Song, Woo-Jung; Hui, Christopher K M; Hull, James H; Birring, Surinder S; McGarvey, Lorcan; Mazzone, Stuart B; Chung, Kian Fan
The Lancet. Respiratory medicine
2021May ; 9 ( 5 ) :533-544.
PMID : 33857435
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Song, Woo-Jung -
Hui, Christopher K M -
Hull, James H -
Birring, Surinder S -
McGarvey, Lorcan -
Mazzone, Stuart B -
Chung, Kian Fan -
ABSTRACT
Cough is one of the most common presenting symptoms of COVID-19, along with fever and loss of taste and smell. 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. 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. The post-COVID syndrome might also result from neuroinflammatory events in the brain. 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. 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. CI - Copyright ??2021 Elsevier Ltd. All rights reserved.
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