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

Area of Science:

• Pulmonology
• Infectious Diseases
• Neurology

Background:

• A significant number of patients experience persistent symptoms after acute COVID-19 recovery.
• Post-COVID-19 cough is a prevalent and often prolonged symptom, regardless of initial disease severity.
• Existing literature uses varied terminology for persistent post-viral symptoms, with cough being the most frequent.

Purpose of the Study:

• To systematically review and summarize the existing literature on post-COVID-19 cough.
• To investigate the prevalence and underlying mechanisms of persistent cough following SARS-CoV-2 infection.
• To explore potential therapeutic strategies for managing post-COVID-19 cough in clinical practice.

Main Methods:

• Systematic literature search on post-COVID-19 cough, its prevalence, and management.
• Analysis of studies investigating the pathophysiology of persistent cough after viral respiratory infections.
• Review of current and potential therapeutic interventions targeting cough reflex suppression.

Main Results:

• Augmented cough reflex sensitivity is identified as a key mechanism for persistent cough post-viral upper respiratory infection (URI).
• SARS-CoV-2 infection may induce neurotropism, neuroinflammation, and neuroimmunomodulation via vagal sensory nerves, contributing to heightened cough reflex.
• Inhaled corticosteroids are suggested for airway inflammation in non-responsive cases, though novel therapies require further investigation.

Conclusions:

• Post-COVID-19 cough is often linked to an overactive cough reflex, potentially involving neurological pathways.
• Current therapies focus on cough reflex suppression, with inhaled corticosteroids as a potential option for refractory cases.
• Further research with novel therapies and varied outcome measures is needed to effectively manage post-COVID-19 cough.