Persistent Cough and Chest Infections in London. When It Is Viral, When It Needs Antibiotics and When It Needs a Chest X-Ray

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The single most useful number about coughs is 3 weeks. Below that, the overwhelming majority are viral, antibiotics do nothing, and an acute cough lasts a median of around 18 days whatever anyone prescribes. Beyond 3 weeks the calculation changes, because NICE guideline NG12 identifies a cough persisting more than 3 weeks in anyone over 40 as a reason for a chest X-ray when it appears alongside another feature, and lung cancer remains the biggest cause of cancer death in the UK with survival heavily dependent on the stage at which it is found. Between those 2 positions sit the conditions most often missed entirely. Asthma presenting as a cough rather than a wheeze. Reflux causing a dry cough with no heartburn. Post-nasal drip. ACE inhibitor cough, which affects up to around 15% of people taking that class of blood pressure medication and resolves on switching. Undiagnosed COPD in a smoker who has accepted a morning cough as normal. And whooping cough, which is not confined to children and produces the classic weeks of paroxysms in vaccinated adults. At The Wellness you are examined properly, which for a chest is most of the diagnosis, testing is arranged where it will change the answer, and a chest X-ray is organised at a specialist centre with consultant radiologist reporting where the history warrants it. Consultations from £150 by video and £220 in person. Fees appear further down this page.

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Reviewed by the medical team at The Wellness. Last updated August 2026.

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Get seen today on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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When does a cough need urgent assessment

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Coughing blood needs assessment now, at any age and in any quantity, because it is the symptom least likely to be innocent. Breathlessness at rest or on minimal exertion, chest pain, a fever with rigors, confusion in an older person, or a rapid deterioration over hours all need same-day assessment or an emergency department depending on severity.

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The 3-week rule carries the most diagnostic weight in the everyday setting. A cough persisting beyond 3 weeks, particularly in anyone over 40 or with a smoking history, warrants a chest X-ray. The features that raise the priority further are haemoptysis, unexplained weight loss, persistent chest or shoulder pain, hoarseness lasting over 3 weeks, finger clubbing, persistent or recurrent chest infection in the same area, and a neck or supraclavicular lump.

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Anyone with a history of cancer, immunosuppression or recent foreign travel to a tuberculosis-endemic area sits in a different category and should be assessed rather than watched. Night sweats with weight loss and a chronic cough is the classic tuberculosis presentation and it is not rare in London.

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Everything else is the majority, and the majority is viral.

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Do I need antibiotics for a chest infection

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Usually not, and this is where most private appointments go wrong. Acute bronchitis is overwhelmingly viral, and trials consistently show antibiotics shorten symptoms by less than a day while carrying the risks of side effects and resistance. A green or yellow colour to sputum indicates inflammatory cells rather than bacterial infection and is not a reason to prescribe.

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Pneumonia is different and needs treating. The features that separate it are fever, focal chest signs on examination, a raised respiratory rate, low oxygen saturation and feeling systemically unwell rather than simply coughing. That distinction comes from an examination, which is exactly why a chest complaint is one of the presentations where remote assessment reaches its limit and where an in-person appointment earns its fee.

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Where antibiotics are appropriate they are prescribed in the appointment. Where they are not, you get an explanation, a realistic timeline, symptomatic treatment that helps, and the specific signs that should bring you back. An acute cough lasting a median of 18 days is normal, which is worth knowing before day 12 convinces you something is seriously wrong.

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Ask whether you need to be seen on WhatsApp or email team@thewellnesslondon.com.

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What causes a cough that will not go away

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Post-infectious cough is the commonest, lingering for 3 to 8 weeks after a viral illness because the airways stay irritable long after the virus has gone. It is benign and it is also a diagnosis of exclusion in anyone with risk factors.

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Asthma frequently presents as a cough rather than a wheeze, particularly at night, after exercise and in cold air, and cough-variant asthma is regularly treated as recurrent infection for years. Spirometry and a trial of treatment settle it. Reflux causes a dry persistent cough in a substantial proportion of people who report no heartburn at all, worse lying flat and after meals. Post-nasal drip from allergic or non-allergic rhinitis produces throat clearing and a cough worse in the morning.

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ACE inhibitor cough is the easiest win in medicine and is missed constantly. Up to around 15% of people taking ramipril, lisinopril and similar develop a dry cough, sometimes months after starting, and switching the drug resolves it within weeks. Anyone with a persistent dry cough should have their medication list reviewed before anything else.

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Then the ones that need finding. COPD in a smoker or ex-smoker over 35 with a chronic productive cough, which is substantially underdiagnosed. Bronchiectasis in someone with recurrent infections and daily sputum. Whooping cough in an adult with weeks of paroxysmal coughing and a whoop or vomiting afterwards. Heart failure, where a cough and breathlessness worse lying flat is the presentation people attribute to a chest infection. And lung cancer, which is why the 3-week rule exists.

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How the assessment works

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You are examined. Chest auscultation, respiratory rate, oxygen saturation, temperature, pulse, throat, ears and lymph nodes, and the examination distinguishes pneumonia from bronchitis, wheeze from stridor, and a chest problem from a cardiac one. That is not available remotely, and a video appointment for a cough with any red flag is converted to an in-person one before you pay for the wrong thing.

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Testing is arranged where it changes the answer. Bloods at an accredited laboratory covering full blood count, inflammatory markers and, where relevant, D-dimer, BNP for suspected heart failure, or eosinophil count and total IgE where asthma is plausible. Sputum culture where infection is recurrent. Spirometry where obstruction is suspected. A chest X-ray at a specialist centre with consultant radiologist reporting where the history warrants it, usually within days, and CT where the X-ray or the picture requires it.

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Then a review appointment, going through the report and the results together, with treatment started, a respiratory or cardiology referral written to a named consultant where needed, and the appointment booked rather than suggested. Where a cancer pathway is indicated, it is escalated the same day.

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What does assessment cost in London

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Consultant respiratory appointments in the Harley Street district run £250 to £450 before any investigation, with imaging and lung function testing charged separately. Private chest X-ray commonly runs £150 to £350 and CT of the chest £500 to £1,000. Comprehensive imaging programmes at the top of the market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, remote appointments where nobody listens to your chest, which for a cough is most of the examination and all of the difference between bronchitis and pneumonia.

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At The Wellness the assessment, the coordination and the review are 1 fee, and all figures are from prices. The Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, is from £11,995. The Executive Body Scan, consultant-reported imaging with full bloods and consolidated review, is from £5,995. The Comprehensive Blood Panel with consultation and interpretation is from £495, and a Targeted Blood Panel from £295. An extended 45-minute consultation for complex or long-standing respiratory problems is from £395. An in-person consultation with full chest examination in Marylebone is from £220, and a same-day video consultation from £150. A home, hotel or office visit is from £495 daytime and £695 evenings and weekends, which suits anyone too unwell to travel. Chest X-ray, CT, spirometry and respiratory or cardiology referral are arranged at specialist centres with consultant reporting and the appointment booked.

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Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.

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Why The Wellness is the best place in London for a persistent cough

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Because you get examined and because you get told the truth about antibiotics. A clinic that prescribes on request has a high satisfaction rating and a poor safety record, and the reason most private cough appointments end in a prescription is that it is easier than a conversation. Here you get the conversation, the examination that separates bronchitis from pneumonia, and antibiotics where they are actually indicated.

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Because the 3-week rule is applied deliberately rather than remembered occasionally. A cough beyond 3 weeks in anyone over 40 gets a chest X-ray arranged at a specialist centre with consultant radiologist reporting, usually within days, and a suspicious result is escalated the same day into a cancer pathway rather than posted to you.

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And because the causes people carry for years get found. The ACE inhibitor nobody reviewed. The asthma treated as recurrent infection. The reflux with no heartburn. The COPD accepted as a smoker's cough. Thirty minutes, an examination and a medication review resolve a remarkable proportion of coughs that have already survived several 10-minute appointments.

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Book an appointment on WhatsApp or call 020 3951 3429.

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Frequently asked questions

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How long should a cough last before I see a doctor

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An acute viral cough lasts a median of around 18 days and needs no antibiotics. Beyond 3 weeks it warrants assessment, and NICE NG12 identifies a cough persisting more than 3 weeks in anyone over 40 as a reason for a chest X-ray when other features are present. Coughing blood, breathlessness at rest, chest pain or a high fever needs assessment now.

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Do I need antibiotics for a chest infection

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Usually not. Acute bronchitis is overwhelmingly viral and antibiotics shorten symptoms by less than a day while carrying side effects and resistance risk. Green sputum indicates inflammatory cells rather than bacterial infection. Pneumonia is different and does need treating, and the distinction comes from an examination.

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What causes a cough that will not go away

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Post-infectious airway irritability lasting 3 to 8 weeks is commonest. Then cough-variant asthma, reflux causing a dry cough even without heartburn, post-nasal drip, and ACE inhibitor cough which affects up to around 15% of people on that class of blood pressure drug and resolves on switching. COPD, bronchiectasis, whooping cough, heart failure and lung cancer all need excluding where the history fits.

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When do I need a chest X-ray

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A cough beyond 3 weeks in anyone over 40 or with a smoking history, or at any age alongside coughing blood, unexplained weight loss, persistent chest pain, hoarseness over 3 weeks or recurrent infection in the same area. We arrange it at a specialist centre with consultant radiologist reporting, usually within days.

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Can a cough be assessed by video

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For advice and for straightforward cases, yes. Where any red flag is present or where the chest needs listening to, video reaches its limit, and we will convert the appointment to an in-person one or a home visit rather than prescribing blind.

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Could my blood pressure tablet be causing my cough

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It is one of the commonest causes of a persistent dry cough and one of the most missed. Up to around 15% of people taking ACE inhibitors such as ramipril or lisinopril develop it, sometimes months after starting, and switching the drug resolves it within weeks. A medication review is part of every cough assessment here.

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The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Imaging is arranged at specialist centres and reported by consultant radiologists, and blood analysis is performed by accredited laboratories. Coughing blood, breathlessness at rest, chest pain or confusion needs urgent assessment, and in an emergency call 999. This article is general information and not a substitute for medical advice about your own health.

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Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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References. NICE guideline NG12, suspected cancer recognition and referral, lung and pleural cancer provisions including cough persisting more than 3 weeks. NICE guideline NG138 on pneumonia in adults and NG120 on cough associated with an upper respiratory tract infection. NICE guideline NG115 on chronic obstructive pulmonary disease and NG80 on asthma diagnosis and monitoring. NICE Clinical Knowledge Summaries on cough, ACE inhibitor cough and gastro-oesophageal reflux. Cancer Research UK lung cancer incidence, mortality and stage-related survival statistics. Published evidence on the natural duration of acute cough and on antibiotic efficacy in acute bronchitis. Published 2026 London private respiratory and imaging market pricing.