From the Guidelines
The best treatment for post-viral cough syndrome is a trial of inhaled ipratropium, as it may attenuate the cough, according to the American College of Chest Physicians evidence-based clinical practice guidelines 1. When a patient complains of cough that has been present following symptoms of an acute respiratory infection for at least 3 weeks, but not more than 8 weeks, consider a diagnosis of postinfectious cough. Some key points to consider in the treatment of post-viral cough syndrome include:
- Therapy with antibiotics has no role, as the cause is not bacterial infection 1.
- In patients with postinfectious cough, when the cough adversely affects the patient’s quality of life and when cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids 1.
- For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time when other common causes of cough have been ruled out 1.
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail 1. It is essential to note that the optimal treatment for postinfectious cough is not known, and the approach should be individualized based on the patient's specific symptoms and underlying conditions. In addition to these treatments, patients can try over-the-counter cough suppressants, such as dextromethorphan, and home remedies like honey and humidifiers to help manage their symptoms. If the cough persists beyond 8 weeks, worsens, or is accompanied by fever, shortness of breath, or blood, it is crucial to consult a healthcare provider to rule out other conditions that may require medical evaluation.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Purpose Cough suppressant The best treatment for post-viral cough syndrome is not explicitly stated in the provided drug labels.
- Guaifenesin 2 is used to loosen phlegm and thin bronchial secretions, making coughs more productive.
- Dextromethorphan 3 is a cough suppressant. Since the FDA drug labels do not directly address the question of the best treatment for post-viral cough syndrome, no conclusion can be drawn.
From the Research
Treatment Options for Post-Viral Cough Syndrome
- A combination of a β-agonist and an anticholinergic agent can effectively reduce post-viral cough, as demonstrated in a randomized, double-blind, placebo-controlled trial 4.
- Inhaled corticosteroids can be used to suppress airway inflammation in patients with post-COVID-19 cough who do not respond to early symptomatic treatment 5.
- Oral corticosteroids are being investigated as a potential treatment for post-infectious cough, with a randomized controlled trial currently underway to evaluate their effectiveness 6.
- Neuromodulators such as gabapentin or opioids may be considered for acute and chronic COVID-19-associated cough, although further research is needed to fully understand their potential benefits and risks 7.
Pathogenesis of Post-Viral Cough Syndrome
- Post-viral cough is thought to be mediated by inflammatory processes, as well as neurotropism, neuroinflammation, and neuroimmunomodulation via the vagal sensory nerves 5, 7.
- Augmented cough reflex sensitivity is responsible for persistent cough after acute viral upper respiratory infection (URI) 5.
- The post-COVID syndrome may result from neuroinflammatory events in the brain, leading to a range of long-term effects including chronic fatigue, cognitive impairment, and dyspnoea 7.
Current Therapeutic Options
- Current therapeutic options for post-infectious cough are limited and often only moderately effective 8.
- Symptomatic relief can be provided by several agents, although non-response or refractory cough continues to be a challenge 5.
- Further research is needed to develop more effective treatments for post-viral cough syndrome and to fully understand the mechanisms underlying this condition 4, 5, 6, 7.