Still coughing after COVID? Here's why it happens and what to do about it
Coughing is a socially awkward symptom, particularly since the COVID pandemic hit.
The problem is, coughing may persist for weeks or months after the infection has gone. Around 2.5% of people arestill coughing a year afterbeing infected with COVID.
A recurrent cough can undermine your capacity to work, leave you withmedical bills, and prompt a withdrawal fromsocial situationsbecause you don't want others to fear you're spreading COVID.
As a GP, I have patients ask whether there's anything that can fix their post-COVID cough. Here's how I answer.
What causes a COVID cough?
It's not surprising COVID causes a cough, because thevirus affects our respiratory tract, from our nasal passages right down to our lungs.
Coughing is one of the body's ways of getting rid of unwanted irritants such as viruses, dust and mucus. When something "foreign" is detected in therespiratory tract, areflex is triggeredto cause a cough, which should clear the irritant away.
While this is an effective protective mechanism, it's also the way theCOVID virus spreads．This is one reason the virus has so effectively and quickly travelled around the world.
Why do coughs drag after the infectious period?
Inflammation is a defensive process ourimmune systemuses to fight off COVID. Inflamed tissues both swell up and produce fluid. This can last a long time, even after the virus has gone.
Coughing may persist for any of four key reasons, all of which involve inflammation:
- if theupper airways(nasal passages and sinuses) stay inflamed, the fluid produced drips down the back of your throat causing a "post-nasal drip". This makes you feel the need to "clear your throat", swallow and/or cough
- if the lungs and lower airways are affected, coughing is the body's way of trying to clear the fluid and swelling it senses there. Sometimes there isn't a lot of fluid (so the cough is "dry"), but the swelling of the lung tissue still triggers a cough
- theneural pathwaysmay be where inflammation is lurking. This means thenervous systemis involved, either centrally (the brain) and/or peripherally (nerves), and the cough isn't primarily from the respiratory tissues themselves
- a less common but more serious cause may be the lung tissue being scarred from the inflammation, a condition called "interstitial lung disease". This needs to be diagnosed and managed by respiratory specialists.
Interestingly, people may experience a range of post-COVID symptoms, including coughing,regardless of whether they were sick enough to be hospitalised．耶鲁大学管理学院e patients tell me they weren't particularly unwell during their COVID infection, but the post-infective cough is driving them crazy.
When should you get it checked out?
We need to be wary not to label a cough as a post-COVID cough and miss other serious causes of chronic coughs.
One thing to watch out for is a secondary bacterial infection,COVI之上D．Signs you may have a secondary infection include:
- a change in the type of cough (sounds different, more frequent)
- change in the sputum/phlegm (increased volume, blood present)
- developing new symptoms such as fevers,chest pain, racing heart or worsening breathlessness.
其他潜在的严重的疾病可以导致chronic cough, includingheart failureand lung cancer, so if you're in any doubt about the cause of your cough, have a check-up.
What has evidence for helping the cough?
If the cough is mainly from post-nasal drip, it will respond tomeasures to reduce this, such as sucking lozenges, saline rinses, nasal sprays, and sleeping in an upright posture.
耶鲁大学管理学院e people may developcough hypersensitivity, where the threshold of the cough reflex has been lowered, so it takes a lot less to set off a cough. It's a common response to colds and it can take a while for our bodies to "reset" to a less sensitive state.
If a dry or tickly throat sets off your cough reflex, solutions include sipping water slowly, eating or drinkinghoney, and breathing slowly through your nose.
By slow-breathing through your nose, the air hitting the back of your throat is warmed up and moisturised by first passing through the nasal cavities. Your cough reflex is therefore less likely to be triggered, and over time the hypersensitivity should settle.
If the cause originates from inflammation in the lungs, controlled breathing exercises and inhaled steam (in a hot shower or via a vaporiser) may help.
Thickmucus can also be made more wateryby inhaling saline through a device called anebuliser, which turns liquid into vapour and delivers it directly to the mucus built up in your lungs. This makes it easier to clear out with a cough.
Are there other options?
Budesonide (a steroid inhaler), when given early after a COVID diagnosis, has been shown to reduce the likelihood of needing urgent medical care, as well asimproving recovery time．
Unfortunately, there are no good trials on using budesonide inhalers for a post-COVID cough.
However, anecdotally, it has been of help to some patients who have a post-COVID cough, when nothing else is helping them.
Trials on steroid tabletsto treat a post-COVID cough are still underway, and won't be recommended unless they're shown to result in significant improvement.
Antibiotics won't help
Concerningly, some countries haveguidelinesthat suggest using antibiotics to treat COVID, showing just how prevalent this misunderstanding is.
Unless there is asecondary bacterial infection, antibiotics are not appropriate and may contribute to the development ofantibiotic resistance．
Post-COVID coughing can last for weeks, be debilitating, and have a variety of causes. Most of the ways to manage it are simple, cheap and can be done without needing medical intervention.
However, if you have any doubts about the cause or the progression of yourcough, it is worth a visit to your GP to have it checked out.
Explore further
This article is republished fromThe Conversationunder a Creative Commons license. Read theoriginal article．
