From the Guidelines
To treat persistent coughing fits following an acute respiratory infection, consider a trial of inhaled ipratropium as it may attenuate the cough, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. When a patient complains of cough that has been present following symptoms of an acute respiratory infection for at least 3 weeks, but not more than 8 weeks, consider a diagnosis of postinfectious cough. The following treatment options can be considered:
- Inhaled ipratropium to attenuate the cough, with a level of evidence of fair and a net benefit of intermediate 1
- Inhaled corticosteroids 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 net benefit of intermediate 1
- Prednisone (30-40 mg per day) for a short, finite period of time for severe paroxysms of postinfectious cough, with a level of evidence of low and a net benefit of intermediate 1
- Central acting antitussive agents such as codeine and dextromethorphan when other measures fail, with a level of evidence of expert opinion and a net benefit of intermediate 1 It is essential to rule out other common causes of cough, such as upper airway cough syndrome, asthma, or gastroesophageal reflux disease, before initiating treatment. If the cough lasts longer than 8 weeks, consider diagnoses other than postinfectious cough, as recommended by the ACCP guidelines 1.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves: cough due to minor throat and bronchial irritation as may occur with a cold or inhaled irritants The treatment for persistent coughing fits following an acute respiratory infection (ARI) may include:
- Guaifenesin to help loosen phlegm and thin bronchial secretions, making coughs more productive 2
- Codeine to temporarily relieve cough due to minor throat and bronchial irritation, such as that caused by a cold 3
From the Research
Treatment Options for Persistent Coughing Fits
- The treatment of persistent coughing fits following an acute respiratory infection (ARI) typically involves addressing the underlying cause of the cough 4.
- In some cases, suppression of cough may be necessary, and this can be achieved through disease-specific therapies or symptom-related antitussives 4.
- Currently available cough suppressants include centrally acting opioids such as morphine, codeine, pholcodeine, and dextromethorphan, although their efficacy can be limited and may be associated with side effects 4.
Efficacy of Antitussives
- Studies have shown that the efficacy of some over-the-counter symptomatic antitussives is often no better than that of a placebo 4, 5.
- A study on the antitussive efficacy of dextromethorphan in cough associated with acute upper respiratory tract infection found little support for its clinically significant antitussive activity 5.
- New agents, such as Rengalin, have shown promise in reducing cough severity in patients with chronic obstructive pulmonary disease (COPD) 6.
Post-Infectious Persistent Cough
- Post-infectious cough is a common symptom associated with common colds and/or upper respiratory tract infection, and can persist for longer than three weeks 7.
- Current therapeutic options for post-infectious cough are limited, and more effective treatments are needed 7.
- A clinical approach to acute cough involves identifying the underlying cause and providing appropriate treatment, such as a combination of first-generation antihistamine and decongestant for cough due to the common cold 8.