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WESTERN ADVOCATE – Winter Cough Could Be Something More

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“A viral or post-viral cough is the most common cause of the winter cough that’s going around,” said Dr Nicholas Wilsmore, a Sleep and Respiratory Physician at Victoria’s Epworth Eastern and Box Hill Hospital.

“But if a cough is chronic – which by definition is a cough that has lasted for more than three months – or if it’s presenting with other signs, you might have more than just a cough.”

Common causes of a cough that aren’t a virus

Post-nasal drip

“The second most common cause of a cough is a post-nasal drip, where mucus from the nose drips backwards down your throat,” Dr Wilsmore said. Over-the-counter steroids like Nasonex in the form of a nasal spray are the first line of treatment.

“These can take up to two or three weeks to work, which is important [to note] because sometimes patients try it for a night or two and then stop using it.”


“If a patient only has a dry cough, especially if it is associated with any shortness of breath, wheezing or chest tightness, then asthma may be a possibility. This is usually confirmed with some breathing tests. In the absence of an asthma history, a trial of Ventolin may be reasonable in the first instance. But if a person is using Ventolin frequently, it’s worth them seeing their doctor, because an inhaled steroid might be better,” Dr Wilsmore said.


Cough keeping you up all night? Gastro-Oesophogeal Reflux Disease (GORD) or put simply, reflux could be the culprit.

“Patients with GORD might find that their cough worsens when they lie down, particularly if they lie down immediately after a meal,” Dr Wilsmore said.

“Going to bed on an empty stomach and propping yourself up a bit on a pillow can help. We might also give the patient a trial of an antacid tablet. Again, this can take a few weeks to work so perseverance is key.”

And if it is just a cough?

“Avoid throat-clearing, carry a bottle of water around and keep lozenges on you to relieve irritation in the upper airway,” Dr Wilsmore said. “If it’s a non-productive cough, try not to cough if you don’t have to.” And skip the cough medicine. “There is no evidence that cough suppressants actually work,” he said.

“The majority of coughs in winter are benign and are usually related to a viral infection and not a bacterial infection, and so will not benefit from antibiotics most of the time. We don’t want patients rushing into antibiotic treatment when they don’t need it.”

When to see your doctor

“If a cough is interfering with your ability to live your life, if you can’t sleep or go to work [because of your cough], or if you’re coughing so severely that you’re starting to gag or retch – even if your cough is only a recent phenomenon – that’s a good enough reason to see your doctor,” Dr Wilsmore said.

“If other concerning features are present – such as breathlessness, chest pain, high fever or coughing up blood – then the patient should see their doctor sooner rather than later, even if cough has only been around for a short period of time.”

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Published: 26th June, 2018