If your cough is hanging on much longer than you expected, the problem isn’t the cough; it’s you.

People expect acute coughing from a cold or flu to last seven to nine days, according to a new report, when it actually takes closer to 18 days to run its course.

The perception gap leads to more doctor visits, more pointless use of antibiotics (which don’t work on viruses, the cause of most coughs), higher medical bills and more drug resistance.

“There is a mismatch in what people believe and reality,” said Mark Ebell, associate professor of epidemiology at the University of Georgia College of Public Health, who analyzed data on the topic with several colleagues and published a report in the Annals of Family Medicine.

When acute bronchitis persists past the point of expectations, people call their doctors. Doctors respond by overprescribing antibiotics, the authors said, and the cost of a virus escalates from $20 for over-the-counter cough medicine and pain relievers to $200 for office visits, tests and prescriptions.

In the analysis, the researchers looked at 19 observational studies in the United States, Europe, Russia and Kenya. Based on untreated control groups, they found that acute coughing lasts an average of 17.8 days. They also measured patient expectations by inserting a question on the subject into the biannual Georgia Poll, a random telephone survey of 500 Georgia residents conducted by the university’s Survey Research Center. Respondents said that a cough should last seven to nine days.

“If someone gets acute bronchitis and isn’t better after four or five days, they may think they need to see a doctor and get an antibiotic,” Dr. Ebell said. “And when the first one doesn’t work, they come back four or five days later for another.”

According to the U.S. Centers for Disease Control and Prevention in Atlanta, coughing accounts for 2 to 3 percent of visits to outpatient clinics. More than half of those patients are put on antibiotics — Dr. Ebell said that number should be much lower — and of that group, half get wide-spectrum versions that can lead to resistance.

“We know from clinical trials there is very little, if any, benefit to antibiotic treatments for acute cough because most of those illnesses are caused by a virus,” he said. Meanwhile, resistance due to overuse already is leading to illnesses that can no longer be treated by the drugs that used to work.

But why are physicians prescribing drugs that aren’t indicated for coughs in the first place? Apparently, it’s either because patients are insisting and doctors are caving in, or physicians have not kept current with guidelines for prescribing antibiotics.

“I do think the medical profession has to take some responsibility for this, giving prescriptions because patients demand it,” said Amy Crawford-Faucher, a family practice physician at the UPMC Department of Family Medicine.

“We always feel we’re doing our darndest to convince patients they don’t need antibiotics,” she said. “It takes a lot of energy to educate a patient who’s insisting and explain why they don’t need it.”

She said patients tend to trust the word of doctors they’ve been seeing for a while, as opposed to a one-time contact in the emergency room or urgent care center. Another factor could be that doctors don’t realize the average cough lasts 17 days, so they’re not advising their patients to wait it out.

So how does one know when to call a doctor about a cough?

“If they’re concerned they should call,” Dr. Crawford-Faucher said. “The problem isn’t in calling; it’s in expecting an antibiotic. It would be great if they accepted what we tell them. Going to the doctor is time-consuming and expensive. You want to use that resource appropriately.”

It would also help if people knew why their coughs were so stubborn.

“Even if the initiating infection is gone, the airways can be hypersensitive for another week or two,” she said. “Anything that comes into contact, like mucus, cold air, even talking, can cause the airways to spasm. Antibiotics won’t do anything to change that.”

Is there a way to tell when a cough is becoming dangerous?

“If it’s been two weeks and you’re feeling sicker, if your fever returns or you have new symptoms, like wheezing you didn’t have before, or it’s harder to catch your breath,” said Dr. Crawford-Faucher.

Coughing is very disruptive, she said, so people naturally want it to end, but it would be better all around if they let it run its course. However, she recommends that patients older than 6 take over-the-counter cough medicines at night to help with sleeping.

“The whole world looks better if you can sleep through the night.”

– Sally Kalson

Posted February 11, 2013.

Originally published in the Pittsburgh Post-Gazette.