Article Figures & Data
Figures
- Figure 1
Weighted mean of the Bronchitis Severity Score by the number of days from the onset of symptoms.
- Figure 2
Predicted duration of acute cough illness (ACI) in days by a random sample of Georgia adults.
Tables
First Author, Year Duration of Follow-up Setting Inclusion Criteria Mean Age, y Male % Country Stott, 19765 13 d 3 Group practices Aged >14 y with cough and purulent sputum for ≤1 wk NR NR Wales Williamson, 19846 2 mo 2 Academic family medical centers, University of Missouri Adults aged 21 to 65 y with cough and sputum as prominent complaints, who also had concurrent URTI, rhonchi, or history of fever 35 34 United States Brickfield, 19867 7 d Academic family medicine center, Washington, DC Adults aged 18 to 65 y with clinically diagnosed acute bronchitis (lower respiratory infection with sputum production) of <2 wk 32.5 58 United States Dunlay, 19878 14 d Academic family medicine center, Chelsea, Mchigan Adults with productive cough 44 42 United States Scherl, 19879 2 wk Outpatient medical clinic, University of Kentucky Patients aged ≥12 y with cough and purulent sputum for <2 wk 31 26 Unite d States Verheij, 199410 11 d 22 General practices Adult with cough and purulent sputum 41 42 Netherlands Hueston, 199411 7 d 2 Family practice centers, Kentucky and Wisconson Adults aged 18 to 65 y with productive cough <30 d and no signs pneumonia 36.9 30 United States King, 199612 14–18 d 3 Academic family medicine centers, North Carolina Aged >8 y, cough and sputum production, and onset within 2 wk 38.2 36 United States Littenberg, 199613 7 d Dartmouth Hitchcock Medical Center Adults with nonspecific bronchitis or acute cough <4 wk 33.7 39 United States Matthys, 200014 4 wk 40 Outpatient clinics Adults with acute bronchitis (<5 d, ≥4 nightly awakenings due to cough); otherwise in good mental and physical condition 39 46 Poland Matthys, 200315 7 d Outpatient clinics, totaling 36 physicians Adults with clinically diagnosed acute bronchitis, <4 8 h of symptoms, and BSS ≥5 39.9 32 Germany Chuchalin, 200516 7 d Urban primary care outpatient clinics Adults with clinically diagnosed acute bronchitis <48 h and BSS ≥5a 35.9 37 Russia Little, 200517 21 d 37 General practice physicians Patients aged ≥3 y (83% >6 y) with primary symptom of cough and ≥1 other lower respiratory symptoms 38 NA England Kemmerich, 200718 11 d 23 Outpatient clinics Adults with clinical diagnosis of acute bronchitis and onset of bronchial mucus production in past days, as well as ≥10 coughing f ts on previous day 43.5 38 Germany Matthys, 200719 7 d 3 Academic polyclinics, Moscow Adults aged 18 to 65 y with clinically diagnosed acute bronchitis, <4 8 h, and BSS >5 37.4 21 Russia Nduba, 200820 14 d Public clinic, Nairobi Adult with productive cough <2 wk 29.7 38 Kenya Matthys, 200821 7 d 6 Outpatient clinics, Moscow Adults with acute bronchitis, BSS ≥5, symptoms <48 h 37 21 Russia Matthys, 201022 7 d 18 Centers Adults with acute bronchitis <48 h, BSS ≥5 38.5 NR Ukraine Butler, 201023 28 d 387 General practitioners Patients aged ≥18 y, with acute or worsened cough as predominant symptom or clinical signs of lower respiratory tract infection, duration up to 28 d 36 13 European countries -
BSS = Bronchitis Severity Score; NR = not reported; URTI = upper respiratory tract infection.
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↵a Scores range from 0–20, with higher scores indicating greater severity of illness.
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Outcome First Author, Year Patients Studied Days of Cough Mean (SD) Any cough 17.8a Williamson, 1984 32 28.6 Nduba, 2008 275 15.3 (4.3) Scherl, 1987 15 17.8 Little, 2005 269 21.3 (5.8) Butler, 2010 1,230 17.3 (6.6) Daytime cough 12.7a Stott, 1976 103 10.3 (3) Verheij, 1994 69 16.2 (3.2) Nighttime cough 10.4a Stott, 1976 84 8.9 (3.1) Verheij, 1994 69 12.2 (2.7) Productive cough 13.9a Williamson, 1984 32 13.7 Scherl, 1987 15 17.4 Verheij, 1994 69 13.3 (3) Note: standard deviation shown only if reported by the original study.
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↵a Weighted mean.
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- Table 3
Predicted Days of Duration of Acute Cough Illness by Vignette, Illness Characteristics, and Patient Characteristics
Characteristics No. Predicted Duration Mean (95% CI) P Value Vignettes Yellow sputum and fever 58 7.2 (5.8–8.6) .45 Yellow sputum and no fever 66 7.9 (6.1–9.7) Green sputum and fever 69 8.3 (6.8–9.8) Green sputum and no fever 53 9.3 (7.5–11.1) Dry cough and fever 80 6.9 (5.6–8.2) Dry cough and no fever 69 8.4 (6.0–10.7) ACI characteristics Green sputum 122 8.7 (7.6–9.9) .06 Other 273 7.6 (6.7–8.4) Yellow sputum 124 7.6 (6.4–8.7) .25 Other 271 8.1 (7.2–9.0) Dry cough 149 7.6 (6.3–8.9) .21 Other 246 8.1 (7.3–9.0) Fever 207 7.5 (6.6–8.3) .08 No fever 188 8.5 (7.3–9.6) Self-reported previous use of antibiotics for ACI Yes 246 8.7 (7.7–9.7) .004 No 149 6.7 (5.9–7.6) Self-reported asthma or chronic lung disease Yes 43 10.9 (7.1–14.6) .002 No 352 7.6 (6.9–8.2) Annual income $75,000 or higher 174 7.7 (6.9–8.6) .31 Less than $75,000 221 8.1 7.0–9.1) Sex Male 136 6.4 (5.5–7.4) .001 Female 259 8.7 (7.8–9.6) Race White 262 8.7 (7.8–9.7) .001 Nonwhite 133 6.4 (5.5–7.2) Educational attainment College or professional 157 7.1 (6.3–7.9) .03 Some college or less 238 8 .5 (7.4–9.5) -
ACI = acute cough illness.
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Variable Antibiotics Always Helpful No. (%) PValue Antibiotics Always or Usually Helpful No. (%) P Value Education College or professional (n= 191) 29 (15.2) 73 (38.2) Other (n = 302) 83 (27.5) .001 143 (47.4) .047 Income ≥$75,000 (n = 208) 39 (18.7) 81 (38.9) <$75,000 (n = 285) 73 (25.6) .072 135 (47.4) .063 Marital status Married (n = 297) 56 (18.9) 124 (41.7) Other (n = 196) 56 (28.6) .012 92 (46.9) .256 Race White (n = 330) 64 (19.4) 129 (39.1) Other (n = 163) 48 (29.5) .012 87 (53.4) .003 Sex Male (n = 182) 45 (24.7) 84 (46.1) Female (n = 311) 67 (21.5) .416 132 (42.4) .423 Residence Rural (n = 122) 35 (28.7) 55 (45.1) Other (n = 371) 77 (20.7) .07 161 (43.4) .745 Self-reported asthma or chronic lung disease Yes (n = 57) 21 (36.8) 29 (50.9) No (n = 436) 91 (20.9) .007 187 (42.9) .253 Self-reported any chronic disease Yes (n =209) 47 (22.5) 93 (44.5) No (n = 284) 65 (22.9) .917 123 (43.3) .793 Previous antibiotic use for respiratory tract infection Yes (n.= 287) 78 (27.2) 144 (50.2) No (n = 206) 34 (16.5) .005 72 (34.9) .001 Age, y 54.6 (alwayshelpful) vs 56.6(other) .14 55.5 (always orusually helpful) vs56.6 (other) .23 - Table 5
Logistic Regression With Antibiotics Always Effective and Antibiotics Always or Usually Effective as Dependent Variables
Variable Antibiotics Always Effective OR (95% CI) Antibiotic Always or Usually Effective OR (95% CI) Age 0.99 (0.98–1.01) 1.00 (0.99–1.01) Married 0.66 (0.41–1.07) 0.93 (0.62–1.40) Nonwhite 1.82 (1.14–2.94)a 2.04 (1.35–3.12)a Male 1.52 (0.96–2.40) 1.37 (0.93–2.02) Some college or less education 2.08 (1.26–3.45)a 1.45 (0.9 8–2.17) Income ≥$75,000/y 0.90 (0.55–1.48) 0.78 (0.52–1.16) Self-reported asthma or chronic lung disease 1.94 (1.00–3.76) 1.11 (0.60–2.04) Any chronic medical condition 0.77 (0.47–1.27) 0.96 (0.64–1.44) Self-reported previous antibiotic use for ACI 2.20 (1.34–3.55)a 2.22 (1.49–3.30)a -
ACI = acute cough illness; OR = odds ratio.
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↵a P <. 0 5.
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The Article in Brief
How Long Does a Cough Last? Comparing Patients' Expectations With Data From a Systematic Review of the Literature
Mark H. Ebell , and colleagues
Background Acute cough illness is one of the most common reasons patients seek primary care treatment. Although it is usually caused by viruses and resolves itself without treatment, many patients seek care and request antibiotics. This study examines whether there is a mismatch between patient expectations of the duration of acute cough and the natural history of the condition. Such a mismatch could help explain why patients believe antibiotics are effective for this condition.
What This Study Found There is a large mismatch between patients' expectations of the duration of an acute cough and the actual duration. This study finds that the average duration of a cough is 17.8 days. In contrast, nearly 500 adults surveyed expect a cough to last an average of 7 to 9 days. If patients seek antibiotics after 5 to 6 days, and begin taking an antibiotic 7 days after the onset of symptoms, they may begin to feel better 3 or 4 days later, with the episode fully resolving 10 days later. Although this reflects the natural history of cough, it can reinforce the mistaken idea that the antibiotic worked. Those expecting a longer illness are more likely to be white and female and have self-reported asthma or lung disease. Those who believe antibiotics are always helpful for cough are more likely to be nonwhite, report some college education or less, and have previously taken antibiotics for acute cough.
Implications
- By emphasizing to patients the natural history and actual duration of acute cough, doctors can help prevent unnecessary antibiotic prescribing.
Supplemental Table
Supplemental Table 1. Cough Outcomes by Days Since Onset of Symptoms
Files in this Data Supplement:
- Supplemental data: Table 1 - PDF file, 1 page, 168 KB
Annals Journal Club
Jan/Feb 2013: Matching Illness Expectations with Clinical Reality
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patient expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5-13.
Discussion Tips
An important and under-appreciated role of the savvy clinician is to help patients to match their illness expectations with what is likely to happen. This study finds a huge mismatch between what the general public expects about the course of acute illnesses with cough, and how long acute coughs last on average. The study also identifies personal characteristics associated with expectations for shorter than usual cough duration and expectations that antibiotics will help. How can we use this knowledge?
Discussion Questions
- What question is asked by this study and why does it matter?
- How does this study advance beyond previous research and clinical practice on this topic?
- How strong is the study design for answering the question? How helpful is it to bring together the 2 sources of data (population survey and systematic literature review)?
- To what degree can the findings be accounted for by:
- How patients were selected, excluded, or lost to follow-up?
- How the main variables were measured?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
- Chance?
- How the findings were interpreted?
- What are the main study findings?
- How comparable are the study samples (for the survey and the literature review) to similar patients in your practice? What is your judgment about the transportability of the findings?
- What contextual factors are important for interpreting the findings?
- How might this study change your practice? Policy? Education? Research?
- Who are the constituencies for the findings, and how they might be engaged in interpreting or using the findings?
- What are the next steps in interpreting or applying the findings in clinical or public health settings?
- What researchable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
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