From the Guidelines
Management of post-viral cough should prioritize non-pharmacological measures, including adequate hydration, using a humidifier, avoiding irritants, and honey, before considering pharmacological options like dextromethorphan or inhaled ipratropium bromide, as suggested by 1.
Non-Pharmacological Management
Non-pharmacological measures are the first line of treatment for post-viral cough. These include:
- Adequate hydration to thin out mucus
- Using a humidifier to add moisture to the air
- Avoiding irritants like smoke or pollution
- Honey (1-2 teaspoons as needed for adults) for its soothing effects
Pharmacological Management
For pharmacological management, the following options can be considered:
- Dextromethorphan (15-30mg every 4-8 hours, maximum 120mg daily) for non-productive cough
- Guaifenesin (200-400mg every 4 hours, maximum 2400mg daily) for productive cough
- Inhaled ipratropium bromide (2 puffs 3-4 times daily) may help cough associated with underlying respiratory conditions, as noted in 1 and 1
Considerations for Treatment
- Therapy with antibiotics has no role in the treatment of post-viral cough, as there is no evidence that bacterial infection plays a role, as stated in 1 and 1
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, with caution due to their potential for addiction
- 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, as suggested by 1 and 1
Duration and Further Evaluation
Post-viral cough typically resolves within 3-8 weeks as airway inflammation subsides. However, persistent cough beyond 8 weeks warrants further evaluation to rule out complications or alternative diagnoses, such as upper airway cough syndrome (UACS) due to rhinosinus diseases, asthma, or gastroesophageal reflux disease, as mentioned in 1 and 1. Treatment should be targeted to the specific cough characteristics and underlying mechanisms, as post-viral cough results from temporary airway hyperresponsiveness and inflammation following respiratory infections.
From the FDA Drug Label
USES Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. The management option for post-viral cough includes the use of guaifenesin (PO) to help loosen phlegm and thin bronchial secretions, making coughs more productive 2.
- The primary benefit of guaifenesin is to make coughs more productive, which can help manage post-viral cough.
From the Research
Management Options for Post-Viral Cough
The management of post-viral cough can be challenging due to its multifactorial nature and the lack of clear guidelines for treatment. Several studies have investigated different approaches to managing post-viral cough, including:
- Pharmacological interventions, such as oral corticosteroids, which have shown promise in reducing cough-related quality of life 3
- Non-pharmacological remedies, including herbal agents, honey, and saline solutions, which may provide relief for post-viral acute cough 4
- Neuromodulators, such as gabapentin or opioids, which may be considered for acute and chronic COVID-19-associated cough 5
Treatment Approaches
Treatment approaches for post-viral cough may involve:
- Identifying and addressing underlying causes and potentiators of cough, as emphasized in a practical approach to diagnosis and management 6
- Using a combination of treatments, as post-viral cough is often multifactorial in nature
- Considering the potential benefits and harms of different treatment options, including oral corticosteroids and non-pharmacological remedies 3, 4
Future Directions
Further research is needed to fully understand the mechanisms of post-viral cough and to develop effective treatment strategies. This may involve:
- Investigating the role of viral neurotropism, neuroinflammation, and neuroimmune responses in COVID-19-associated cough 5
- Conducting rigorous studies to confirm the efficacy and safety of natural products for relieving post-viral acute cough 4
- Developing new anti-inflammatories or neuromodulators that may successfully target both the cough of COVID-19 and the post-COVID syndrome 5