More about Early symptoms

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Typical whooping cough, with nothing except choking attacks of coughing, vomiting or retching afterwards, and sometimes a whoop after a few seconds of breath-holding, usually takes about 2 weeks to develop. What happens in these first two weeks is quite important to know when one is trying to distinguish whooping cough from other possible causes of a choking cough.

If you read text books about whooping cough, or web sites with information about whooping cough (which are all based on textbooks) you are told, without exception, that the disease starts with catarrhal symptoms like a regular cough and cold, with sneezing, runny eyes and nose. These symptoms last for several days and turn into a hacking cough particularly at night. After 10 to 14 days typical choking paroxysms are occurring. We are told that low grade fever can occur.

I have to tell you, after documenting about 700 cases now (2008), that the above is not what happens to my patients.  Only about a third of my patients have had the above catarrhal symptoms to any degree, the remaining two thirds simply start with a sore throat (the ones old enough to be able to say) which turns in a couple of days into a dry hacking cough that gets gradually worse until after about 2 weeks is becoming paroxysmal. Some cough up quite a lot of sputum, some have small amounts of very thick and sticky sputum that comes up only with great difficulty. Most of the latter feel that they are coughing in order to get up these little bits of sputum, not realizing that the coughing spasms are the real problem. Sometimes people describe coughing up copious amounts of thin sputum. I suspect that this may be reflex salivation.

Feverishness is unusual in my view, but listlessness in the early stages seems quite common.

Sometimes the cough is worse in the day, or only at night, or when lying down. It varies tremendously from person to person. But they all end up with the characteristic choking cough at some time or other.

I believe that having a cough or cold makes people more susceptible to whooping cough. So commonly, people who turn out to have whooping cough, have had a pre-existing viral respiratory infection, after which whooping cough has come on. It is impossible then, not to believe that the first early symptoms were not due to whooping cough, but rather the viral disease. This is why in practice, the early symptoms and the duration of them, before typical paroxysms occur, seems so variable in practice. This makes diagnosis even more difficult for both lay and professional people.

It can be very confusing for asthmatics, who are quite used to coughing, sometimes with choking. But asthmatics are more susceptible to whooping cough and are likely to be undiagnosed for longer. There is a useful sign however.  Asthmatics with whooping cough are usually aware that although the cough is a bit familiar, their chest is not tight as they would expect if it were asthma doing it. They usually recognize this but do not think it important enough to mention. Indeed, its significance is usually missed at the time by everyone.