As the cough reflex is mediated by the vagus nerve, 8 interactions between the virus and the airway vagus nerve, with ensuing neuroinflammation, represent the likely primary events for the initiation of cough.Īn increasing number of reports describes an array of fluctuating or persistent symptoms experienced by patients for months after recovery from COVID-19. The co-presence of cough, anosmia, and ageusia 6 indicates that neuroinflammatory mechanisms might be operative in COVID-19 pathogenesis. A study in Wuhan, China, found that the median time from illness onset to cough was 1 day and that cough persisted for an average of 19 days cough lasted for 4 weeks or more in approximately 5% of patients. 6 A systematic review and meta-analysis 7 of 21 682 adults infected with SARS-CoV-2 in nine countries reported that cough was present in 57%. 1, 2, 5 Using an app-based COVID symptom tracker on smartphones, cough was reported in about 50% of patients who tested positive for SARS-CoV-2, and in combination with a loss of smell (anosmia), loss of taste (ageusia), unusual fatigue, and loss of appetite, was highly predictive of SARS-CoV-2 infection. We conclude by discussing the management of acute and chronic COVID-19 cough and future directions for research and clinical practice.ĭry cough is one of the most common initial symptoms of COVID-19, reported in about 60–70% of symptomatic patients. In this Personal View, we review the knowledge that has accumulated on cough in COVID-19, and discuss neuroinflammatory and neuroimmune mechanisms that could potentially underlie COVID-19-associated cough based on our understanding of the pathogenesis of COVID-19 and of the cough associated with other respiratory viruses. However, we currently have little understanding of the mechanisms underlying COVID-19-associated cough. We propose that it is important to consider cough as a target of intervention in the management of COVID-19 and post-COVID syndrome. Patients with chronic cough also often seek antitussive therapies, but it is unknown whether such approaches are effective in post-COVID cough patients. Identifying ways to control COVID-19-associated cough could help to prevent community transmission and disease spread, as well as removing the stigma of this symptom.Įvidence-based treatment options for COVID-19 cough are needed because patients with cough caused by common viral infections, including cold and flu, frequently resort to over-the-counter cough medicines. 3 Stigmatisation of patients with cough can occur, leading to social isolation, 4 particularly during the COVID-19 pandemic. Cough is not only distressing to patients, but also increases the risk of community transmission by respiratory droplets. Similar to the more common but less serious infections of the common cold or flu, cough is a key symptom of COVID-19 in the acute phase of the infection, and one that persists in the post-infective phase. With limited availability of effective vaccines, measures to reduce disease spread-such as physical distancing, wearing masks, and avoiding crowds-remain key strategies to combat the infection. 1, 2 Even in countries where the first pandemic wave of the virus was controlled, second or third waves are happening or have been predicted to occur. The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has had an unprecedented effect on global health since its discovery in Wuhan, China. Although neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID-19 cough, we discuss the possible mechanisms of COVID-19-associated cough and the promise of new anti-inflammatories or neuromodulators that might successfully target both the cough of COVID-19 and the post-COVID syndrome. We highlight gaps in understanding of the mechanisms of acute and chronic COVID-19-associated cough and post-COVID syndrome, consider potential ways to reduce the effect of COVID-19 by controlling cough, and suggest future directions for research and clinical practice. The post-COVID syndrome might also result from neuroinflammatory events in the brain. We hypothesise that the pathways of neurotropism, neuroinflammation, and neuroimmunomodulation through the vagal sensory nerves, which are implicated in SARS-CoV-2 infection, lead to a cough hypersensitivity state. Cough can persist for weeks or months after SARS-CoV-2 infection, often accompanied by chronic fatigue, cognitive impairment, dyspnoea, or pain-a collection of long-term effects referred to as the post-COVID syndrome or long COVID. Cough is one of the most common presenting symptoms of COVID-19, along with fever and loss of taste and smell.
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