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What to look out for with TB

May 21 2009
A Rough Guide to Coughs and other symptoms Since this issue is focusing on TB, I thought I'd get my oar in about one of the key TB symptoms which leads to people pitching up at the surgery: the cough. Most of the other TB symptoms - coughing up blood, night sweats, weight loss and fever - are fairly self-evident, but when is a cough just a cough? At what point does a tickle in the throat, a great hacking beast or a phlegmy fur-ball mean you should down tools and head for the doc's, anticipating antibiotics, chest x-rays and immediate isolation to stop your spluttering carcass from infecting your nearest and dearest? It's a tough one, as the fear of being whisked off to the nearest infectious diseases unit is off-set by the potential embarrassment of being told that all you have is a cold and to stop being so melodramatic... What most of us could do with is a one of those magazine tick-box quizzes ("you have mostly 'A's and so you have bird flu" or "you have all 'B's and should be on life support‚Äö?Ñ??), but unfortunately, that's just not a realistic option - even if it feels like the way in which NHS Direct operates! Instead, the cougher (you) and the recipient of your phlegm-filled tissue (me) need to have a chat about your cough, and then I need to listen to your rasping airways. I'm going to ask when you first noticed your cough and whether it has changed since then. Are you bringing up sputum and if so, what colour is it? Are you coughing up blood? When do you cough and what triggers it? Do you cough at night or after exertion? Have you taken anything that makes it better, or worse? Bear in mind that the key feature of a worrying cough is persistence (ie, a cough that has lasted over three weeks), so try and think back to when it all kicked off. Now I've a good idea about your cough, I will need to ask about other symptoms such as fever, wheeze, chest pain, weight loss, night sweats and loss of appetite. Of course, it's really important to know about any prescribed meds you're taking and any other drugs - including tobacco. It makes sense, too, if I ask about your social situation and whether anyone else you share space with has been unwell. Naturally, if you've any medical conditions I need to know, even if it's something you consider unrelated. Your answers to these questions give a good indication as to whether I should fill in X-ray referral forms or shuffle you out the door without a backwards glance, but first I've got to listen to your chest. For starters, most people with a cough expect me to do so: there's something about a stethoscope that just looks so professional... and also I love the squeaks, crackles and groans that lungs make. Once that's done, we can talk about how likely you are to have something - or nothing - to be worried about. As has been been discussed elsewhere in this issue, the homeless suffer disproportionately from TB, so I'm more likely to ship you up to the hospital for a chest X-ray if you are in a hostel or sleeping rough. But it is up to you to get the pics done and to come on back for the results. Key management for TB is to identify those people with the condition as early as possible and to get them into treatment. Bear in mind that every one person who has active, untreated TB will infect 12-15 others every year, so see it as your duty to others to seek diagnosis. I'm hoping this Rough Guide to Coughs gives you some understanding about what, how and why we ask what we do, to give you heads-up when you're coming on in to the surgery.