A Journal of Observational Laryngology

Clinical observations, anecdotes, and insights which other clinicians may want to consider and test with further research.

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Still Coughing After COVID-19?

Covid-19 has intruded into our lives in innumerable ways. Worst of all for some, is that they contracted the virus.

 

Among those stricken by the virus are surely a number of persons who are some weeks or even months past the acute infection and who feel generally well. But, they are experiencing a lingering cough. Especially early on, this cough may be continuing to clear secretions that accompany resolving lung inflammation. In that case, the lingering cough has a purpose—it is accomplishing something.

For others, the cough is no longer solving a problem, but it IS the problem. That is because for them, the infection has “damaged,” or “sensitized” sensory nerve endings in the trachea, larynx, or throat. These “wild” nerve endings go “ZING!!” and demand that you cough.

Such persons may have developed a condition called sensory neuropathic cough (SNC).

Key features of SNC are:

  1. Each episode of coughing (whether a single cough, a few seconds of coughing, or a violent and protracted 30-second or longer attack) is initiated by a stereotyped sensation:  a “tickle,” “dry patch,” “itch,” “pinprick,” “dripping sensation,” etc. Commonest location is at the sternal notch—the lowest part of the neck before you reach the sternum.
  2. The cough is out of proportion to anything produced by that cough. The cough is dry, or it produces mucus only after hard coughing. The person says, “Who coughs this much to produce that much mucus?” The person may even cough hundreds of times a day, mostly briefly, but also have agonizing protracted and exhausting episodes a few times a day … to the point of embarrassment or even humiliation when they occur in public.
  3. Trigger phenomena. While coughing spells can occur spontaneously, certain actions make it more likely that you will cough. Things like talking, a loud laugh, breathing in air either colder or warmer than ambient (going outside, etc.), a strong odor, swallowing, change of position (such as when getting in bed or getting up in the night). Or touching a certain spot on the neck, and most commonly again at the sternal notch.
  4. Seeming futility of usual treatments. Taking an expression from the classic film, Casablanca, “rounding up the usual suspects” of allergy, acid reflux, and asthma is pointless.  Steroids may help but only while on them. Narcotic cough suppressants may provide some relief, but are purely a symptomatic treatment.
  5. The correct approach is to target the irritable nerve endings. Things like amitriptyline (or desipramine), gabapentin, citalopram, mirtazepine, venlafaxine, capsaicin spray, etc. Usually one of the first two is effective. Persons with resistant cases may need to work their way down a longer list of medication trials.  Occasionally, injection of a long-acting local anesthetic (mepivacaine, bupivacaine, or similar) combined with a locally-acting steroid (triamcinolone or similar) into a sensitized area can help.

What are the practicalities of getting help for a “Covid-19 Cough?”  Some ideas:

  1. If really early after the infection and the cough is congested and productive, stay the course of conventional Covid-19 treatments, possibly including steroids and standard cough suppressants.
  2. If the infection was weeks ago; you are feeling reasonably well; and the main impediment to recovery and return of quality of life is your cough, educate yourself more fully about sensory neuropathic cough. Laryngopedia.com has many articles, videos, patient interviews, etc. that you can find by typing “cough” into the search window. Or read this article on the subject: https://peerj.com/articles/816/ It is a peer-reviewed article found in an open-source medial journal (that is, not behind a paywall).
  3. Raise the question with your personal physician. Consider providing the above article for his or her perusal, since your doctor may not have encountered this diagnosis before. The treatment protocol is clearly outlined.
  4. Call nearby ENT or pulmonary doctor groups in particular and ask to speak to the triage nurse.Ask him or her “Do any of your doctors treat sensory neuropathic cough?” If “crickets,” call the next group with the same question.
  5. If you exhaust all local sources of help, consider a teleconversation with Laryngopedia.com, or with a Bastian Voice Institute physician. Doctors there would also be glad to help you in person, if convenient for you.

Here’s wishing you speedy resolution of your cough, maybe as a brief aftermath of Covid-19.  This information is offered just in case you struggle with coughing that won’t go away after many weeks, and despite many tests and treatments.  If, as it appears, SNC has for all of human history been “caused” in many cases by endemic viruses, why not by a novel one like Covid-19?

14 thoughts on “Still Coughing After COVID-19?

  1. Laryngeal Sensory Neuropathy
    I have had this type of cough since 2008. It began immediately after I tried to swallow one of those HUGE Centrum Silver pills. My mother had this after what we remember as the Hong Kong flu in 1968. She had it for 40 years before she passed. None of her doctors had any idea what the problem was. Her coughing fits were so bad that she hesitated to go anywhere, especially restaurants, where the first bite of food would trigger an embarrassing episode. My own doctor doesn’t seem interested in the problem even though I’ve told her twice what I think it is.
    After trying different ways of dealing with it, I finally settled on Mucinex Cough Suppressant, sometimes twice a day and definitely before going out in public. I think that preventing the cough finally allowed the nerves to heal. It has taken a number of years doing this, but my coughing episodes are greatly reduced in frequency and severity and I am taking that medication very seldom at present.

  2. After I had covid I am constantly coughing everyday and it leads to where I have alot of mucus I news to know how can I get rid of this coughing it is going 2 weeks already please give me advice..n what can I do to stop this coughing

  3. I had covid for a second time july 19th. It was the worst of the 2 times carching it. It is now September almost october. I still have a horrible cough.
    Now I do smoke (not as much as before I caught covid)
    Wearing my mask seems to make it even worse but Im a CNA. and required to wear one at work for my 16 hr shifts.
    Inwake up coughing a few hours after going to sleek and once Im up I stay up coughing for a while before I can go back to sleep. My doctor put me on an inhaler. Told me to take Delsym and musinex which i have been doing, but its been a month and the medicine only helps for a little while.
    I cant laugh without coughing, talk for more than a few seconds at a time, at work the cough pretty much never stops because im constantly on the move. Im miserable, i feel like tgis cough is taking over my whole life. Help!

  4. honestly I had covid 2x the first it had no long term effects the second me and my boyfriend both caught it. We both had a lingering cough. I have no idea if this “fixed” it, but I was required to get a vaccine for work. (I have nothing against vaccines I just did not want it until it was proven safe) After I got the covid vaccine my cough stopped completely. My boyfriend still has a cough and sometimes lung pain with deep breaths and he did not, nor has he ever, recieved the covid vaccine.

  5. I have had Covid as well funny thing is well i was in the hospital for that week before or after total 2 weeks..as soon as i got home from the hospital about 3 days home i started coughing ..I am going on week 2 with coughing.I am using mucinex which helped a little ..but if it continues another week im going to the doctor..

  6. I had the same thing earlier this summer. After a month of incessant coughing, to the point of vomiting, she finally agreed that I had bacterial bronchitis and prescribed an antibiotic. The intense cough was gone within three days on antibiotics. I still had lingering effects of the intense coughing (see the article above), but was able to function again. I recommending pushing for antibiotics. After one month of intense coughing, the risk of taking antibiotics for a viral illness is lower than the continuing problems with coughing.

  7. I had COVID over Labor Day and feel fine now but have this annoying cough mostly at night. I’ll get a tickle like the article says and then start coughing and can’t stop. Cough drops seem to help. Sure hoping this resolved soon. SO IRRITATING!!!

  8. I thought I had a cold but it got really bad and was informed I had COVID on sept 19 and was hospitalized for 3 days. All better now but can’t shake the cough tried a lot of hot tea and other home remedies. I guess I’ll start taking musinex that seems like a starting point. I was on a stereo maybe I should get back on that. Thank you doctor for making the informative video.

  9. I had a persistent cough for months. Took 12mg Ivermectin / 200mg Hydroxychloroquine / 500 mg Azithromycin / 50mg Zinc / 2-3 pipettes of Lomatium for 10 days and it went.

  10. I have coughed about 10 years. Nothing seems to help. I have been to two allergists with no help.
    My sinuses are completely clear. I was told to see a pulmonologist so that is my next stop.
    My brother also has a similar cough. Two other siblings have had no cough.
    Our mother coughed about 30 years before she passed away. She would choke, coughing up so
    much phlegm when she had a really bad spell. Her cough started after having surgery in 1954. She
    was in a room with a woman who smoked and my mother coughed from that time forward. She
    finally stopped coughing when she began having mini strokes before she passed away.
    Thanks for your interest in this problem.

  11. My Uncle picked up a steady and intense cough when he got Covid…. even after he recovered from Covid, the cough persisted, albeit intermittently. He tried numerous pharmaceutical treatments, nothing worked. He also tried some natural remedies, and they seemed to help a bit, at least with soothing his irritated throat. The cough was enduring. He got the Covid shot. Seemed to be doing fine initially, but then went down hill from there. Died shortly after. Had the intermittent cough until he passed.

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