What is the treatment for ongoing post-viral cough and shortness of breath?

From the Guidelines

The treatment for ongoing post-viral cough and shortness of breath should prioritize a trial of inhaled ipratropium to attenuate the cough, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.

Key Considerations

• The optimal treatment for postinfectious cough is not known, but antibiotics have no role as the cause is not bacterial infection 1.
• Inhaled ipratropium may help attenuate the cough, with a fair level of evidence and intermediate net benefit 1.
• In patients with postinfectious cough that adversely affects quality of life and persists despite inhaled ipratropium, consider the use of inhaled corticosteroids, with expert opinion and intermediate net benefit 1.
• For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time, with low level of evidence and intermediate net benefit 1.

Supportive Care

• Staying hydrated, using a humidifier, avoiding irritants like smoke, and getting adequate rest can help manage symptoms.
• Breathing exercises, such as diaphragmatic breathing and pursed-lip breathing, can help manage breathlessness.

Monitoring and Follow-up

• Symptoms typically improve gradually over 4-8 weeks as the body heals from viral damage to respiratory tissues.
• If symptoms persist beyond 8 weeks, worsen significantly, or are accompanied by fever, chest pain, or discolored sputum, medical evaluation is necessary to rule out complications or alternative diagnoses.

From the FDA Drug Label

USES Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. The treatment for ongoing post-viral cough may include guaifenesin (PO), which helps loosen phlegm and thin bronchial secretions to make coughs more productive 2. However, for shortness of breath, the provided information is insufficient to determine a specific treatment.

From the Research

Treatment for Ongoing Post-Viral Cough and Shortness of Breath

• The treatment for ongoing post-viral cough and shortness of breath aims at suppressing the cough reflex and reducing airway inflammation 3.
• Inhaled corticosteroids can be given a trial to suppress airway inflammation in patients who do not respond to early symptomatic treatment 3.
• Several agents are currently available for symptomatic relief, including gabapentin and gabapentin/montelukast combination, which have been shown to improve cough frequency and severity in hospitalized patients with COVID-19 4.
• Non-pharmacological remedies such as honey, glycerol, and herbal agents like polyphenols, flavonoids, and saponins may also be effective in relieving post-viral acute cough, although further rigorous studies are needed to confirm their efficacy and safety 5.
• Controlling cough and addressing neuroinflammatory events in the brain may be crucial in reducing the effect of COVID-19 and the post-COVID syndrome, with potential treatments including neuromodulators like gabapentin or opioids, as well as new anti-inflammatories or neuromodulators 6.

Clinical Characteristics and Management

• Post-COVID-19 persistent cough has similar clinical characteristics to chronic cough, and current cough guideline-based approaches may be effective in most patients with post-COVID cough 7.
• Measurement of fractional exhaled nitric oxide (FeNO) levels may be useful for cough management, with significantly higher proportions of patients with post-COVID cough having FeNO ≥ 25 ppb compared to those with non-COVID chronic cough 7.
• Cough-specific patient-reported outcomes (PROs) and systemic symptoms can improve significantly over time with usual care, although some patients may experience worsening of symptoms 7.