Chronic Cough after COVID-19: What can you do about it?

Chronic cough can be a cumbersome condition to deal with for most. Oftentimes, the persistence of a cough is deemed mysterious [1], with patients reportedly struggling with the condition for up to 10 years. As of 2020, we have witnessed a rise in chronic cough as a consequence of COVID-19. A study [2] has reported that up to 2.5% of patients struggled with a chronic cough a year after their COVID-19 diagnosis. We imagine the numbers in Singapore is understated. As with the typical chronic cough, it would be unexaggerated to assume, many have accepted this as their new norm. In this article, we aim to take a deep dive into the potential reasons for chronic coughing after COVID-19 and what remedies are available to overcome this condition.  

What is chronic coughing and what does it have to do with COVID-19?

A cough is considered chronic when it is persistent for over 8 weeks for adults and over 4 weeks for children. In rare cases, patients have claimed to have unresolved coughing for years. In fact, the most inquired query online in Singapore is  “chronic coughing for 10 years”. Unfortunately, many patients become accustomed to coughing and accept it as their new norm after a certain period of time. 

Persistent coughing after COVID-19 is also known as a symptom of “long covid” [3]. It can be understood as an ongoing health problem one faces after the infection of COVID-19. Long-COVID is not a condition on its own, but rather an aftermath of COVID-19. Symptoms of long-covid range from dry cough, chesty cough, fatigue, brain fog, heart palpitations, sensory changes (test and smell), and even mental health conditions such as depression and anxiety. 

The prevalence of chronic cough after COVID-19 is indicative of acute respiratory distress. In other words, your respiratory system is affected significantly, leading to its inability to recover fully. 

There are a few reasons why you might have an unresolved cough after COVID-19. The fundamental cause would be inflammation and your body’s management mechanism in dealing with said inflammation. 

For some time, the medical community was dumbfounded [4]about why COVID-19 triggered such an intense inflammatory response. However, recently it has been revealed [5] that the blood cells, monocytes, [6] and macrophages [7]  die off in our body in an attempt to fight a COVID-19 infection, subsequently causing the persistence of inflammation as a response. 

The death of monocyte and macrophage cells causes chronic inflammation in the body.

Chronic coughs and inflammation induced by COVID-19 

Having established that chronic coughs are fundamentally a result of inflammation, let’s look into the mechanism of how this occurs. 

  1. Irritated lungs and lower airways 

Given that COVID-19 is fundamentally a respiratory disease, it is likely that your lungs are significantly inflamed. This causes a pneumonia-like response where your lungs are filled with liquid and are swollen. Cough is the body’s response to overcome this buildup. Even if there is no mucus buildup in your lungs, your coughs may manifest as a “dry cough”. This could signify that your lung cells are at least swollen. 

  1. Interstitial lung disease

Your initial COVID-19 condition has likely undergone a progression march leading to the occurrence of interstitial lung disease (ILD). Also known as diffuse parenchymal lung disease (DPLD),  this condition occurs when excess fibrous or scar tissues form in the lungs as a result of inflammation. This subsequently impairs the ability of effective gaseous exchange (taking in oxygen and dispelling carbon dioxide). 

nterstitial lung disease
Visualisation of the lungs with interstitial lung disease (ILD).
  1. Disruption in the neural pathway

Likely, your cough has not got anything to do with your lungs or your nasal passage. Instead, an inflammation of the nervous system has occurred eliciting cough symptoms. This is not unheard of, and is in fact, almost identical to conditions such as a damaged laryngopharyngeal nerve [8].

  1. Postnasal drip 
Nasal passages
Inflammation of the upper airway may result in chronic cough after COVID-19.

When the upper airway which is made up of nasal passages and sinuses is inflamed, liquid builds up in the area as a response. This fluid is also known as mucus. The mucus subsequently drips into the throat, inflicting a cough, a response as means of dealing with the irritations. 

What should I do about my chronic cough from COVID-19? 

First things first, you need to identify the exact cause of your chronic cough so treatment can be administered. This would mean seeking medical intervention by visiting a respiratory specialist so the necessary treatment can be issued. Depending on the cause of your chronic cough, treatment will vary. 

In the meantime, it is important that you do not exacerbate your condition. There are a few management steps you can take to control your chronic cough condition, however, it is important to remember this does not cure you of your condition. For instance, if a secondary bacterial infection has occurred, you may need a cycle of antibiotics. Determining the cause of your chronic cough is pertinent and non-negotiable. 

  • Consuming anti-inflammatory diets: having established that chronic cough from COVID-19 is an inflammatory response, consuming a diet that fights inflammation [9] will provide the additional support your body can benefit from. These would include turmeric, olive oil, leafy vegetables, a variety of nuts (not roasted), fatty fish such as salmon and sardines, and fruits such as strawberries, blueberries, and oranges. You must also avoid inflammation-inducing foods such as red meats, refined carbohydrates, sweet carbonated drinks, and fast food. 
Anti-inflammatory diets
Anti-inflammatory diets could help support your immune system when dealing with long-covid chronic coughs.
  • Avoid cold temperatures: an overly chilly room or consumption of cold drinks and food could trigger your coughs. Cold rooms also tend to lack humidity causing irritation, in which case, it may be worth investing in a humidifier. 
  • Avoid allergens and pollutants: cigarette smoke, haze, and dust will trigger your cough and exacerbate your condition. Wear a mask to protect yourself outdoors if necessary. 
  • Over-the-counter medications: lozenges, saline rinses, and nasal sprays may aid if nasal drips are causing your chronic coughs.

Conclusion 

Chronic cough is not a condition you have to live with for the rest of your life. If you are feeling discouraged because there seems to be no end to your condition, it is about time you seek a specialist so that a thorough investigation can be conducted. The sooner treatment is sought, the better the chances of a speedy recovery. If you are reading this article because your chronic cough has been driving you up the wall, contact us now as a better quality of life awaits you. 

Frequently asked questions

Is my chronic cough infectious?

No. Your chronic cough will not contain any COVID-19 viruses that pose a threat to others. However, if a secondary infection has occurred, your bacterial infection could be contagious. 

Why is there blood in my cough?

If you are coughing up specks of blood with phlegm, you likely have an irritated throat or airway. However, coughing blood (hemoptysis) [10] could also be indicative of serious issues such as bronchitis, lung cancer, pneumonia, and tuberculosis. You must seek the service of your healthcare provider promptly if there is blood in your cough (anywhere from a teaspoon of blood). 

Coughing blood after COVID-19 has been reported previously [11] in cases of COVID-19 and may be indicative of secondary bacterial infection or viral pneumonia. Both require treatment and should not be delayed. 

References

  1. DuBosar, R. (2018) Solving mysterious chronic cough cases, ACP Internist. Available at: https://acpinternist.org/archives/2018/07/solving-mysterious-chronic-cough-cases.htm (Accessed: 28 June 2023).
  2. Fernández-de-Las-Peñas, C. et al. (2021) Prevalence of post-COVID-19 cough one year after SARS-COV-2 infection: A multicenter study, Lung. Available at: https://pubmed.ncbi.nlm.nih.gov/33993321/ (Accessed: 28 June 2023).
  3. Centers for Disease Control and Prevention (2022) Long Covid or post-covid conditions. Available at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html (Accessed: 28 June 2023).
  4. Del Valle, D.M. et al. (2020) An inflammatory cytokine signature predicts COVID-19 severity and survival, Nature News. Available at: https://www.nature.com/articles/s41591-020-1051-9 (Accessed: 28 June 2023).
  5. Del Valle, D.M. et al. (2020a) An inflammatory cytokine signature predicts COVID-19 severity and survival, Nature News. Available at: https://www.nature.com/articles/s41591-020-1051-9 (Accessed: 28 June 2023). 
  6. Cleveland Clinic (2021) Monocytes: A type of white blood cell - what are normal ranges? Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/body/22110-monocytes (Accessed: 28 June 2023).
  7. Mandal, A. (2022) What is a macrophage?, News Medical. Available at: https://www.news-medical.net/life-sciences/What-is-a-Macrophage.aspx (Accessed: 28 June 2023).
  8. Sherrell, Z. (2023) Laryngeal sensory neuropathy: Symptoms, diagnosis and treatment, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/laryngeal-sensory-neuropathy (Accessed: 28 June 2023).
  9. Harvard Health Publishing (2021) Foods that fight inflammation, Staying Healthy. Available at: https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation (Accessed: 28 June 2023).
  10. Corey, R. (no date) Hemoptysis, National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK360/ (Accessed: 28 June 2023).
  11. Al Maqbali, M., Al badi, K. and Dickens, G.L. (2021) Clinical Features of COVID-19 Patients in the First Year of Pandemic: A Systematic Review and Meta-Analysis, Sage Journals. Available at: https://journals.sagepub.com/doi/10.1177/10998004211055866 (Accessed: 28 June 2023). 
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