From the Guidelines
Post-viral cough management should prioritize supportive care, avoiding antibiotics, and considering inhaled ipratropium or corticosteroids for symptomatic relief, as recommended by the ACCP evidence-based clinical practice guidelines 1. The management of post-viral cough involves a combination of supportive care and targeted medications.
- Start with adequate hydration and rest, which helps thin mucus secretions and supports recovery.
- For symptomatic relief, consider a trial of inhaled ipratropium as it may attenuate the cough, with a level of evidence rated as fair and a net benefit considered intermediate 1.
- In patients with postinfectious cough, when the cough adversely affects the patient’s quality of life and when cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids, although the level of evidence is expert opinion and the net benefit is intermediate 1.
- Avoid antibiotics unless there's clear evidence of bacterial infection, as therapy with antibiotics has no role in the treatment of postinfectious cough, with a level of evidence rated as expert opinion and a net benefit of none 1.
- For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time when other common causes of cough have been ruled out, with a level of evidence rated as low and a net benefit considered intermediate 1.
- Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, with a level of evidence rated as expert opinion and a net benefit considered intermediate 1. Post-viral cough typically resolves within 3-8 weeks as airway inflammation subsides and nerve hypersensitivity normalizes. If cough persists beyond 8 weeks or is accompanied by warning signs like hemoptysis, weight loss, or night sweats, further evaluation is necessary to rule out other conditions.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Purpose Cough suppressant For the management of post viral cough,
- Guaifenesin 2 can be used to help loosen phlegm and make coughs more productive.
- Dextromethorphan 3 can be used as a cough suppressant. It is essential to note that the choice between these two options depends on whether the goal is to make the cough more productive or to suppress it.
From the Research
Definition and Impact of Post Viral Cough
- Post-infectious cough is a common symptom associated with common colds and/or upper respiratory tract infections, expected to last only a few days but can persist for longer than three weeks and be defined as "persistent" 4.
- Persistent post-infectious cough can cause morbidity, interfering with daily life, and is associated with a tickling or irritating sensation in the throat leading to paroxysms of coughing 4.
Therapeutic Options for Post Viral Cough
- Current therapeutic options for post-infectious cough are little or only moderately effective, despite recent advances in understanding the mechanisms regulating cough in physiological and pathological conditions 4.
- Non-pharmacological remedies, including traditional herbs and natural substances, are considered a potentially effective and safe way to relieve post-viral acute cough (PAC) 5.
- Specific non-pharmacologic remedies with some evidence of efficacy include honey, glycerol, Althea officinalis, Drosera rotundifolia, Grindelia, Hedera helix, Pelargonium sidoides, Sambucus nigra, Thymus vulgaris, hyaluronic acid, and saline solutions 5.
Need for Further Research
- Further rigorous studies are needed to confirm the efficacy and safety of natural products in relieving post-viral acute cough (PAC) 5.
- The European Medicine Agency has recognized the value of plant extracts and other natural substances in treating PAC, but more research is necessary to fully understand their potential benefits 5.