Management of Post-Viral Cough in Moderately Asthmatic Adults

Introduction to Treatment Guidelines

For a moderately asthmatic adult with viral infection, post-nasal drip, and cough, the American Thoracic Society recommends prednisone should be reserved as a third-line therapy only after failure of inhaled ipratropium and inhaled corticosteroids, and only if the cough severely impacts quality of life and other causes have been excluded 1, 2

The European Respiratory Society suggests that post-nasal drip may be contributing to cough and should be treated first with topical nasal corticosteroids for 1 month 3
The British Thoracic Society recommends that moderate asthma requires optimization of controller therapy with inhaled corticosteroids per standard asthma guidelines 3
The American College of Chest Physicians states that post-infectious cough (if present 3-8 weeks after viral infection) has a specific treatment algorithm that does not prioritize oral corticosteroids 1, 2

The American Academy of Allergy, Asthma, and Immunology recommends starting with inhaled ipratropium bromide as first-line therapy for attenuating post-infectious cough 1, 2
The European Respiratory Society suggests considering inhaled corticosteroids as second-line therapy when cough adversely affects quality of life and persists despite ipratropium 1, 2
The American Thoracic Society recommends that oral prednisone should only be considered when all of the following criteria are met: severe paroxysms of cough, failure of both inhaled ipratropium and inhaled corticosteroids, and other common causes ruled out 1, 2, 5

The American College of Allergy, Asthma, and Immunology recommends a diagnostic-therapeutic trial of prednisone 30 mg daily for 2 weeks to establish the diagnosis of cough variant asthma 5

The Infectious Diseases Society of America states that antibiotics have no role in post-infectious cough as bacterial infection is not the cause 1, 2, 4
The American Academy of Family Physicians recommends not using prednisone as first-line therapy for post-infectious cough 4, 5, 6

The American College of Chest Physicians recommends that if no improvement with prednisone within 2 weeks, the diagnosis should be reconsidered 5
The European Respiratory Society suggests that if cough persists beyond 8 weeks total duration, it should be reclassified as chronic cough and other causes investigated 1, 2, 4