From the Guidelines
The management of post-viral cough should prioritize non-pharmacological measures and reserve pharmacological interventions for cases where the cough significantly impacts the patient's quality of life. When managing post-viral cough, it's essential to consider the potential causes and pathogenesis of the cough, including inflammation and disruption of airway epithelial integrity 1. The following management options can be considered:
- Non-pharmacological measures such as adequate hydration, using a humidifier, and avoiding irritants like smoke or pollution.
- For pharmacological management, consider a trial of inhaled ipratropium as it may attenuate the cough 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.
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, but with caution due to potential side effects and risk of dependence 1. It's crucial to rule out other common causes of cough, such as upper airway cough syndrome, asthma, or gastroesophageal reflux disease, before initiating treatment 1. If the cough persists beyond 8 weeks, is accompanied by fever, shortness of breath, chest pain, or if the patient coughs up blood, they should seek medical attention as these may indicate a more serious condition requiring different treatment 1.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Warnings ... Ask a doctor before use if you have • chronic cough that lasts as occurs with smoking, asthma or emphysema • cough that occurs with too much phlegm (mucus)
The management options for post-viral cough include:
- Using guaifenesin (PO) to loosen phlegm and thin bronchial secretions, making coughs more productive 2
- Considering dextromethorphan (PO), but only under the guidance of a doctor, especially if the cough is chronic or occurs with too much phlegm 3 Key considerations:
- Consult a doctor before use, especially if the cough persists or is accompanied by other symptoms such as fever, rash, or headache
- Report any side effects to the FDA or a healthcare professional 3
From the Research
Management Options for Post-Viral Cough
- The management of post-viral cough can involve various treatment options, including pharmacological and non-pharmacological approaches 4, 5, 6, 7, 8.
- Pharmacological options may include expectorants such as guaifenesin, which acts by loosening mucus in the airways and making coughs more productive 4.
- Oral corticosteroids may also be considered for post-infectious cough, as they have been shown to provide patient-relevant benefits in conditions with similar inflammatory processes 5.
- Inhaled corticosteroids can be given a trial to suppress airway inflammation in patients who do not respond to early symptomatic treatment 6.
- Non-pharmacological remedies, such as honey, glycerol, and herbal agents, may also be effective in relieving post-viral acute cough, although further rigorous studies are needed to confirm their efficacy and safety 7, 8.
Treatment Considerations
- Informing patients about the self-limited nature of the common cold can help manage expectations and limit antibiotic use 8.
- Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants, and ipratropium for cough 8.
- In children, established safe and effective treatments include acetylcysteine, honey, nasal saline irrigation, and topical application of ointment containing camphor, menthol, and eucalyptus oils 8.
- Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 8.