What is the treatment for a patient with a wheezy cough and flu-like symptoms?

From the Guidelines

For a patient with a wheezy cough and flu-like symptoms, treatment should focus on symptom relief and addressing both the respiratory symptoms and potential influenza infection, with the most recent guidelines suggesting initiation of antiviral treatment within 48 hours of symptom onset if influenza is suspected 1.

Key Recommendations

• Start with rest, adequate hydration, and over-the-counter medications like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours to reduce fever and alleviate body aches.
• For the wheezy cough, an inhaled bronchodilator such as albuterol (2 puffs every 4-6 hours as needed) can help relax airway muscles and improve breathing, as suggested by previous guidelines 1.
• An over-the-counter expectorant containing guaifenesin (such as Mucinex) 600mg every 12 hours can help loosen mucus.
• If symptoms suggest influenza and it's within 48 hours of symptom onset, prescription antiviral medications like oseltamivir (Tamiflu) 75mg twice daily for 5 days may be beneficial, according to the most recent guidelines 1.
• Honey-lemon tea or lozenges can soothe throat irritation.

Important Considerations

• If wheezing is severe, breathing is difficult, symptoms worsen after 7-10 days, or high fever persists, seek immediate medical attention as this could indicate complications like pneumonia or asthma exacerbation requiring additional treatments such as oral corticosteroids or antibiotics.
• The decision to use antibiotics should be based on clinical judgment and suspicion of bacterial infection, with routine antibiotic treatment not recommended for uncomplicated acute bronchitis 1.
• The use of antiviral medications and the diagnosis of influenza should be guided by the most recent guidelines and clinical presentation 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm

The treatment for a patient with a wheezy cough and flu-like symptoms may include albuterol sulfate inhalation solution. The recommended dosage is 2.5 mg administered three to four times daily by nebulization 2. It is essential to follow the instructions for use and only use as directed by a physician. If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately 2.

From the Research

Treatment for Wheezy Cough and Flu-like Symptoms

• The treatment for a patient with a wheezy cough and flu-like symptoms depends on the underlying cause of the symptoms 3, 4.
• If the patient is diagnosed with influenza, treatment with one of four approved anti-influenza drugs may be considered if the patient presents within 48 hours of symptom onset 3.
• The benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom onset, and it can decrease the duration of illness by about 24 hours in otherwise healthy patients 3.
• For patients with chronic cough, empiric treatment should be initiated based on the clinical evaluation, and other potential causes such as angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea should be considered 5.
• A trial of short-acting beta agonists can be considered while awaiting formal evaluation for patients with wheezing 4.
• It is essential to develop a standardized evaluation of wheezing and expeditiously manage symptoms, as wheezing is associated with reduced quality of life and increased health care costs 4.

Diagnostic Approach

• The diagnosis of influenza is typically made clinically, and laboratory confirmation is not necessary for most patients in the outpatient setting 3.
• Rapid molecular assays are the preferred diagnostic tests for influenza because they can be done at the point of care, are highly accurate, and have fast results 3.
• For patients with chronic cough, chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions 5.
• Initial tests for wheezing typically include a chest x-ray and pulmonary function testing with bronchodilator challenge 4.

COVID-19 Considerations

• COVID-19 illness is highly variable, ranging from infection with no symptoms through to pneumonia and life-threatening consequences 6.
• Symptoms such as fever, cough, or loss of sense of smell (anosmia) or taste (ageusia) can help flag early on if the disease is present 6.
• The presence of anosmia or ageusia may be useful as a red flag for the presence of COVID-19, and the presence of cough also supports further testing 6.