Management of Persistent Cough in Patients on Trelegy

Assessment and Treatment

The American Thoracic Society recommends determining if the cough is postinfectious (3-8 weeks following respiratory infection) or chronic (>8 weeks) 2, 3
Evaluate for potential contributing factors including postviral airway inflammation 3, bronchial hyperresponsiveness 2, mucus hypersecretion 2, impaired mucociliary clearance 2, upper airway cough syndrome (UACS) 2, and gastroesophageal reflux disease (GERD) 2
The American College of Chest Physicians recommends inhaled ipratropium bromide as the first-line treatment option for cough suppression in patients on Trelegy 1, 4
Inhaled corticosteroids may be considered as a second-line option if ipratropium is ineffective, with dose adjustment if cough persists despite ipratropium 2
A short course of oral prednisone (30-40 mg daily for a short period) may be considered for severe paroxysms of cough when other common causes have been ruled out 2, 3
Central acting antitussive agents such as codeine and dextromethorphan may be recommended for short-term symptomatic relief in chronic bronchitis 2, 4

Hypertonic saline solution is recommended on a short-term basis to increase cough clearance in patients with bronchitis 1, 4
The huffing technique should be taught as an adjunct to other methods of sputum clearance in COPD patients 5, 6
Manually assisted cough should be avoided in patients with airflow obstruction like COPD as it may be detrimental 5

Antibiotics have no role in postinfectious cough unless there is evidence of bacterial infection 2
Albuterol is not recommended for acute or chronic cough not due to asthma 4
Over-the-counter combination cold medications (except older antihistamine-decongestants) are not recommended for cough suppression 4
If cough persists beyond 8 weeks, consider diagnoses other than postinfectious cough 2
Evaluate for potential Bordetella pertussis infection if cough has lasted ≥2 weeks with paroxysms of coughing, post-tussive vomiting, or inspiratory whooping sound 2

Assess response to therapy within 1-2 weeks 4
If cough persists despite sequential therapies, consider systematic evaluation for other common causes of chronic cough (UACS, asthma, NAEB, and GERD) 7