Constant cough: Causes, treatments and when to seek medical advice

Are you prone to repeat respiratory infections and coughs that won’t go away – even for months? A pulmonologist advises how to stay healthier this winter.

Why respiratory infections are common in cold weather

Colds and flu are common winter problems, with more than 100 viruses circulating at this time of year. All these can cause upper respiratory tract infections (URTIs) that result in symptoms like sneezing, coughing, blocked nose, and fever. 

“The most common of these viruses in adults is respiratory syncytial virus (RSV) and the more dangerous influenza, which has a higher mortality rate than most of the other respiratory viruses,” says Dr Becky Kgole, a pulmonologist at Mediclinic Medforum.

Children, especially those who attend creches and mix closely with other children, are more susceptible to other viruses, such as adenovirus and enterovirus. These viruses are brought back home, potentially infecting family members.

Reasons why a cough “won't go away”

A cough can persist for three to eight weeks after a viral infection, says Dr Kgole. This is usually called a post-viral or post-infectious cough and is typically associated with a postnasal drip – when mucus drains into the back of the throat. It could also be related to the initial inflammation.

“The cough will usually subside by itself in a while and, while it may cause significant discomfort, symptomatic treatment is usually sufficient,” she says.

“Cough-variant asthma is a type of asthma where the cough is the only symptom, and you don’t have the traditional wheezes. Exercise, cold air and weather changes may trigger this cough, which responds to asthma treatment.”

Can medications cure flu?

The short answer is that there is no cure for URTIs, but you can get medication to relieve the symptoms. Dr Kgole notes that oseltamivir (Tamiflu), an antiviral medication used to treat influenza, can reduce the duration of symptoms by about 16 hours but does not cure the virus.

A cough following an influenza infection can last more than a month because of the inflammation and swelling in the lungs. “When people go to their healthcare professional with flu-like symptoms, they often ask for antibiotics. But they don’t need antibiotics because their infection is viral, not bacterial,” says Dr Kgole. “That’s why patient education is very important. Just because you’re sneezing doesn’t mean you need antibiotics.”

Some healthcare professionals prescribe cortisone for people with cold- and flu-like symptoms, but Dr Kgole cautions against this: “Cortisone is often prescribed to reduce inflammation, but it also weakens the immune system, making the course of the illness worse, especially if cortisone is taken at the start of the disease. When cortisone can be helpful is if a patient has complications or is admitted to ICU and the inflammation needs to be reduced quickly.

“However, because cortisone can further compromise the immune system this puts you at risk of bacterial infections, in addition to the viral infection. Cortisone is cheap and readily available, but in some cases, it may do more harm than good.”

The importance of good hygiene

When you have a viral infection, you’re at greater risk of getting a bacterial infection because your immune system is low, Dr Kgole warns. “It’s also important to practise good hygiene so you don’t spread viruses when you have them.”

This involves washing your hands regularly with soap and sanitising as we did during the COVID-19 pandemic. If you have flu-like symptoms, wear a face mask to prevent infecting others and stay away from public places if possible. If your child is ill, even with a snotty nose, keep them away from school.

Lifestyle habits make a difference

Smoking makes respiratory infections much worse by reducing the natural protection of your airways. This makes it easier for viruses and bacteria to enter the body. Dr Kgole emphasises that this applies to any kind of smoking, from cigarettes and cannabis to electronic cigarettes (vapes) and glass waterpipes (hookahs or hubbly bubblies).

Consuming excess alcohol also affects your immune system, increasing the risks of viral and bacterial infections, she says.

Diet is another important factor. “Eating a healthy, balanced diet throughout the year – and not just during winter – will help to keep your immune system in top form, making you less susceptible to the worst outcomes of flu.”

Do annual flu jabs make any difference?

Each time you get a respiratory virus, you build up antibodies that last about a year, so within a 12-month period, you’re unlikely to get the same virus again. An annual flu vaccine can prevent you from becoming dangerously ill as it’s formulated to combat the most virulent strains of influenza circulating in winter. However, you are not protected against other viruses. “If you do take a flu vaccine and later get flu-like symptoms, it's likely to be caused by infection from another respiratory virus,” says Dr Kgole.

People with underlying lung diseases are particularly susceptible to seasonal viruses, such as influenza, which can exacerbate existing conditions. Patients with asthma, for example, are usually the ones who get admitted to hospital because of the worsening of their asthma symptoms. “If you have an underlying lung disease, like asthma, it’s particularly important to get an annual influenza vaccination, so you don’t end up in hospital with an acute exacerbation,” Dr Kgole says.

To find a pulmonologist or other healthcare professional near you, go to www.mediclinic.co.za