Is Medrol (methylprednisolone) effective for treating a lingering cough?

Medrol for Lingering Cough

For postinfectious lingering cough (3-8 weeks duration), oral corticosteroids like Medrol (methylprednisolone) can be considered only for severe paroxysmal cough after ruling out other common causes, but inhaled corticosteroids should be tried first. 1

When to Consider Systemic Corticosteroids

Oral prednisone 30-40 mg daily for a short, finite period may be prescribed for severe paroxysms of postinfectious cough when:

• Upper airway cough syndrome (post-nasal drip), asthma, and gastroesophageal reflux disease have been ruled out 1
• The cough adversely affects quality of life 1
• Inhaled ipratropium has been tried and failed 1
• Inhaled corticosteroids have been tried without adequate response 1

This represents a stepwise approach where systemic steroids are reserved for refractory cases. 1

First-Line Treatments to Try Before Medrol

Before considering Medrol, the following should be attempted:

• Inhaled ipratropium - may attenuate postinfectious cough and should be the initial bronchodilator therapy 1
• Inhaled corticosteroids - should be tried when cough persists despite ipratropium and adversely affects quality of life 1
• Central acting antitussives (codeine, dextromethorphan) when other measures fail 1

Important Diagnostic Considerations

Duration matters for treatment decisions:

• Cough lasting 3-8 weeks is classified as subacute and often represents postinfectious cough 1
• If cough persists beyond 8 weeks, consider diagnoses other than postinfectious cough and evaluate as chronic cough 1

Rule out these common causes before using systemic steroids:

• Cough-predominant asthma or eosinophilic bronchitis - these may benefit from a therapeutic trial of prednisolone 30-40 mg daily if spirometry is normal 1
• Upper airway disease/post-nasal drip - topical nasal corticosteroids for 1 month are more appropriate than systemic steroids 1
• Gastroesophageal reflux - requires proton pump inhibitors (omeprazole 20-40 mg twice daily) for at least 8 weeks, not corticosteroids 1
• ACE inhibitor use - stop the medication; cough typically resolves within days to 2 weeks (median 26 days) 1

Evidence Limitations and Caveats

The evidence for systemic corticosteroids in postinfectious cough is weak:

• The recommendation for prednisone 30-40 mg daily carries only "low" level of evidence with "intermediate" net benefit (Grade C) 1
• A large randomized trial found oral prednisolone did NOT reduce cough duration or severity in adults with acute lower respiratory tract infection without asthma 2
• Systemic corticosteroids have significant side effects that must be weighed against limited evidence of benefit 3

Antibiotics have no role in postinfectious cough unless bacterial sinusitis or early Bordetella pertussis infection is present 1

Practical Algorithm

1. Confirm duration: Is cough present 3-8 weeks post-respiratory infection? 1
2. Rule out other causes: Check for ACE inhibitor use, perform chest X-ray and spirometry 1
3. Try inhaled ipratropium first 1
4. If inadequate response, try inhaled corticosteroids 1
5. Only if severe paroxysmal cough persists and significantly impacts quality of life, consider short course of oral prednisone/methylprednisolone 1
6. If cough exceeds 8 weeks, reassess for chronic cough causes 1