Approach to post COVID-19 persistent cough: A narrative review

Abstract

A large proportion of patients who completely recovered from acute coronavirus disease 2019 (COVID-19) infection later continued to experience symptoms even after recovery, irrespective of the severity of the disease. Various terms with varying duration were used for those who had persistent symptoms, of which cough was the most common. We systematically searched the published literature concerning post-COVID-19 cough, its prevalence, and the potential ways to reduce it in clinical practice. The aim of this review was to provide an overview of existing literature concerning post-COVID-19 cough. Literature shows that augmented cough reflex sensitivity is responsible for persistent cough after acute viral upper respiratory infection (URI). Overall, the heightened cough reflex associated with SARSCoV2 induces neurotropism, neuroinflammation, and neuroimmunomodulation via the vagal sensory nerves. Therapies for post-COVID-19 cough aim at the suppression of cough reflex. For a patient who does not respond to early symptomatic treatment, Inhaled corticosteroids can be given a trial to suppress airway inflammation. More trials of novel cough therapies in patients with post-COVID-19 cough using various outcome measures need to be studied in future research. Several agents are currently available for symptomatic relief. However, non-response or refractory cough continues to preclude adequate symptom relief.

Keywords: Cough; inhaled steroids; post-COVID.

Figure 1

Overview of the evaluation of Persistent post-COVID-19 cough. ACE-I: angiotensin converting enzyme inhibitor; AHR: Airway Hyperreactivity; CVA: Cough Variant Asthma; PNDS: post-nasal drip syndrome; GERD: gastro-oesophageal reflux disease; COPD: Chronic Obstructive Pulmonary Disease; ILD: Interstitial lung disease