Exactly when to visit your doctor with cold symptoms can be puzzling. Every week I see patients that can’t seem to wait to come in to let me know they have “been sick for three days”, whereas others “have been fighting this for 3 months” before they seek care.
A recent study in the Journal of the American Medical Association shows that treating an acute sinus infection with an antibiotic did no better than a sugar pill – they all had the same rate of clearing up at 10 days. Similarly, studies are currently battling it out about whether antibiotics have any impact at all on the course of simple ear infections. So when is it really beneficial to visit the doctor with your acute upper respiratory infection?
By far the most common kinds of upper respiratory infections (URIs)we humans get are VIRAL in nature. Viruses are very communicable person-to-person, usually cause symptoms of sore throat, cough, runny nose, muscle aches, nasal congestion, and even some bronchitis or fevers. Viral infections usually run their course in about 1 week, after which there can be some residual inflammation in the lungs and sinus linings to keep your symptoms lingering for another week or so. For most common viruses there really is no specific anti-viral pill that will do any good. The only medicines we have are to control the symptoms – medicines to suppress cough, improve body aches, reduce congestion, and help you sleep.
If after a week you are still no better or are getting worse, there is then the possibility that a bacterial sinus infection, bronchitis, or even pneumonia is setting in. These infections can be more serious but do respond to antibiotics. Because it does not seem that taking antibiotics ahead of time will actually prevent a bacterial infection, doctors recommend waiting out a cold for about 7-10 days before starting an antibiotic.
I asked a local Allergy, Asthma, and Immunology specialist, Dr. David Redding, to provide some thoughts about persistent cough. Dr. Redding recommends a conservative approach to cough for most uncomplicated patients. “A cough may last four to six weeks after the infection has cleared,” says Redding. Sometimes this is a simple sporadic cough and other times this can develop into a “coughing fit” that can be quite troubling. “A ‘coughing fit’ really does not have any special medical significance,” says Redding. “It may simply be the way your voice box and wind pipe are healing and there is little we can do.” Coughing in a teenager or adult, without shortness-of-breath or chest tightness, is generally not due to asthma.
Warning signs for pneumonia are: an abrupt onset of an excessive amount of coughing productive of mucus that does not feel like it is coming from the nose, severe fatigue, temperature in an adult over 100.0 degrees F, shortness-of-breath, and overall feeling worse than you have felt with “colds” in the past.
In short, two weeks is a good cut-off period for visiting the doctor with sinus or chest symptoms that are not improving yet. Of course, use your common sense with any general guideline. Coughing up blood, being very short of breath, chest pain, swelling of the face, vision change, and severe headache can all be signs of something more serious and should not be ignored. Also, elderly patients over 75 years old, and those with impaired immune systems should report earlier to their doctor.
Dr. David Redding is in practice at The Redding Allergy & Asthma Center, 3193 Howell Mill Rd #102, Atlanta, Georgia. He can be reached at (404) 355-0078 or www.reddingallergyatl.com.