From the Guidelines
Post-COVID cough can be managed with a combination of over-the-counter medications and home remedies, and it is essential to consider the potential for bacterial coinfections, such as Mycoplasma pneumoniae, which can occur in up to 4.3% of COVID-19 patients 1. For immediate relief, try using dextromethorphan (Robitussin DM) 10-20 mg every 4 hours or benzonatate (Tessalon Perles) 100-200 mg three times daily for up to 7-10 days. Staying well-hydrated, using a humidifier, and consuming honey with warm tea can also help soothe throat irritation. For nighttime cough, elevate your head with extra pillows and consider taking guaifenesin (Mucinex) 600-1200 mg twice daily to thin mucus. Post-COVID cough typically resolves within 4-8 weeks as the airways heal from inflammation caused by the viral infection. If your cough persists beyond 8 weeks, produces blood or discolored mucus, or is accompanied by fever, chest pain, or difficulty breathing, consult a healthcare provider as these may indicate complications requiring medical attention, such as bacterial pneumonia, which can be treated with antibiotics, such as a β-lactam plus a macrolide or a respiratory fluoroquinolone 1. The lingering cough occurs because COVID-19 damages airway cells and triggers inflammation that sensitizes cough receptors, which take time to return to normal function, and respiratory muscle performance may also be affected, leading to persistent dyspnea in some patients 1. Some key points to consider when managing post-COVID cough include:
- Staying hydrated to thin out mucus
- Using a humidifier to soothe the throat
- Avoiding irritants, such as smoke and pollution
- Getting plenty of rest to help the body recover
- Considering the potential for bacterial coinfections and seeking medical attention if symptoms persist or worsen. It is also important to note that some patients may experience persistent dyspnea, which can be addressed through respiratory muscle testing and training 1.
From the Research
Post Covid Cough
- Post Covid cough is a common symptom experienced by patients after recovery from acute coronavirus disease 2019 (COVID-19) infection, irrespective of the severity of the disease 2.
- The heightened cough reflex associated with SARS-CoV-2 induces neurotropism, neuroinflammation, and neuroimmunomodulation via the vagal sensory nerves, leading to persistent cough after acute viral upper respiratory infection (URI) 2.
- Therapies for post-COVID-19 cough aim at the suppression of cough reflex, and inhaled corticosteroids can be given a trial to suppress airway inflammation for patients who do not respond to early symptomatic treatment 2.
Treatment Options
- Several agents are currently available for symptomatic relief of post-COVID-19 cough, but non-response or refractory cough continues to preclude adequate symptom relief 2.
- Ibuprofen can be used for managing COVID-19 symptoms, including post-COVID-19 cough, as it suppresses the production of various pro-inflammatory cytokines implicated in the 'cytokine storm' and subsequent ARDS in COVID-19 disease 3.
- However, the use of systemic corticosteroids, such as those used in asthma treatment, may be associated with increased risk of moderate to severe COVID-19 and all-cause mortality, and should be used with caution 4.
Safety of NSAIDs
- The use of NSAIDs, including ibuprofen, in COVID-19 patients has been a topic of controversy, but systematic reviews and meta-analyses have found no association between NSAID use and increased risk of SARS-CoV-2 positivity, hospital admission, death, or severe outcomes 5, 6.
- The existing evidence on the use of NSAIDs in acute lower respiratory tract infections, including COVID-19, is of poor quality and should be interpreted with caution, highlighting the need for further mechanistic and clinical studies 5.