to know how long you have had it, at which time of day it is worst, whether you feel ill with it, and if anything you do seems to bring it on.

Two very recent examples come to mind. One was a lady of 60 who came at the end of April with a cough she had had since January. It often woke her at night, and she was worst first thing in the morning. It was better as she moved about during the day.

Listening to her chest I could hear a wheeze, yet she hadn't noticed obvious wheezing herself. She did feel short of breath. She had never had asthma (the main cause of a wheeze).

The fact that the cough was worst at night suggested a possible allergen in her bedroom, so I asked if she had changed anything, such as the carpet, or re-decorated, or had changed her bedlinen or pillows.

That rang a loud bell. She had bought new pillows for Christmas. She wasn't sure of the fillings. She still had her old pillows - I suggested she try them over the next week, and see if things would change. I'm waiting for the result. A persistent cough may be the only symptom of asthma that starts in later life, and an anti-asthma inhaler may well help her.

There are other reasons you might have a cough, but for now let's hope the good weather gives everyone a fillip - and, who knows, you might just forget about it!

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