Australian Regenerative Medicine Institute

Postinfectious Cough: Treatment

Postinfectious Cough: TreatmentThis regimen may be tried in those patients whose coughs become protracted and persistently troublesome. The organisms that are associated with postinfectious cough cause considerable transmigration of neutrophils across bronchial epithelial cells, and sputum analysis may show an increase in lymphocytes followed by an increase in neutrophils. M pneumoniae causes intense airway neutrophil inflammation and bronchial hyperresponsiveness in animal models, and both can be suppressed by inhaled fluticasone propionate. Clinical data to support this approach in humans are lacking. In one small controlled trial, ipratropium bromide was shown to attenuate postinfectious cough. There have been no clinical trials conducted on the effect of centrally acting antitussive agents on postinfectious cough. Failure to respond to treatment should alert one to consider UACS due to rhinosinus diseases, asthma, or gastroesophageal reflux disease as the cause of the cough. yaz birth control

For adult patients with postinfectious cough, not due to bacterial sinusitis or early on in a Bordetella pertussis infection, while the optimal treatment is not known:
Therapy with antibiotics has no role, as the cause is not bacterial infection. Level of evidence, expert opinion; net benefit, none; grade of evidence, I
Consider a trial of inhaled ipratropium as it may attenuate the cough. Level of evidence, fair; net benefit, intermediate; grade of evidence, B
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. Level of evidence, expert opinion; net benefit, intermediate; grade of evidence, E/B. 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 (eg, UACS due to rhinosinus diseases, asthma, or gastroesophageal reflux disease) have been ruled out. Level of evidence, low; net benefit, intermediate; grade of evidence, C. Central acting antitussive agents such as codeine and dextromethorphan should be considered when other measures fail. Level of evidence, expert opinion; net benefit, intermediate; grade of evidence, E/B

Category: Respiratory Symptoms

Tags: Bordetella pertussis, pertussis infection, postinfectious cough, postviral cough