From the Guidelines
Ipratropium (Atrovent) may be considered for treating post-viral cough, but its effectiveness is limited and it is not a first-line treatment. According to the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1, ipratropium may attenuate the cough in some patients, but other treatments are generally more effective.
Key Points to Consider
- Post-viral cough typically results from airway inflammation and heightened cough reflex sensitivity following a viral infection.
- Other treatments, such as dextromethorphan (15-30mg every 6-8 hours) or codeine-containing cough suppressants, may provide short-term symptom relief.
- Inhaled corticosteroids may be beneficial if there is a significant inflammatory component.
- If a patient has underlying asthma or COPD exacerbated by the viral infection, ipratropium may be more beneficial as part of their treatment regimen.
- The standard dosage of ipratropium for respiratory conditions is typically 2 inhalations (34 mcg) four times daily.
Recommendations
- Consider a trial of inhaled ipratropium as it may attenuate the cough, but only after ruling out other common causes of cough, such as upper airway cough syndrome, asthma, or gastroesophageal reflux disease 1.
- Address any underlying conditions like postnasal drip or asthma for effective management.
- Most post-viral coughs resolve within 3-8 weeks with or without treatment.
Important Considerations
- Therapy with antibiotics has no role in treating post-viral cough, as the cause is not bacterial infection 1.
- Central acting antitussive agents, such as codeine and dextromethorphan, should be considered when other measures fail 1.
From the Research
Effectiveness of Atrovent for Post-Viral Cough
- Atrovent, also known as ipratropium, has been studied as a potential treatment for post-viral cough in several clinical trials 2, 3.
- A randomized, double-blind, placebo-controlled trial found that a combination of ipratropium and salbutamol significantly reduced daytime and nighttime cough severity in patients with post-viral cough after 10 days of treatment 2.
- Another study found that inhaled ipratropium bromide produced significant reductions in daytime and nighttime cough in patients with persistent post-viral infective cough 3.
- However, a systematic review and meta-analysis of randomized clinical trials found that no clear patient-relevant benefits were observed with various treatments, including inhaled ipratropium-bromide, for post-infectious cough 4.
- Other studies have focused on non-pharmacological remedies for post-viral acute cough, such as honey, glycerol, and herbal agents, but further research is needed to confirm their efficacy and safety 5.
- The pathogenesis of post-infectious persistent cough is not fully understood, and current therapeutic options are limited, making further research necessary to develop effective treatments 6.