From the Guidelines
Management of post-viral cough primarily involves symptomatic treatment while the condition resolves naturally over time, typically within 3-8 weeks. First-line treatments include over-the-counter cough suppressants containing dextromethorphan (15-30mg every 4-6 hours) for non-productive coughs or guaifenesin (200-400mg every 4 hours) to thin mucus for productive coughs, as recommended by 1. Honey (1-2 teaspoons as needed) can soothe throat irritation, while staying well-hydrated helps thin secretions. For severe or persistent coughs, prescription options may include benzonatate (100-200mg three times daily), inhaled ipratropium bromide (2 puffs 3-4 times daily), or short courses of inhaled corticosteroids like fluticasone (2 puffs twice daily) 1. Antibiotics are not effective since the cough is viral or post-inflammatory in nature, as stated in 1. Avoiding irritants such as smoke, dust, and strong fragrances is important, as is elevating the head during sleep to reduce nighttime coughing. Some key points to consider in the management of post-viral cough include:
- Identifying and treating underlying conditions that may be contributing to the cough, such as upper airway cough syndrome, asthma, or gastroesophageal reflux disease 1
- Using a stepwise approach to treatment, starting with over-the-counter medications and progressing to prescription options as needed 1
- Avoiding the use of antibiotics, which are not effective in treating post-viral cough 1 Most post-viral coughs are self-limiting and represent ongoing airway inflammation after the viral infection has cleared, with gradual improvement as the airways heal and inflammation subsides. It is essential to note that the optimal treatment for post-viral cough is not known, and therapy should be individualized based on the patient's specific needs and circumstances, as recommended by 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, as suggested by 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, as recommended by 1. Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail, as stated in 1. Overall, the management of post-viral cough should focus on relieving symptoms, treating underlying conditions, and avoiding unnecessary medications, with the goal of improving the patient's quality of life and reducing morbidity and mortality.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Purpose Cough suppressant The management for post-viral cough may include cough suppressants like dextromethorphan 2 or expectorants like guaifenesin 3 to help loosen phlegm and make coughs more productive.
- Guaifenesin 3 can be used to thin bronchial secretions.
- Dextromethorphan 2 can be used as a cough suppressant.
From the Research
Management of Post-Viral Cough
The management of post-viral cough can be challenging, and various treatment options have been studied.
- A combination of a β-agonist and an anticholinergic agent, such as salbutamol and ipratropium bromide, has been shown to effectively reduce post-viral cough 4.
- Inhaled corticosteroids can be used to suppress airway inflammation in patients who do not respond to early symptomatic treatment 5.
- Gabapentin, alone or in combination with montelukast, has been found to improve cough frequency and severity in hospitalized patients with COVID-19 6.
- Dextromethorphan has also been shown to be effective in reducing cough severity, with a significant reduction in BCSS and VAS scores 6.
Treatment Options
The following treatment options have been studied for post-viral cough:
- Oral corticosteroids: a randomized controlled trial is being conducted to evaluate the effectiveness of oral corticosteroids for post-infectious cough 7.
- Inhaled ipratropium and salbutamol: a randomized, placebo-controlled, double-blind trial found that this combination can effectively reduce post-viral cough 4.
- Gabapentin and gabapentin/montelukast combination: a randomized, controlled clinical trial found that this combination can improve cough frequency and severity in hospitalized patients with COVID-19 6.
- Dextromethorphan: a randomized, controlled clinical trial found that dextromethorphan can reduce cough severity, with a significant reduction in BCSS and VAS scores 6.
Mechanisms of Post-Viral Cough
The mechanisms of post-viral cough are not fully understood, but it is thought to be mediated by inflammatory processes and cough hypersensitivity state 5, 8.