Post-Viral Cough - Treatment

by Dr. Moshe Ipp

Post-viral cough. Is it appropriate to prescribe bronchodilators and inhaled steroids? What is the role of codeine containing syrups for prolonged coughs?

The occurrence of viral induced bronchospasm in children less than 6 years of age is much more common than was previously thought1. However most children with a protracted post viral cough, do not require, and will likely not respond to, bronchodilator (e.g. ventolin) or inhaled steroid therapy (e.g. flovent). The factors that would indicate that these medications might be effective and worth a therapeutic trial include the following:

  1. Obvious clinical bronchospasm.
  2. A productive cough that is significantly worse at night and/or early morning.
  3. A cough that is worse with running, laughing or crying.
  4. Previous history of bronchospasm.
  5. Previous history of recurrent croup.
  6. Radiological evidence of hyperinflation or air trapping.
Cough suppressants may be used on a when necessary basis, in order to provide symptomatic relief and a good nights rest. Over the counter dextromethorphan products should be tried initially. More potent codeine containing products should only be used sparingly and reserved for the most intractable coughs, after all other treatable conditions have been excluded.

Reference:1. Martinez FD et al. Asthma and wheezing in the first six years of life NEJM 1995. 332;133-138.

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