What is the treatment for post-viral cough syndrome?

From the Guidelines

Post-viral cough syndrome is typically treated with a combination of over-the-counter medications and home remedies while the condition resolves naturally over time. For symptom relief, consider using dextromethorphan (15-30 mg every 4-6 hours) for cough suppression or guaifenesin (200-400 mg every 4 hours) to thin mucus, as suggested by 1. Honey (1-2 teaspoons as needed) can soothe throat irritation, while staying well-hydrated helps thin secretions. Inhaling steam or using a humidifier can moisturize airways and reduce cough triggers. Some key points to consider in the treatment of post-viral cough syndrome include:

• Therapy with antibiotics has no role, as the cause is not bacterial infection, according to 1.
• Consider a trial of inhaled ipratropium as it may attenuate the cough, as mentioned in 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, as suggested by 1.
• For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time when other common causes of cough have been ruled out, according to 1.
• Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, as mentioned in 1. For persistent symptoms, prescription options may include inhaled corticosteroids like fluticasone (2 sprays per nostril daily) or benzonatate capsules (100-200 mg three times daily), as these treatments work by reducing inflammation in the airways and suppressing the cough reflex that remains hypersensitive after a viral infection, as suggested by 1. Most post-viral coughs resolve within 3-8 weeks without specific treatment. If your cough persists beyond 8 weeks, worsens, or is accompanied by fever, shortness of breath, or blood in sputum, consult a healthcare provider to rule out other conditions.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. The treatment for post-viral cough syndrome may include guaifenesin (PO), which helps loosen phlegm and thin bronchial secretions to make coughs more productive 2.

• Key points:
  • Guaifenesin is used to help loosen phlegm and thin bronchial secretions.
  • This can make coughs more productive.

From the Research

Treatment Options for Post-Viral Cough Syndrome

The treatment for post-viral cough syndrome can be challenging, but several options are available.

• Treatment directed at associated conditions such as asthma (with anti-inflammatories) and gastro-oesophageal reflux (with proton-pump inhibitors) can improve cough 3.
• Centrally acting opioids such as morphine, codeine, and dextromethorphan can be used as cough suppressants, but they may produce side effects such as drowsiness, nausea, constipation, and physical dependence 3, 4.
• Peripherally acting antitussives such as moguisteine and levodropropizine can also be used to reduce cough 4.
• Inhaled corticosteroids (ICS) may improve impaired lung function in patients with post-COVID-19 chronic cough, but their impact on symptom management is limited 5.
• Antitussive preparations, including combinations of codeine or dextromethorphan with antihistamines, decongestants, and expectorants, can provide symptomatic relief for dry cough 6.
• Neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID-19-associated cough, and new anti-inflammatories or neuromodulators may offer promise for targeting both COVID-19 cough and post-COVID syndrome 7.

Considerations for Treatment

When treating post-viral cough syndrome, it is essential to:

• Identify and address any underlying conditions that may be contributing to the cough 3, 5.
• Monitor patients for potential side effects of cough suppressants and adjust treatment as needed 3, 4.
• Consider the use of slow-release morphine or other centrally acting drugs for intractable cough 4.
• Evaluate the efficacy of cough suppressants in double-blind randomized trials using validated measures of cough 4.