Managing Persistent Cough After COVID-19: A Guide for Patients

I have been coughing for three and a half months. How should I manage it?

Hello, Doctor.
I am currently in Chicago, USA.
Since last Christmas, I have been experiencing cold symptoms (sore throat, fatigue, nasal congestion, and mild diarrhea).
I took over-the-counter cold medication for three days, which improved my symptoms.
At the same time, a family member tested positive for COVID-19, and in retrospect, I suspect I may have had COVID rather than just a cold.
After the three days of cold medication, I was left with only nasal congestion, so I took a single dose of Sudafed PE, which alleviated the congestion.
However, I then started experiencing a dry cough every night between 2-4 AM, which later developed into a wet cough, and I even experienced symptoms of wheezing and asthma.
Eventually, I began coughing to the point of nausea/vomiting, with intermittent coughing lasting for two hours.
When lying down at night, I would start coughing and could not fall asleep.
On February 16, a doctor in the U.S.
diagnosed me with bronchitis and prescribed five days of benzonatate and ten days of prednisone.
After completing all the medications, I still continued to cough every night between 2-4 AM, with thick, white, foamy sputum, and occasionally coughed up white, thread-like or short cylindrical objects.
Two weeks later, I returned to the same doctor for assistance, but he stated that there was nothing more he could do and that I should wait for it to resolve on its own.
As of now, I am able to function normally during the day, with occasional mild coughing, and I can exercise and walk normally.
However, when I lie down at night, I immediately start coughing and producing phlegm, and I wake up between 2-4 AM with a productive cough that lasts from one and a half to two and a half hours, which is causing significant disruption to my life.
What should I do, Doctor? Thank you.

Aman, 30~39 year old female. Ask Date: 2022/03/09

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the situation you described may be due to 1.
chronic pharyngitis.
It is recommended to seek medical attention for a laryngoscopy examination (to rule out any masses) and medication treatment.
In addition to medication, daily lifestyle precautions include avoiding lying down for two hours after eating and avoiding coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
2.
For bronchopulmonary diseases, please consult a pulmonologist.
Wishing you peace and health.

Reply Date: 2022/03/09

More Info

Managing persistent cough after a COVID-19 infection can be challenging, especially when symptoms evolve and impact daily life. Your experience of developing a cough that worsens at night, along with the presence of phlegm and occasional asthma-like symptoms, is not uncommon among those who have had COVID-19. Here’s a comprehensive guide to help you navigate this situation.

Understanding Your Symptoms
1. Post-COVID Cough: After a COVID-19 infection, many individuals experience lingering symptoms, including a persistent cough. This can be due to residual inflammation in the airways, bronchial hyperreactivity, or even secondary infections. The fact that your cough worsens at night suggests that it may be related to post-nasal drip or changes in airway dynamics when lying down.

2. Bronchitis and Asthma Symptoms: Your diagnosis of bronchitis indicates inflammation of the bronchial tubes, which can lead to increased mucus production and coughing. The development of asthma-like symptoms, such as wheezing and shortness of breath, can occur due to airway sensitivity post-infection.

Recommended Management Strategies
1. Medication Review: Since you have already been prescribed benzonatate and prednisone, it’s essential to discuss with your healthcare provider the possibility of adjusting your treatment plan. If your symptoms persist, additional medications such as inhaled corticosteroids or bronchodilators may be beneficial to reduce inflammation and open the airways.

2. Expectorants: Consider using expectorants like guaifenesin, which can help thin mucus and make it easier to expel. This may alleviate some of the coughing and help clear the phlegm.

3. Hydration: Staying well-hydrated is crucial. Drinking plenty of fluids can help thin mucus, making it easier to cough up. Warm fluids, such as herbal teas or broths, can also soothe the throat.

4. Humidification: Using a humidifier in your bedroom can help keep the air moist, which may reduce coughing at night. Dry air can irritate the airways and exacerbate coughing.

5. Sleep Positioning: Elevating your head while sleeping can help prevent mucus from pooling in the back of your throat, which may reduce nighttime coughing. Consider using extra pillows or a wedge pillow.

6. Avoid Irritants: Stay away from smoke, strong odors, and allergens that can trigger coughing. If you have known allergies, managing them with antihistamines may also help.

7. Breathing Exercises: Engaging in breathing exercises can help improve lung function and reduce coughing. Techniques such as diaphragmatic breathing or pursed-lip breathing can be beneficial.

8. Follow-Up Care: Since your symptoms have persisted despite treatment, it’s important to maintain regular follow-ups with your healthcare provider. They may consider further investigations, such as a chest X-ray or pulmonary function tests, to rule out other underlying conditions.

When to Seek Immediate Care
If you experience any of the following, seek medical attention promptly:
- Difficulty breathing or wheezing that worsens
- Chest pain or tightness
- High fever or chills
- Coughing up blood or significant changes in sputum color

Conclusion
Persistent cough after COVID-19 can be distressing, but with appropriate management and follow-up care, many patients see improvement over time. It’s essential to communicate openly with your healthcare provider about your symptoms and any changes you experience. They can help tailor a treatment plan that addresses your specific needs and improves your quality of life. Remember, recovery can take time, and patience is key as your body heals from the effects of the virus.

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