Cough After Covid – Why do I Still Cough?

The Hyfe Mind

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April 8, 2021
CoughPro is not a medical product. It is a wellness app intended only for users to obtain a better understanding of their cough. It is not intended to diagnose, monitor, or treat any illness.

We at Hyfe, Inc., are a company devoted to working on tools to better understand the importance of cough. It is Hyfe’s intention in the future to seek regulatory approval for medical products that analyze cough in order that they may be used to diagnose, monitor, and facilitate better treatment of respiratory illnesses.

Coughing young man at home
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The COVID-19 pandemic has changed how we look at symptoms of infection. The cough is one such symptom that has evolved from something harmless to being considered rather insidious during the era of this pandemic. Identifying the cause and suppressing the nagging cough is becoming a primary requirement. For some, lingering cough after covid is a serious concern.

Is Cough A Usual Symptom of COVID-19?

A dry cough was present in about 50% of COVID patients who tracked their symptoms in real-time during a primary clinical presentation. 

Initial signs of coronavirus infection can include a high fever, headache, and loss of smell. So,  people rarely notice coughs in the acute (initial) phase of infection. Instead, a cough often comes in after a week or so of COVID-19 infection. In other words, it might take some time for cough to emerge as a primary sign.

People with a coronavirus infection often report a cough of a dry and persistent variety. A few individuals also noted some phlegm or mucus with their coughs. This productive cough, though rare with COVID-19, had two likely origins:

  • Possible pre-existing respiratory condition OR
  • Co-infection with bacteria (greenish-yellow phlegm with cough)

According to the CDC, people with COVID can additionally report various symptoms depending on their infection severity. These other possible indications of underlying COVID- 19 include:

  • Fever
  • Headache
  • Body ache
  • Sore throat
  • Loss of smell 
  • Difficulty breathing

Nausea, diarrhea, loss of taste, and chills have also been reported among many people as initial phase symptoms of SARS-Cov2 infection. However, symptoms can vary depending on the viral load and subsequent severity of the infection.

Why Do I Still Have A Cough?

Coughing can be one of the final symptoms to appear as a consequence of underlying COVID-19 infection. It is also one of the primary indications of a previous COVID infection.

During the infective phase, a cough develops as a reflex to remove the irritant from the respiratory airways. However, with time, this coughing can lead to inflammation of the breathing passages. This inflammation further increases cough frequency forming a vicious loop.

African-american man relaxing, taking a deep breath

Taking deep breaths to compensate for the compromised lungs might also increase cough frequency. Most of this breathing occurs through the mouth, and this air doesn’t receive adequate moisture from the rest of the nasal passages. This dry air further aggravates coughing.

The effects on the respiratory passages due to COVID-19 infection can also directly cause coughing observed in the post-COVID phase.

What Are the Causes of Post-COVID Cough?

The viral infection leaves many lasting imprints during infection that may remain in the post-infectious phase. This lasting impact leads to a lingering discomfort, of which one of the signs is a nagging dry cough.

In some studies, researchers found SARS-CoV2 impacts the nervous system, resulting in hypersensitivity reactions. Coughing was one outcome of this hypersensitivity reaction. According to those studies, the virus affected the sensory neurons and resulted in cough and a loss of smell as early signs of underlying infection.

Since the primary impact of SARS-CoV2 is on the respiratory system, a cough can be a post-COVID sign if not present at the outset. For example, a study in Italy documented a post-COVID-19 cough lasting about two months in 16% of previously hospitalized COVID-19 patients. 

Post-COVID syndrome can also include fatigue, chest pain, difficulty breathing, and brain fog. 

Today, having a documented COVID-19 infection previously is a potential cause for developing a chronic cough. Individuals who had severe acute COVID-19 infection or have other comorbidities/co-infection during the acute phase might subsequently develop a post-COVID cough. Recurrent cough can also lead to laryngotracheitis, an inflammation of the upper respiratory pathways, further increasing post-COVID-19 cough.

In some cases, the coronavirus infectious process and the cough could have damaged the nerves, specifically within the larynx and trachea. This damage can manifest in what is known as sensory neuropathic cough. Thus, a slight irritation to these nerves can instigate a cough that would have otherwise not occurred. 
It is also crucial to consider that other persistent factors can worsen a cough once an infection has subsided. Lifestyle factors such as resuming smoking are one such cause. In addition, exposure to allergens, asthma, or postnasal drip are causes of chronic cough. Following COVID-19, these conditions can contribute to prolonged symptoms, especially the cough.

How Can I Control My Cough? 

Coughing can be a nuisance, especially during the recovery phase following COVID-19 infection. Due to the vast stigma attached to a cough today, it is not easy to get back to a form of normalcy if your cough still lingers.

While there are medications currently being used to suppress a dry cough, their effectiveness in acute cough management is not completely elucidated. 

Healthcare professionals are encouraged to review the possibility of respiratory changes at the outset to prevent post-COVID symptoms such as pain and dry cough. Due to the high incidence of interstitial lung changes, which often manifest as a dry cough, a course of oral corticosteroids is considered during the viral infective phase.

Since cough is a primary means of viral transmission, measures to manage dry cough are a vital aspect of COVID-19 management. 

For a nagging cough in the post-COVID phase, it would be optimal to consider visiting your healthcare professional. This is primarily considered to also rule out other possible underlying causes for your cough. Your primary care physician might recommend a cough suppressant to reduce the cough frequency. This on its own might reduce inflammation, pain, and further sensory nerve irritation occurring due to the cough.

Physicians might also suggest opting for medications that manage pain and inflammation, consequences of recurrent dry coughing. 

Initial recommendations toward managing a post-COVID dry cough are always by considering non-drug measures. This often includes taking honey, consuming warm liquids, and chewing on some lozenges. In addition, you can try home remedies such as steam inhalation or using vaporizers to ease soreness or congestion.

Mindful breathing practices can help bring down cough frequency gradually.

Besides your cough, also consider tracking other symptoms such as the reappearance of fever, shortness of breath, or headache. The incidence of reinfection with another variant is currently a high possibility. Additionally, weakened lungs are susceptible to other infections, requiring a whole different course of medical management. 
If you have a dry cough, it might not necessarily be coming from something wrong with the respiratory system. A few examples include stomach acid reflux, allergies, heart failure, or, as mentioned previously, a sensory neuropathic cough.

Cough and The Post COVID Era

While coughing, we should consider being mindful of our immediate surroundings. Today people wear a mask because of the mandates. However, mask-wearing should shift into a common practice to prevent the spread of infection.

When coughing, consider doing so in a disposable tissue or the inner sleeve of your shirt. Limit handshakes and clinging on to public surfaces. Simple acts, often taken for granted, are significant to help limit the spread of viral infections.

Most of us are witnessing, around the globe, COVID-19 leaving a long-term impact on those directly affected by it. However, once the infection has subsided, it would be ideal for keeping track of any new or prolonged symptoms to manage them better in the future. 

Unfortunately, it takes months to recuperate from the impact of COVID-19 on one’s system. Therefore, it will take longer for the world to grapple with the effects of COVID-19.

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