NMA: Nonprescription Medicines Academy

Cough Likely Lasts Longer Than Many People Expect

April 17th, 2013

Is antibiotic overuse for acute cough illness (ACI) due in part to a mismatch between patients’ expectations and the natural history of ACI? Possibly, according to the results of a population-based random digit dialing survey of 493 community-dwelling adults in Georgia.

A systematic review of observational studies and the placebo or untreated control groups of randomized controlled trials revealed a mean duration of cough in the published medical literature of 17.8 days. Survey participants were asked some version of the following question:

Suppose that you get sick and the main symptom is a cough. You are coughing up yellow mucus and have a slight fever (100.5°F). You are not taking any medicine for the cough. About how long do you expect that it will take from the time you first feel sick until the time where you feel well and the cough is gone?

Depending on the specific scenario, respondents reported a median cough duration of 5 to 7 days and a mean duration of 7.2 to 9.3. Patients expecting a longer duration of illness were more likely to be white, female, and have self-reported asthma or chronic lung disease.

Participants also were asked whether they believed antibiotics would be effective for the condition described in the scenario. Independent predictors of the belief that antibiotics would always helpful included nonwhite race (OR, 1.82; 95% CI, 1.14–2.92), some college education or less (OR, 2.08; 95% CI, 1.26–3.45), and previous antibiotics for ACI (OR, 2.20; 95% CI, 1.34–3.55).

Ann Fam Med. 2013;11(1):5-13.