“Bob, you were up all night coughing . . . and you kept me up, too. Will you please go to the doctor and get some antibiotics.”
How many times have you heard this?
Odds are, you have, and while there are some very good reasons to be seen for a cough we need to discuss the most likely diagnosis and, more important, the unlikelihood that antibiotics are going to be needed.
Cough is the most common reason people visit their primary care doctor. In an Urgent Care setting, this is no different. More often than not, the diagnosis is acute bronchitis and more often than not, patients believe that they really, really need an antibiotic. They usually don’t.
Bronchitis, or a “chest cold,” is an infection and inflammation of your bronchial tubes, the passageways that bring air into your lungs. Go ahead and feel your breastbone or sternum. Underneath that bone are your bronchial tubes. There is a main one in the center and two that branch off into each of your two lungs. When you get a cold, these tubes become infected and irritated. That causes mucous production and the persistent, annoying cough that keeps you and your spouse up.
And that stinks! No one wants to cough all the way through a meeting, getting branded the office Typhoid Mary. Persistent coughing sometimes hurts, it’s gross and may keep you from doing sports or other activities that you enjoy. You want to feel better — and now. Sounds like an antibiotic is in order . . . Whoops, wait a minute, Bob.
The truth is, approximately 90 percent of cases of acute bronchitis are caused by viruses. Antibiotics don’t kill viruses. They kill bacteria. Despite this fact, about two-thirds of patients diagnosed with bronchitis are unnecessarily prescribed antibiotics. This isn’t a good thing. Overuse of antibiotics can lead to numerous problems, both for you and the community. When you take an antibiotic when there isn’t indeed a bacterial infection, you expose what bacteria your body naturally has around to the drug. Bacteria may be small but they’re smart. They can develop resistance to the drug and become “superbugs” capable of defeating more antibiotic drugs.
So why do we physicians sometimes prescribe antibiotics for bronchitis when we know they aren’t needed? Well, we’re getting better at not doing it but many patients believe that they need antibiotics and sometimes we want to be able to meet the patient’s expectations. But recent studies have shown that if a physician takes the time to explain bronchitis and its causes, most patients are satisfied to NOT receive an antibiotic prescription. That’s a good thing.
So then, why go to the doctor in the first place?
First of all, there are many things that can cause a cough, everything from a simple cold to very serious conditions. But common things are common and bronchitis is the most usual diagnosis. You would want to see a doctor to determine this and also to rule out that you don’t have pneumonia or the flu. There are also some instances in which an antibiotic for bronchitis is warranted. The nurse and doctor will make sure that you are not having trouble breathing and that your “oxygen level” is good. If the physician hears pneumonia or suspects it on a chest X-ray, an antibiotic may be required.
If the physician feels that you have a viral bronchitis, he or she may discuss with you the expected duration of your symptoms and things that you can do to feel better. Some physicians recommend cough medicine, either over-the-counter drugs or the more potent, narcotic-based cough medicines, although there seems to be a lack of good evidence for their use in medical literature. If you have wheezing, often an inhaler will benefit.
How long can bronchitis last? Most patients will have the cough for less than two weeks but 26 percent of patients will have the cough after two weeks. Some will have the cough for several weeks. This is hard to hear and almost as hard to tell a patient. But the human body is an amazing machine that fends off nasty organisms all the time and viruses ‘burn” themselves out.
“Good news Bob. Based on your history and your exam, I don’t think that you have pneumonia or any other serious condition. It sounds like bronchitis. I think that this cough medicine may help quiet your cough at night. Hang in there but please let me know if anything changes.”
Bob and his wife slept better that night.