Clinical Pearl Wednesday #17

Have a patient with a severe cough possibly from pneumonia, bronchitis or an upper respiratory infection?

This cough can at times be severe enough to affect normal activities of daily living.

Often times OTC products and prescription medications like Tessalon Pearls (benzonatate) are ineffective. What can you do at this point?

Many of us avoid prescribing cough medications that contain opioids for various reasons. Therefore, this usually is not a good option.

Give an ipratropium bromide inhaler a try next time instead. Ipratropium works great in reducing bronchospasms and the severe cough often found with patients who have acute bronchitis. Ipratropium relaxes the smooth muscles in the airways, which reduces the cough.

You can prescribe it as 1 puff every 6 hours for 3-5 days during the acute phase of the respiratory illness. It becomes effective within minutes of using it.

It is a category B medication and deemed safe in pregnancy. I have used it multiple times in pregnant individuals who have a severe cough with excellent results.

One of the downsides is the cost though. Thankfully, most insurances will cover this, but be prepared for denials.

Give it a try next time you have a patient with severe cough! It works wonders!

3 Responses

    1. SOB? Chest pain? Nausea? It should be fairly evident it is cardiac related if you have any inkling of clinical skill to you.

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