Respiratory viruses have become less predictable since the pandemic.
It is known that the coronavirus that causes covid is not seasonal.
That is why it is not at all uncommon for it to cause
peaks in cases at any time of the year
, even in the middle of summer, like the one we have gone through.
The flu, which had its strong season between May and August, is no longer so punctual, as is the respiratory syncytial virus (RSV).
One of the main symptoms that these respiratory conditions (and many others) have in common is cough, which can last from days
to several weeks
after the infection has resolved.
How long can a cough last after a respiratory infection?
Should it be treated?
As?
What warning symptoms should not be missed?
These are some of the frequently asked questions we ask ourselves in relation to this topic.
"It is important to reassure patients that post-infectious cough
has a time limit
" and that "in most cases they will improve without medication," say the authors of an article published this week in the Canadian Medical Association Journal (CMAJ). , following the recent outbreak of respiratory infections affecting Canada.
Kevin Liang, Philip Hui and Samantha Green, members of the Department of Family Medicine at the University of British Columbia (in Vancouver, Canada) identified five keys to post-infectious cough.
.
Post-infectious cough is common
It affects up to a quarter of adults after a respiratory infection and can last up to 8 weeks.
It occurs because the previous infection triggers an
inflammatory cascade
that increases bronchial sensitivity and mucus production, while reducing its elimination, explain the authors of the article published in CMAJ.
One in five people with covid may have a post-infectious cough.
Photo Shutterstock.
But people usually consult long before eight weeks have passed,
Alejandro Videla, head of the Pulmonology service at the Austral Hospital and former president of the Argentine Association of Respiratory Medicine (AAMR), responded to
Clarín .
They usually do this during the second to third week of persistent cough.
"Many people go to the emergency department and it is not uncommon for them to be given antibiotics."
However, "it is not a good idea to receive them without a complete evaluation," he questioned.
"And above all ,
you should not take antibiotics on your own
, something we also see, people who self-medicate easily."
"Prolonged cough often has to do with a state of inflammation of the airways or stimulation of the nerves that produce cough and
is not due to persistence of the infection
, so antibiotics are not usually indicated," he insisted.
—Are there conditions that are associated with more post-infectious cough?
—In the medical literature, some studies have measured the frequency with which germs are isolated or the immunological response to the presence of a previous germ and what is most frequently reported is in
Mycoplasma pneumoniae
,
Chlamydia pneumoniae
and
Bordetella pertussis
, the germ that causes whooping cough or whooping cough, which also causes prolonged coughing in adults.
And in Argentina we have frequently seen increases in consultations during peaks of covid activity, which have sometimes occurred in conjunction with RSV and influenza.
International statistics show that
up to 20% of people who have had covid
can be left with a post-infectious cough.
.
The diagnosis is by exclusion
What does it mean?
That to diagnose it, there must have been a previous infection and
the absence of worrisome findings on physical examination
and other symptoms of subacute cough (such as asthma, chronic obstructive pulmonary disease [COPD], gastroesophageal reflux disease, or use of enzyme inhibitors). angiotensin converting), the Canadian authors list.
And they add that whooping cough or whooping cough should be considered in patients with paroxysmal cough (a spasmodic cough that usually ends in a prolonged sharp inhalation or wheezing) or vomiting after coughing.
.
"Red flags" and prolonged duration require further study
"Symptoms such as problems swallowing, excessive difficulty breathing, and coughing up blood
may need to be investigated
. Red flags include a history of recurrent pneumonia or a history of smoking, and cough lasting more than 8 weeks needs further evaluation." , they specify.
"In general, what is worrying when the cough lasts over time is if it is accompanied by wheezing, audible snoring or difficulty breathing; fever or
weight loss and/or night sweats
; or when it passes the threshold of two or three weeks. And if more than 8 weeks pass, you should definitely consult, because it is very unlikely that it is a post-infectious cough," Videla told
Clarín
.
The doctor placed special emphasis on not delaying the consultation if the cough is accompanied by these alarm symptoms.
"Especially in a country like Argentina, where there is tuberculosis, people have to be careful to consult," he warned.
"And also especially if symptoms of bronchial obstruction appear, because we must remember that asthma is a very common disease and that infections can act as triggers, then it may be that what we are seeing is not a post-infectious cough, but reactivated asthma due to an infection."
.
Treatment?
There is no good evidence that a medication works to stop post-infectious cough, states the article published in the CMAJ.
"Systematic reviews of randomized controlled trials evaluating inhaled corticosteroids, bronchodilators, and oral agents for postinfectious cough concluded that
there is no evidence of benefit
," say their authors.
And they point out that most studies found that post-infectious cough symptoms
improve without medication
, "highlighting its self-limiting nature."
"
The majority of these conditions resolve on their own
, so in general taking medication is the same as not taking medication," Videla agreed. "When the conditions are very aggressive, it may be necessary to use inhaled or oral corticosteroids to stop the condition. And when "probable or confirmed cause is whooping cough or whooping cough (caused by
Bordetella pertussis
), antibiotic treatment should be prescribed."
—Are there “home remedies” that can help resolve a cough?
—There are not many things that can help stop a cough other than pharmacological alternatives.
Water is a good expectorant.
Home remedies
don't necessarily hurt
, but they are not very effective," the pulmonologist responded.
.
Tranquility and education
According to the authors of the article, "patient reassurance and education are essential" and maintain that doctors should recommend a follow-up visit for tests if the cough does not resolve within 8 weeks or if new symptoms appear.
Follow-up visits should be indicated if the cough persists.
Photo Shutterstock.
For the former president of the AAMR, this consultation should be sooner.
"I think the most prudent thing is to do it after the three-week threshold, first to rule out other causes such as those we mentioned: bronchial obstructive symptoms or persistent infections such as Bordetella
pertussis
, or less frequently tuberculosis."
Regarding the importance of patient education, he considered it important to remember that there are other very common causes of cough, including
blood pressure medications
(such as enalapril), gastroesophageal reflux, respiratory diseases. obstructive and postnasal drip.
"Evaluation by a doctor is quite important, which generally does not require many studies: it is enough for him to examine and listen
to the person, question him well
and sometimes he can indicate a trial treatment. Other times, if it is necessary to request auxiliary studies, but it is not mandatory or essential to ask for them in a first consultation," he concluded.
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