People typically fall into three categories when it comes to COVID-related cough. In one group, people cough hard and often deal with bronchitis and pneumonia before recovering from acute infection. 

Weeks or months after recovery, a second group is still dealing with a lingering, semi-productive cough as the body clears away mucus and debris left by the illness, but they otherwise feel better. Their cough still has a purpose as the body works to resolve remaining inflammation. 

In a third group, the illness has completely resolved, and the lungs are clear, yet there is persistent, non-productive (dry) coughing. For these people, coughing isn’t solving the problem of clearing debris; rather, coughing is the problem as it interferes with daily life.

*Dr. Robert W. Bastian of the Bastian Voice Institute discusses the three categories of coughing in the context of COVID-19 and post-COVID syndrome, specifically sensory neuropathic cough. 

Why Do Patients Cough for No Apparent Reason?

For this last group of people, lingering cough following COVID-19 could be from damaged, irritated sensory nerve endings in the pharynx, larynx, and trachea of the throat, caused by weeks and months of coughing during post-COVID recovery. These people may have what’s called sensory neuropathic cough (SNC).

About Sensory Neuropathic Cough (SNC)

People with SNC typically experience the following: 

• A sudden tickle, dry patch, or other sensory disturbance that triggers coughing (usually at the base of the neck, or sternal notch). 
• Besides spontaneous coughing, other factors like talking, cold air, and swallowing cause sensory disturbance and coughing.
• Coughing is often frequent, though usually short in duration and mild in intensity, but episodes can also be extensive (a minute or longer) and violent.
• The cough is dry and non-productive, with mucus only later appearing after long periods of coughing.
• No relief from allergy, acid reflux, or asthma medications. 

Steroids and narcotic-containing cough suppressants may provide some immediate relief but are not an effective long-term solution.

What’s the Best Approach to SNC?

The best approach to SNC is targeting the irritated nerve endings with medications, such as amitriptyline and gabapentin (one of these two is usually effective). Sometimes, a combined long-lasting local anesthetic and local steroid may be injected into the sensitized area.

If a person is still early in COVID-19 recovery with a productive (wet) cough, a normal course of treatment is advised: hydration, cough suppressants, etc. If weeks have passed and the only obstacle to full recovery and restored quality of life is a dry, non-purposeful cough, SNC may need to be considered. 

*Bastian, R. (2021, March 3). Still Coughing After COVID? | Sensory Neuropathic Cough (SNC) [Video file]. Retrieved from https://www.youtube.com/watch?v=MWxbFiiQPi0

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.