From the Guidelines
Post-viral cough is typically a self-limiting condition that resolves within 3-8 weeks, and management should focus on relieving symptoms and addressing underlying causes, such as airway inflammation, rather than treating the cough itself. The etiology of post-viral cough is often multifactorial, involving postviral airway inflammation, bronchial hyperresponsiveness, mucus hypersecretion, and impaired mucociliary clearance, as well as other conditions like upper airway cough syndrome (UACS), asthma, and gastroesophageal reflux disease (GERD) 1.
Key Considerations
- Post-viral cough can be triggered by minor irritants, temperature changes, or deep breathing due to heightened airway sensitivity.
- Common viral causes include influenza, rhinovirus, respiratory syncytial virus (RSV), and coronavirus.
- Management includes staying hydrated, using honey (for adults and children over 1 year), trying over-the-counter cough suppressants like dextromethorphan, and using inhaled corticosteroids if there's significant airway inflammation 2.
- For severe cases that impact sleep or daily activities, prescription medications such as codeine-containing cough suppressants or short courses of oral steroids might be considered, with a trial of inhaled ipratropium also being an option to attenuate the cough 1.
Diagnostic Approach
- 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 3.
- In patients with subacute postinfectious cough, judge which factors are most likely provoking cough before considering therapy, including postviral airway inflammation, UACS, asthma, and GERD 1.
- Persistent coughs lasting beyond 8 weeks should be evaluated further to rule out other conditions that may be contributing to or mimicking post-viral cough 1.
From the Research
Post-Viral Cough Etiology
- Post-viral cough is a type of cough originating from upper respiratory tract infections that persists after the infection is resolved 4
- The exact etiology of post-viral cough is not fully understood, but it is thought to be mediated by inflammatory processes 5
- Augmented cough reflex sensitivity is responsible for persistent cough after acute viral upper respiratory infection (URI) 6
- Cysteinyl leukotrienes are involved in the pathogenesis of postinfectious cough and whooping cough (pertussis) 7
Pathogenesis
- Post-infectious cough is associated with tickling or an irritating sensation in the throat which often leads to paroxysms of coughing 8
- The heightened cough reflex associated with SARS-CoV2 induces neurotropism, neuroinflammation, and neuroimmunomodulation via the vagal sensory nerves 6
- Inflammatory processes are also present in exacerbations of asthma or chronic obstructive pulmonary diseases, for which there is strong evidence that oral corticosteroids provide patient-relevant benefit without relevant harm 5
Therapeutic Options
- A combination of a β-agonist and an anticholinergic agent can effectively reduce post-viral cough 4
- Inhaled corticosteroids can be given a trial to suppress airway inflammation in patients who do not respond to early symptomatic treatment 6
- Montelukast, a cysteinyl leukotriene receptor antagonist, is not an effective treatment for postinfectious cough 7
- Oral corticosteroids may be beneficial in patients with post-infectious cough, but more research is needed to confirm this 5