Help Treat Coughs That Linger After a Cold

Colds and influenza can have similar presentations, with both making patients feel miserable, but there are key differences that pharmacists can help identify.

Colds produce gradual symptoms, with slight aches, some fatigue and weakness, mild to moderate chest discomfort and cough, sneezing, sore throat, and stuffiness, but no chills, fever, or headache. Influenza, on the other hand, produces abrupt symptoms, usually including aches, chest discomfort, chills, cough, fatigue, fever, headaches, some congestion and sneezing, and weakness. Cold symptoms may last 3 to 10 days, whereas influenza symptoms may last 7 to 14 days and can even linger for up to 3 weeks. Generally, having influenza is worse than having a cold, and
a cold will not result in other serious health conditions. But influenza can lead to bacterial infections, pneumonia, and even hospitalization.¹

The CDC estimates that in the United States between 2010 and 2020, influenza has resulted in around 9 to 41 million illnesses, 140,000 to 700,000 hospitalizations, and 12,000 to 52,000 deaths annually.² With such a high number of patients affected by influenza and its complications, prevention is important.

Some cold and flu symptoms can linger, including postinfectious coughs. These are usually dry coughs that may happen at various times of the day, and they can linger for about 3 to 8 weeks after the infection and be bothersome to patients.³

Coughs can linger for many reasons, aside from influenza, including adenovirus, bronchitis, pharyngitis, pneumonia, and respiratory syncytial virus. Some infections may cause the cough receptors in the body to be more sensitive and enter a state of hyper-responsiveness. When this happens, the smallest trigger or lingering infection can make the receptors activate and create a cough that does not go away easily. A lingering cough can also result from the inflammation of the lining of the airways, which could be extensive after recovery from infection. If the cough starts from the lower airways, excessive mucus production may be a responsible factor. Lingering coughs affect 1 of 4 individuals who have influenza or an infection.⁴

Other underlying conditions may also cause a cough to linger. These include asthma, laryngeal pharyngeal reflux (LRP), and obstructive sleep apnea (OSA). Asthma causes the airways to become inflamed, sensitive, and swollen. When an individual who has asthma also develops influenza, additional inflammation in the airways can create many more symptoms, including a lingering, persistent, and severe cough. The inflammation can also cause the asthma to worsen. LRP can cause the acid from the stomach to travel to the upper esophagus and into the throat area, inflaming and irritating the vocal cords, which can trigger a cough.⁴ In addition, OSA can cause aggressive gastroesophageal reflux disease (GERD), airway inflammation, and cough reflex sensitivity.⁴

Postnasal drip is another reason a cough can linger. When an individual catches a cold, mucus builds up, and that drips back into the throat, causing irritation and a need to cough, which is a natural bodily reaction to clear mucus from the system. Unless the mucus is cleared or stopped, the cough continues. The cough resolves either because the flu or infection go away on their own or medication dries up the mucus, which is often a quicker remedy.⁵

A lingering cough can take a toll on a patient, disrupting sleep, social events, and work.⁶ Antibiotics can often treat a cough, but if the cough started because of a cold, antibiotics may not make a big difference._⁶

OTC mucus drying agents are somewhat effective, but a cough may persist. If related to postnasal drip, treatments could include an antihistamine, such as chlorpheniramine maleate (Chlor-Trimeton) or clemastine (Dayhist). The provider may also suggest nasal sprays, such as azelastine (Astelin), ipratropium bromide (Atrovent nasal spray), and fluticasone propionate (Flonase).

OTC allergy medications such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) are other options. If the cough is related to inflammatory changes, then the provider may suggest inhaled corticosteroids, a leukotriene receptor antagonist such as montelukast (Singulair), or oral prednisone. OTC cough medications are also sometimes recommended, including cough drops, dextromethorphan (Delsym), guaifenesin, and lozenges. Home remedies might include eucalyptus oil, honey with hot water, a humidifier, or a saltwater gurgle.³

When such remedies do not help and the cough lingers for weeks and cannot be explained by smoking or an underlying lung condition, pharmacists should recommend that patients consult their physician. Such lingering coughs may be symptoms of other serious conditions, such as lung infections or even tuberculosis. A health care provider can evaluate the patient and suggest the best treatment approach, which could include antihistamines, inhalers, or medications for GERD, such as esomeprazole (Nexium) or omeprazole (Prisolec).⁶

Conclusion

Colds and influenza can be miserable but suffering from a cough for weeks afterwards can be debilitating and limiting. Pharmacists should recommend that patients seek treatment from their physician if the cough continues for more than a few weeks and cannot be treated with home remedies or OTC medications.

References

1. Cold versus flu. CDC. Updated September 16, 2021. Accessed November 17, 2021. https://www.cdc.gov/flu/symptoms/ coldflu.htm?web=1&wdLOR=c41E8412E-1D06-4517-896F-C2C164574C44

2. Disease burden of flu. CDC. Updated October 4, 2021. Accessed November 17, 2021. https://www. cdc.gov/flu/about/burden/index.html?web=1&wd-LOR=c37541123-4B25-4C84-B137-12E8202FDC06

3. Hayes K. What’s causing your lingering cough and how to treat it. Verywell Health. Updated October 8, 2021. Accessed November 17, 2021. https://www. verywellhealth.com/treatments-for-lingering-cough-4107545

4. Fletcher J. What can cause coughing after the flu. Medical News Today. May 12, 2020. Accessed November 17, 2021. https:// www.medicalnewstoday.com/ articles/cough-after-the-flu

5. Cassata C. I’m over this cold, so why am I still coughing? Healthline. January 17, 2019. Accessed November 17, 2021. https://www. healthline.com/health-news/why-am-i-still-coughing

6. Adams JU. When should you start worrying about that lingering cough? Give it time. Washington Post. December 23, 2013. Accessed November 17, 2021. https://www.washingtonpost.com/ national/health-science/when-should-you-start-worrying-about-that-lingering-cough-give-it-time/2013/12/20/1e615e9c-665d-11e3-ae56-22de072140a2_story.html