Coughs

Most coughs are caused by viral infections, and usually soon go. This leaflet gives some tips on what to do, and the symptoms to look out for which may indicate a more serious illness.

Viral infections commonly affect the throat (larynx), or the main airway (trachea), or the airways going into the lungs (bronchi). These infections are sometimes called laryngitis, tracheitis, or bronchitis. Cough is often the main symptom.

What are the symptoms of cough caused by a virus?

The cough typically develops over a day or so, and may become quite irritating. Other symptoms may develop and include: fever, headache, aches and pains. Cold symptoms may occur if the infection also affects the nose. Symptoms typically peak after 2-3 days, and then gradually clear. However, the cough may persist for up to four weeks after the infection has gone. This is because the inflammation in the airways, caused by the infection, can take a while to clear.

What is the treatment?

There is no 'quick fix' for a cough due to a viral infection. You need to be patient until the cough goes. A main aim of treatment is to ease symptoms whilst your immune system clears the infection. The most useful treatments are:

• Take paracetamol, ibuprofen, or aspirin to reduce fever (high temperature), and to ease any aches, pains and headaches. (Children aged under 16 should not take aspirin.)
• Have lots to drink if you have a fever, to prevent mild dehydration.
• If you smoke, you should try to stop for good. A cough and serious lung diseases are more common in smokers.

What about cold and cough remedies?

You can buy many other 'cold and cough remedies' at pharmacies. There is little evidence of any impact on the infection, but they may be useful for certain symptoms. For example, a decongestant nose spray may help to clear a blocked nose.

But remember, cold and cough remedies often contain several ingredients. Some may make you drowsy. This may be welcome at bedtime if you have difficulty sleeping with a cough. However, do not drive if you are drowsy. Some contain paracetamol, so be careful not to take more than the maximum safe dose of paracetamol if you are already taking paracetamol tablets.

In March 2009 an important statement was issued by the Medicines and Healthcare products Regulatory Agency (MHRA) which says:

"The new advice is that parents and carers should no longer use over-the-counter (OTC) cough and cold medicines in children under 6. There is no evidence that they work and can cause side effects, such as allergic reactions, effects on sleep or hallucinations.

For 6 to 12 year olds these medicines will continue to be available but will only be sold in pharmacies, with clearer advice on the packaging and from the pharmacist. This is because the risks of side effects is reduced in older children because they weigh more, get fewer colds and can say if the medicine is doing any good. More research is being done by industry on how well these medicines work in children aged 6-12 years."

Note: paracetamol and ibuprofen are not classed as cough and cold medicines and can still be given to children.

What about antibiotics?

Antibiotics are not usually advised. Antibiotics do not kill viruses - they only kill bacteria. Antibiotics do not usually ease a cough caused by a virus. They may even make symptoms worse as they sometimes cause side-effects such as diarrhoea, feeling sick, and rashes.

Antibiotics may be prescribed if you already have an ongoing (chronic) lung disease. This is to prevent a 'secondary' bacterial infection rather than to clear a viral infection. Antibiotics may also be prescribed if a complication develops such as secondary bacterial pneumonia - but this is unlikely to occur if you are otherwise healthy.

What symptoms should I look out for?

Most viral coughs clear without complications. However, sometimes a 'secondary' infection with bacteria develops in addition to the viral infection. This may become serious and cause pneumonia. Also, other causes of cough (such as asthma) are sometimes confused with a viral infection. So, see a doctor if any of the following occur.

• If symptoms such as fever, chest pains, or headaches become worse or severe.
• If you develop breathing difficulties such as wheezing or shortness of breath.
• If you cough up blood. Blood may be bright red but dark or rusty coloured sputum may indicate blood.
• If you become drowsy or confused.
• If you develop any symptoms which you are unhappy about, or do not understand.
• If you have a cough that persists for longer than 3-4 weeks.

References

• Respiratory tract infections, NICE Clinical Guideline (July 2008); Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care
• Medicines and Healthcare products Regulatory Agency (MHRA). Children's over-the-counter cough and cold medicines: New advice. 2009