From the Guidelines
Treatment for a persistent dry cough is primarily focused on symptomatic relief, with centrally acting antitussive agents such as codeine and dextromethorphan being considered when other measures fail.
Treatment Options
- For adult patients with postinfectious cough, a trial of inhaled ipratropium may be considered to attenuate the cough 1.
- Inhaled corticosteroids may be used in patients with postinfectious cough when the cough adversely affects the patient’s quality of life and persists despite use of inhaled ipratropium 1.
- For severe paroxysms of postinfectious cough, prednisone (30 to 40 mg per day) may be prescribed for a short, finite period of time when other common causes of cough have been ruled out 1.
- Centrally acting antitussive agents such as codeine and dextromethorphan can be prescribed in patients with a dry and bothersome cough 1.
Important Considerations
- Antibiotics have no role in the treatment of postinfectious cough, as the cause is not bacterial infection 1.
- Expectorants, mucolytics, and antihistamines have limited evidence for beneficial effects in treating cough 1.
- Inhaled bronchodilators have not shown relevant beneficial effects in uncomplicated acute cough 1.
From the Research
Treatment Approaches
- The treatment of persistent dry cough depends on making an accurate diagnosis of the cause, with specific treatment of the cause controlling the cough in most cases 2, 3.
- Common associated conditions that may cause persistent dry cough include post-viral cough, asthma, rhinosinusitis, gastro-oesophageal reflux, and treatment with angiotensin-converting enzyme inhibitors 2, 3, 4.
- If the underlying cause can be identified, intensive treatment of the cause usually leads to improvement or resolution of the cough 3.
- In cases where no underlying cause is identified, symptomatic relief may be considered, but currently available antitussives have limitations, such as sedation and potential for addiction 2, 3.
Diagnostic Workup
- A diagnostic work-up for patients with persistent dry cough is essential to identify the underlying cause 2.
- The work-up may include a chest X-ray, and further investigations are carried out in accordance with the most probable suspected diagnosis 5.
- Probationary therapies are an important part of the workup for chronic cough 5.
Novel Therapies
- Recent guidelines provide algorithms for diagnosis and assessment of cough severity, and novel promising neuromodulatory agents, such as P2X3 inhibitors, are in clinical development 4.
- Neuromodulatory therapy and/or non-pharmacologic treatment, such as speech pathology therapy, may be considered for patients with troublesome chronic cough due to unknown causes or persisting even after adequate treatment of the underlying disease(s) 4.