Experiencing a lingering cough after recovering from COVID-19? A post-COVID cough might be a lingering effect of the virus. However, if your symptoms persist or you notice other unusual signs, it's wise to consult a healthcare provider to rule out other possible conditions, including lung cancer.

In this article, OncoCare, a cancer centre in Singapore, discusses why individuals experience a post-COVID cough, how to recognise signs and symptoms associated with lung cancer, as well as address any risk factors related to prolonged coughing post-COVID that should not go unchecked.

What Causes a Cough During COVID-19?

The COVID-19 pandemic has affected millions of people worldwide. And coughing is one of the common symptoms that those suffering from the virus might have to deal with.

This symptom also manifests in various forms, often persisting even after other symptoms have resolved. After all, the virus triggers a range of respiratory symptoms, from mild irritation to severe distress, which can continue to affect individuals differently.

During a COVID-19 infection, the virus specifically targets the respiratory tract, leading to inflammation. This inflammation is a natural immune response but can irritate the airways, prompting a cough. The act of coughing is a reflex aimed at clearing irritants and pathogens from the body. For COVID-19, this usually results in a dry, persistent cough that can transition into a chesty cough if phlegm becomes involved.

While most people recover from the cough within a few weeks, some develop what is known as a chronic cough—lasting longer than eight weeks. This prolonged cough can be due to various factors:

• Persistent Inflammation: Even after the infection subsides, inflammation can linger, causing continuous coughing.
• Autoimmune Disorders: The immune system might mistakenly target and damage the body’s own tissues. However, there is still uncertainty about why COVID-19 might trigger such reactions, leading to potential autoimmune conditions.
• Sensory Overreaction: The nerves in the airways can become overly sensitive due to viral exposure, leading to an exaggerated cough reflex.

How Long Does it Take the Lungs to Heal After COVID-19?

Recovering from COVID-19's respiratory effects varies significantly from one person to another, as it is typically based on the severity of the infection and individual health factors.

Typically, lung recovery can span anywhere from three months to over a year. The process is akin to recuperating from any significant injury, as it might involve everything from healing the alveoli to other respiratory structures affected by the virus.

What if My Cough is Not Going Away After COVID?

The prevalence of a persistent cough after COVID-19 infection can vary, but statistics show that around 20-25% of symptomatic patients experienced symptoms of cough after its initial onset (Fernández-de-las-Peñas et al., 2021).

This is known as Long COVID cough, or post-COVID-19 syndrome, which refers to a set of symptoms that continue to affect individuals long after the initial virus infection has subsided. These symptoms, which appear about three months post-infection and can last for months, include but are not limited to fatigue, breathlessness, and cognitive impairments such as difficulty focusing or memory lapses.

The World Health Organisation recognises Long COVID as a condition with symptoms that can't be attributed to any other diagnosis. These symptoms can affect anyone, irrespective of the COVID-19 severity they experienced or their demographic characteristics. Long COVID's impact is profound, affecting various body systems and leading to symptoms that may resemble neurological, autoimmune, or cardiovascular conditions, among others.

Why Am I Still Coughing After COVID-19?

Post-COVID cough may be attributed to one of four potential inflammation-related reasons. These include postnasal drip, lower airway and lung infection, neuronal mechanisms of hypersensitivity, and interstitial lung disease (Yates, 2023).

• Postnasal Drip: Postnasal drip results from the continued inflammation of nasal passages and sinuses, which produces fluid that drips down the throat and stimulates the cough reflex (Yates, 2023).
• Lower Respiratory Tract Infection: Lower airway and lung infections are caused by swollen tissues that trigger the cough reflex to clear fluid in the lower respiratory tract (Yates, 2023).
• Neuronal Hypersensitivity: Additionally, the virus may cause inflammation of neural tissues in the brain and/or nerves, leading to hypersensitivity and the triggering of the cough reflex.
• Interstitial Lung Disease: Lastly, interstitial lung disease, which occurs when lung tissue is scarred or injured from inflammation, is a severe condition that requires medical attention (Yates, 2023).

Is My Lingering Cough After COVID-19 Contagious?

If you're experiencing a lingering cough after recovering from COVID-19, it generally does not mean you are still contagious. According to health guidelines, individuals who were asymptomatic or had mild to moderate symptoms typically cease to be contagious seven days after their symptoms first appeared.

Diagnosing Long COVID

Diagnosing Long COVID involves a comprehensive evaluation by healthcare professionals who start by reviewing the patient's medical history and reported symptoms. To gain deeper insights into the lingering effects of COVID-19, various diagnostic tests are employed based on the specific complaints of each patient.

These may include:

• Blood Tests: These help detect ongoing inflammation or other abnormalities that the virus may have triggered.
• Imaging Techniques: Techniques such as chest X-rays and CT scans are crucial for visualising the condition of the lungs and other organs to pinpoint any changes that could be contributing to the patient’s symptoms.
• Pulmonary Function Tests: These tests are critical in assessing how well the lungs are recovering, measuring the airflow and the volume of air the lungs can hold.
• Cardiac Assessments: Electrocardiograms (EKG/ECG) or echocardiograms (Echo) are performed to ensure the heart's functions have not been compromised, as COVID-19 can affect cardiovascular health.

How Do I Recover from a Cough After COVID-19?

If you’ve been wondering how to get rid of post-COVID cough, it is important to note that recovering from a post-COVID cough can be a lengthy process, often influenced by how severe the initial infection was. While the cough may persist for weeks or even months, it is usually not harmful to your physical health. However, it can significantly impact your mental well-being due to the stress and discomfort it causes.

Here are some practical steps to manage your cough and support recovery:

• Hydration and Humidification: Keeping your airway moist is crucial. Regular hydration, drinking warm beverages like honey and lemon mixtures, and using humidifiers are some of the best ways to soothe irritated airways and help reduce the cough reflex.
• Chest Physiotherapy Techniques: Techniques such as deep breathing exercises, chest percussion, and the huff coughing method might potentially help clear mucus from the lungs. Elevating your head while sleeping could also prevent those uncontrollable coughing episodes at night.
• Avoid Irritants: Steer clear of tobacco smoke, dusty or smoky environments, and strong odours like perfumes and scented candles, which can trigger coughing.
• Medications and Supplements: Prescribed medication for COVID symptoms or over-the-counter cough suppressants and lozenges might be able to provide some form of temporary relief.
• Lifestyle Adjustments: Maintaining a healthy lifestyle through balanced nutrition and regular physical activity supports immune function and overall health.

Does Long COVID Cough Increase the Risk of Lung Cancer?

The relationship between Long COVID and lung cancer is an area of ongoing research and concern.

The extensive lung damage and scarring caused by severe COVID-19 infections can lead to chronic inflammation—a condition known to potentially escalate cancer risks.

However, establishing a direct link between Long COVID and an increased likelihood of lung cancer remains speculative at this stage. This is because while chronic inflammation can indeed cause DNA damage and cellular transformations, which are precursors to cancer, more data is needed to understand the long-term effects.

Furthermore, the medical community is vigilantly monitoring patients with Long COVID for any long-term consequences, including potential connections to cancer, given the virus's impact on lung tissue and the overall immune response. While the concern is legitimate, drawing definitive conclusions about Long COVID as a direct precursor to lung cancer requires further in-depth studies, particularly considering the varying degrees of the disease's severity and individual genetic predispositions.

Although specific case studies correlating post-COVID cough turning out to be lung cancer are rare, there have been instances raising concerns. For example, a patient in the United States presenting symptoms typical of COVID-19 pneumonia, despite never testing positive for the virus, was later diagnosed with lung cancer. In Singapore, a similar case involved a non-smoker who initially attributed her persistent dry cough and fatigue to a benign cause, only to learn she had advanced-stage lung cancer. These cases highlight the critical need for comprehensive diagnostic evaluations when persistent respiratory symptoms are present.

Signs And Symptoms of Lung Cancer

Although a prolonged cough may be a cause for concern, those suffering from a post-COVID cough do not need to be alarmed. Instead, they should focus on their recovery and check if they have other lung cancer symptoms, such as:

• persistent coughing that deteriorates or fails to subside
• chest discomfort
• difficulty breathing
• wheezing
• hemoptysis, or coughing up blood
• consistent fatigue
• unintended weight loss

However, it is crucial to consult with a lung cancer specialist in Singapore, such as OncoCare, if more than one of these symptoms are experienced. This is especially for individuals with a history of smoking or exposure to lung cancer risk factors such as frequent exposure to secondhand smoke, radon as well as asbestos, residing near an area with bad air pollution, or a family history of lung cancer. Early detection and treatment can significantly improve the prognosis and quality of life for individuals diagnosed with lung cancer.

Get The Help You Need From OncoCare

Dealing with symptoms of lung cancer can be an overwhelming experience, and looking for medical professionals well-versed in specialised care and treatments such as lung carcinoma treatment is crucial in your journey towards better health. This is where OncoCare comes in - our compassionate team of lung cancer specialists and doctors in Singapore are here to support you every step of the way.

We understand how stressful it can be to face an uncertain situation like this, which is why we are committed to providing personalised care that is tailored to meet your specific needs. Get expert guidance and support by scheduling an appointment today.

Your health and well-being are our top priority, and we are here to offer the support and guidance you need to overcome this challenge.

“Expert knowledge means better care for cancer”

Written by:
Dr Tan Chee Seng
MBBS (Singapore)
MRCP (United Kingdom)

References

Fernández-de-las-Peñas, C., Palacios-Ceña, D., Gómez-Mayordomo, V., Florencio, L. L., Cuadrado, M. L., Plaza-Manzano, G., & Navarro-Santana, M. (2021). Prevalence of post-covid-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. European Journal of Internal Medicine, 92, 55–70. doi:10.1016/j.ejim.2021.06.009

Yates,N. (2023). Retrieved from https://theconversation.com/still-coughing-after-covid-heres-why-it-happens-and-what-to-do-about-it-179471

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