Treating post-viral coughs: This too shall pass


‘Tis the season to be coughing …

It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season.  For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.

Or just ask a primary care clinic what its waiting room sounds like these days.   A chorus of coughs, high, low, dry, moist, choking, barking, hacking, gagging, wheezing.  In our clinic, every patient is handed a surgical mask at the reception desk, whether coughing or not, with the explanation “for your protection and others’.”   A sea of blue masked faces glances up every time the nurse comes to call a patient back to an exam room.

In reality, it isn’t that clear how effective simple disposable masks are in preventing the spread of viral illness, but they are likely better than using nothing in a crowd of symptomatic people on public transportation, in a classroom, or a clinic waiting room.  They make it more difficult to touch facial mucus membranes with contaminated hands if you remember not to rub your eyes.

So we are in the thick of it now, with patient volumes up 30% over the usual load with extra staffing needed to manage the increased phone calls and electronic messaging.   We do rapid flu tests for those patients who fit criteria for Tamiflu treatment, otherwise, we are primarily looking for those at risk for flu complications while trying to make the miserable a little less miserable.  Otherwise all the usual self-treatment advice applies, especially stay home, stay home, stay home.

Once the fever and body aches subside,  one little residual symptom is usually left behind: a post-viral cough serves as a humbling reminder of the persistence of influenza inflammation and irritation in the respiratory tract.  Although no longer infectious by ten days after onset of illness, the cough can last up to three weeks or more, no matter what the patient does or takes.  It can be round the clock, interrupting everyone’s sleep from a constant tickling pressure in the trachea and a sensation of heaviness in the chest.   Although this cough is unlikely a risk to spread infection to others, it certainly sounds like a potential threat, so wearing a mask is advised as a courtesy and a reminder to protect others at all costs.

Has modern medicine found an answer to the plague of post-viral cough besides preventing the whole illness to begin with by vaccinating for influenza?  Dropping out of polite society for three weeks isn’t possible for most people. Post-influenza patients must allow their bodies time to heal from a major insult that required a significant immune system response but we do need to get back to work and school.  What’s a doctor to do?

Antibiotics certainly aren’t the solution and never have been, but historically they (and a narcotic cough suppressant) were the easiest prescription for physicians to write for a tired and frustrated patient.  The aisle in local pharmacies for “cold/flu remedies” seems to lengthen annually with new combination over the counters products.  Heavily marketed items vanish quickly off the shelves as people search in vain for relief.   Every imaginable combination of menthol, eucalyptus, and honey-lemon has been tried and tried again.   Probably chicken soup is still just as effective as anything else.

This is a time for tried and true wisdom:  this too shall pass.   Please just don’t pass it to others.

Emily Gibson is a family physician who blogs at Barnstorming.


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