Is There (Will There Be) a Post-COVID-19 Chronic Cough?
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EDITORIAL
Is There (Will There Be) a Post-COVID-19 Chronic Cough? Peter V. Dicpinigaitis1 · Brendan J. Canning2 Accepted: 2 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Cough is among the most common symptoms associated with an acute viral upper respiratory tract infection (URI; common cold). In the vast majority of afflicted persons, acute cough (defined as cough of less than 3 weeks’ duration) is transient and self-limited. However, in a subgroup of individuals recovering from a common cold syndrome, a dry, troublesome cough will persist as the sole residual symptom. Standard accepted terminology includes subacute cough as a cough lasting 3–8 weeks, and chronic cough greater than 8 weeks [1]. Indeed, clinicians treating patients with chronic cough will regularly obtain a history that the onset of chronic cough was temporally associated with an acute viral URI [2]. Various mechanisms have been proposed to explain viral URI-induced cough [3] as well as prolonged cough reflex hypersensitivity after acute URI [4]. Clinical studies incorporating capsaicin cough challenge, a common method of measuring cough reflex sensitivity, have demonstrated that the sensitivity of the cough reflex is enhanced during acute viral URI and remains so for a month or more beyond resolution of the viral syndrome [5–7]. When the COVID-19 pandemic struck in early 2020, the question arose as to whether infection with SARS-CoV-2 would generate a prolonged postviral cough, such as historically we have witnessed after other acute viral respiratory tract infections each year. Although we are still in relatively early days after the first wave of the pandemic hit North America and Europe, initial observational experience with post-COVID-19 patients supports the conclusion that there is not a high incidence of post-COVID-19 chronic cough and, when such a persistent cough does occur, it is not
* Peter V. Dicpinigaitis [email protected] 1
Albert Einstein College of Medicine and Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
2
reported as severe, nor as the most troublesome symptom affecting a patient. An informal poll of the Directors of 17 subspecialist Cough Centers worldwide (six in the USA; five in the United Kingdom; one each in Canada, China, Germany, Italy, Japan and South Korea) yielded a consensus that chronic cough after COVID-19 was to date either a never-seen, rare or uncommon event at their specialty Cough Centers. Anecdotal experience consistently described that fatigue, dyspnea with exertion and chest tightness/discomfort were more commonly reported than cough, and when cough was described (often as a response to a prompt rather than as an unsolicited complaint), it was not severe nor particularly troublesome. Indeed, initial published data reporting on respiratory symptoms in patients after SARS-CoV-2 infection describe a higher prevalence of symptoms other than cough. In a study from Italy evaluating
