From the Guidelines
For a post-viral cough, the most effective alternative to Advair is a trial of inhaled ipratropium, as it may attenuate the cough, according to the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. When considering treatment options, it's essential to rule out other common causes of cough, such as upper airway cough syndrome (UACS) due to rhinosinus diseases, asthma, or gastroesophageal reflux disease.
- Inhaled corticosteroids may be considered when the cough adversely affects the patient's quality of life and persists despite the use of inhaled ipratropium, as stated in the ACCP guidelines 1.
- Central acting antitussive agents, such as codeine and dextromethorphan, should be considered when other measures fail, due to their potential to provide relief for severe paroxysms of postinfectious cough 1. Some key points to consider when treating post-viral cough include:
- Avoiding therapy with antibiotics, as the cause is not bacterial infection 1
- Considering a short, finite period of prednisone (30 to 40 mg per day) for severe paroxysms of postinfectious cough, when other common causes have been ruled out 1
- Non-medication approaches, such as staying hydrated, using a humidifier, and avoiding irritants like smoke, can also help alleviate symptoms. It's crucial to discuss any medication change with a healthcare provider to ensure appropriate dosing and to rule out other conditions that might require different treatment.
From the Research
Alternatives to Advair for Post-Viral Cough
- There are several alternatives to Advair for post-viral cough, including:
- Inhaled corticosteroids, such as budesonide or ciclesonide, which have been shown to reduce the combined endpoint of admission to hospital or death and increase the resolution of all initial symptoms at day 14 in people with mild COVID-19 2
- A combination of a β-agonist and an anticholinergic agent, such as salbutamol and ipratropium bromide, which has been shown to effectively reduce post-viral cough 3
- Oral corticosteroids, which are being investigated for the treatment of post-infectious cough in adults, with a study currently underway to evaluate their effectiveness 4
- Non-pharmacological remedies, such as honey, glycerol, and herbal agents, which have some evidence for relieving post-viral acute cough, although further rigorous studies are needed to confirm their efficacy and safety 5
Comparison of Alternatives
- Budesonide/formoterol has been shown to have a faster onset of bronchodilatory effect compared to salmeterol/fluticasone, and a similar onset to salbutamol, in patients with chronic obstructive pulmonary disease and reversible airway obstruction 6
- Inhaled corticosteroids, such as budesonide, may have a beneficial effect on post-viral cough, although the evidence is still limited and more studies are needed to confirm their effectiveness 2
Considerations
- The choice of alternative to Advair for post-viral cough will depend on individual patient factors, such as the severity of symptoms, medical history, and preferences
- Patients should consult with their healthcare provider to determine the best course of treatment for their post-viral cough
- Further research is needed to fully understand the effectiveness and safety of these alternatives, particularly in different patient populations and with varying severity of post-viral cough 3, 4, 2, 5, 6