From the Guidelines
For acute viral cough, the most effective inhaler option is ipratropium bromide, as it is the only inhaled anticholinergic agent recommended for cough suppression in patients with cough due to upper respiratory infection (URI) or chronic bronchitis, with a level of evidence of fair and a grade of recommendation of A 1.
Key Points to Consider
- Ipratropium bromide is recommended for cough suppression in patients with acute viral cough, as it may attenuate the cough, with a level of evidence of fair and a grade of recommendation of B 1.
- The use of inhaled corticosteroids may be considered in patients with postinfectious cough when the cough adversely affects the patient's quality of life and persists despite use of inhaled ipratropium, with a level of evidence of expert opinion and a grade of evidence of E/B 1.
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, with a level of evidence of expert opinion and a grade of evidence of E/B 1.
Important Considerations
- Proper inhaler technique is crucial to ensure effective delivery of the medication: shake the inhaler, exhale fully, place the mouthpiece between lips, inhale slowly while pressing the canister, hold breath for 10 seconds, then exhale slowly.
- If symptoms persist beyond 7-10 days or are accompanied by high fever, difficulty breathing, or chest pain, seek medical attention as this could indicate a more serious condition or bacterial infection.
Recommendations for Use
- Adults should use ipratropium bromide as directed by a healthcare provider, typically 2-4 puffs every 4-6 hours as needed.
- For children, dosing depends on age and weight, so consult a healthcare provider for specific guidance.
From the FDA Drug Label
Patient Package Insert Albuterol Sulfate Inhalation Solution, 0.083%* 2. 5 mg*/3 mL *Potency expressed as albuterol, equivalent to 3 mg albuterol sulfate. The FDA drug label does not answer the question.
From the Research
Best Inhalers for Acute Viral Cough
There are several options for managing acute viral cough, including inhalers. The following are some of the best inhalers for acute viral cough:
- A combination of a β-agonist and an anticholinergic agent, such as salbutamol and ipratropium bromide, has been shown to be effective in reducing post-viral cough 2
- Benzonatate and guaifenesin, either alone or in combination, have been found to inhibit cough-reflex sensitivity in acute viral cough 3
- Dextromethorphan, an antitussive, has been shown to be effective for symptom relief in acute cough 4
Mechanism of Action
The mechanism of action of these inhalers varies:
- β-agonists, such as salbutamol, work by relaxing the airway muscles and increasing air flow to the lungs
- Anticholinergic agents, such as ipratropium bromide, work by blocking the action of acetylcholine, a neurotransmitter that stimulates the airway muscles to constrict
- Benzonatate works by numbing the airway tissues and reducing the cough reflex
- Guaifenesin works by thinning and loosening mucus, making it easier to cough up
Efficacy and Safety
The efficacy and safety of these inhalers have been studied in several clinical trials:
- A randomized, double-blind, placebo-controlled trial found that a combination of salbutamol and ipratropium bromide was effective in reducing post-viral cough 2
- A study found that benzonatate and guaifenesin, either alone or in combination, were effective in inhibiting cough-reflex sensitivity in acute viral cough 3
- A review of over-the-counter cough medications found that dextromethorphan was effective for symptom relief in acute cough, but noted that the evidence was limited and that more studies were needed to fully assess its efficacy and safety 5