When a cough becomes a medical emergency

Posted on 6 March 2019

A lingering cough is perhaps one of the most common human ailments. There seems to be no escaping some form of “hack”, either voluntarily or involuntarily.

Effectively a forceful expulsion of your breath, coughing is actually a defensive reflex. Your airways need to remain clear for effective breathing – and coughing does exactly that. But coughing can also be a symptom of underlying illness or even disease. This begs the question: when does a cough become a medical concern?

“While many coughs tend to be resolved within a week or so, any cough lasting longer than a few weeks is cause for more serious concern,” says Dr Karlien Bezuidenhout, a general practitioner at Mediclinic Hoogland. “It is important not to let a cough linger for too long.”

Coughing can be divided into two categories, namely acute or chronic.


Acute coughs last anywhere between one and three weeks. Generally viral in nature, acute coughing is the often result of an upper respiratory infection or irritation. For instance, summertime means drier air conditions, which in turn can adversely affect the upper-respiratory tract. Conditions such as bronchitis as well as sinusitis, post-nasal drip and various allergies are fairly common in this category. More severe illnesses like pneumonia are also more common during the winter months.

A cough mixture can often be prescribed for these coughs. Different cough mixtures have different modes of action (e.g. loosening phlegm, opening airways, suppressing cough or soothing airway irritation.) and each type is indicated for the symptoms or cause of the cough. These medicines are generally used for about a week.

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Chronic coughs linger longer than three weeks and are generally indicative of a more serious underlying issue. Asthma, emphysema, stomach acid reflux and lung cancer all fall into this category, as does tuberculosis (TB). While it is difficult for a doctor to distinguish whether a cough is acute or chronic early on, it is important to identify and treat the cause as opposed to the symptoms.

“Observing the colour of your phlegm is an important indicator as far as the seriousness of illness is concerned,” Dr Bezuidenhout explains. “Clear phlegm indicates a viral or allergic condition, while green or yellow forms may be indicative of acute bacterial infection such as bronchitis. These illnesses can be treated and eliminated fairly rapidly. Blood in the sputum, however, is a very serious sign and could indicate pulmonary oedema, lung cancer or even a bacterial tuberculosis infection.”

With active tuberculosis being the number one cause of death in South Africa, early detection of this disease is critical for effective treatment and recovery. Coughing up blood is only one of its primary symptoms, as is weight loss, night sweats, chest pains and fever.

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“If a patient has blood in the sputum, further tests are required,” says Dr Bezuidenhout. “A sputum test for tuberculosis (TB) will be necessary and chest X-ray to ascertain whether there is any cavitation in the lungs. If you are coughing for an extended period of time, be vigilant and pay attention to the various symptoms mentioned. While tuberculosis is a serious disease, remember that it is fully treatable.” Some resistant strains do, however, make treatment difficult in some cases.


Published in Healthy Life

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.