HealthDay News — Patients drastically underestimate the average duration of acute cough illness, study findings indicate.

Adults who participated in a population-based, random digit dialing survey reported they expect a cough to last an average of 7.2 to 9.3 days, but a literature review revealed the actual mean duration for acute cough illness is 17.8 days, Mark H. Ebell, MD, of the University of Georgia in Athens, and colleagues reported in Annals of Family Medicine.

“We believe that education of the general public, the media, and physicians should emphasize appropriate expectations regarding the natural history of ACI in order to reduce inappropriate demands for antibiotics,” the researchers wrote.

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They conducted a population-based random digit dialing survey involving 493 adults in Georgia to assess their expectations regarding cough duration. They compared the survey findings with results of a systematic review of 19 studies to assess the duration of ACI.

In the meta-analysis, weighted mean duration of any cough was 17.8 days (range = 15.3 to 28.6 days), and 13.9 days (range = 13.3 to 17.4 days) for productive cough. A total of 86.4% to 95% reported cough eight days after symptom onset, the researchers found. In three studies, 91% of patients reported cough at 16 days, 73% at 17 days and 82% at 21 days.

Among survey respondents, a linear regression analysis revealed that expectation for longer duration of cough was more likely among patients who were white, female and had a history of asthma or chronic lung disease. 

Respondents most likely to believe that antibiotics are always helpful tended to be nonwhite (odds ratio [OR]= 1.82; 95% CI: 1.14–2.94), have some college education or less (OR=2.08; 95% CI: 1.26–3.45), and to have previously received antibiotics for ACI (OR=2.20; 95% CI: 1.34–3.55).

“The mismatch between patients’ expectations and reality for the natural history of acute cough illness has important implications for antibiotic prescribing,” the researchers wrote.

For instance, if patients expect acute cough illness symptoms to last about six to seven days, “it makes sense that they might seek care for that episode and request an antibiotic after five or six days.”

Similarly, if a patient has started an antibiotic after seven days, they may begin to feel better within three to four days, the researchers noted. “Although this outcome may reinforce the mistaken idea that the antibiotic worked, it is merely a reflection of the natural history of acute cough illness.”

The metaanalysis only involved patients living in temperate climates, so the findings may not apply to those in tropical countries, the researchers acknowledged. Similarly the survey involved adults living in the state of Georgia, only, and may not accurately reflect the beliefs or expectations of individuals in other parts of the United States or other countries.


  1. Ebell MH et al. Ann Fam Med. 2013; 11:5-13.