What can be done for a patient with a persistent dry cough from an upper respiratory tract infection (URTI) not improving with current medication?

From the Guidelines

For a patient with a persistent dry cough from an upper respiratory tract infection (URTI) not improving with current medication, consider a trial of inhaled ipratropium as it may attenuate the cough.

Treatment Options

• Inhaled ipratropium is 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.
• If the cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids, with a level of evidence of expert opinion and a grade of evidence of E/B 1.
• For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time, with a level of evidence of low and a grade of evidence of C 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

• Therapy with antibiotics has no role in the treatment of postinfectious cough, as the cause is not bacterial infection, with a level of evidence of expert opinion and a grade of evidence of I 1.
• Other common causes of cough, such as upper airway cough syndrome (UACS), asthma, or gastroesophageal reflux disease (GERD), should be ruled out before considering other treatments, as suggested by 1.

From the Research

Treatment Options for Persistent Dry Cough

For a patient with a persistent dry cough from an upper respiratory tract infection (URTI) not improving with current medication, several treatment options can be considered:

• Identifying and treating the underlying cause of the cough, such as post-viral cough, asthma, rhinosinusitis, or gastro-oesophageal reflux, as this can lead to improvement or resolution of the cough 2, 3
• Using antitussive preparations, such as combinations of codeine or dextromethorphan with antihistamines, decongestants, and expectorants, for symptomatic relief of dry or non-productive cough 4
• Considering the use of ipratropium bromide, which has been shown to be effective in reducing cough in patients with persistent post-viral infective cough 5
• Exploring other therapeutic options, such as treating the cough itself, rather than just the underlying cause, as current therapeutic options for post-infectious cough are often little or only moderately effective 6

Underlying Causes of Persistent Dry Cough

The most common underlying causes of persistent dry cough include:

• Post-viral cough
• Asthma
• Rhinosinusitis (post-nasal drip or 'nasal catarrh')
• Gastro-oesophageal reflux
• Treatment with angiotensin-converting enzyme inhibitors 2, 3

Challenges in Treating Persistent Dry Cough

Treating persistent dry cough can be challenging, as:

• In some cases, no underlying cause can be found despite appropriate investigation 2, 3
• Current antitussive therapies may have significant adverse effects, such as sedation and addiction 2, 3
• There is a need for more effective and novel antitussive therapies 3, 4