Why respiratory viruses can cause persistent coughs

August 26, 2024

Coughs are common during every winter virus season. But this year it seems like more people than usual are complaining about a cough that just won’t go away.

Cathy Conger, 60, who works at a vintage furniture store in Washington, said she’s had a persistent cough for a month now after traveling over the holidays. She often wakes up coughing in the middle of the night. “I’m probably going to just keep the bowl of cough drops by my bed,” she said.

Adam Tampio, a 16-year-old who lives in Alexandria, Va., said he’s had “a really bad cough” since he caught a cold in the middle of December.

On social media — TikTok, Bluesky and Threads — people are also commiserating about their persistent coughs. Bryan Jun, 26, who lives in New York, complained about his lingering cough on TikTok last month, in a video that’s garnered more than 7 million views. “I’m coughing in Georgia,” wrote one viewer. “Everyone is coughing in New Jersey,” wrote another.

Cases of persistent cough aren’t tracked in any official way, so it’s impossible to know how this coughing season compares to past seasons. But some physicians say they are seeing more lingering cough than usual. Many of these patients have tested negative for the coronavirus, and the cough may be the aftermath of other circulating respiratory viruses.

Natasha Bhuyan, national medical director and physician at the primary care provider One Medical, said “many of our members” are reporting lingering coughs that they “just can’t shake.” (Washington Post owner Jeff Bezos is the founder of Amazon, which owns One Medical.)

“This winter, it felt like a lot of these circulating illnesses were all peaking at the same time,” she said. “Everywhere you turned somebody around you had a cold or had covid or the flu.”

Michael Stephen, a pulmonary physician at Penn Medicine in Philadelphia, said his practice “has basically been taken over” by patients who have persistent coughs.

“It’s basically hijacked my whole practice,” said Stephen, who’s also the author of “Breath Taking: The Power, Fragility and Future of Our Extraordinary Lungs.” Stephen said his patients have been coughing for one or two months at a time, which can strain chest muscles.

“It’s beating them up,” he said. “These people are coming in with baggy eyes, not sleeping and pulled muscles. By the time they get to me, they’re not doing well.”

More coughing or just more awareness?

It’s possible, say some physicians, that people are just more tuned into coughing since the pandemic. Before covid, people routinely went to work and social gatherings with coughs. Today, that’s frowned on.

Russell Buhr, a pulmonary and critical care medicine physician at UCLA Health in Los Angeles, said anywhere from 20 to 40 percent of adults who get a viral infection can develop a post-infection cough that persists for two to eight weeks.

“I’ve seen it more frequently in my practice than I did a few years ago,” Buhr said. But he thinks it’s because people have been “paying more attention” to their coughs, and other respiratory symptoms, since the start of the pandemic. “Everyone is a little hesitant to show up at work with anything that resembles any kind of illness,” Buhr said.

Ashwin Vasan, the commissioner of the New York City Department of Health and Mental Hygiene and a primary care physician, said health-care officials in New York are getting “a ton of questions from patients” about these lingering coughs, even though “post-viral coughs are actually very common.”

“We are aware of what’s getting posted,” Vasan said. “It’s not entirely surprising to doctors, like me, that there is this post-viral cough, because there’s always been post-viral cough.”

Charles A. Powell, system division chief of pulmonary, critical care and sleep medicine at the Icahn School of Medicine at Mount Sinai in New York, said it’s very likely “the incidence of these diseases is higher than it was pre-covid” and that’s why more patients have these lingering coughs.

“With the influenza, the covid and the rhinovirus, the common cold virus — all those things are coming around the same time for us,” Powell said. “It makes it very, very common.”

Why do some coughs linger?

A cough is a “protective reflex” intended to clear the lungs and keep the airway clear, said Peter Dicpinigaitis, director of the Montefiore Cough Center and editor in chief of the journal Lung. When someone has a lingering cough because of a viral infection, the reflex “isn’t serving any protective or beneficial purpose,” he said. “It just simply is a bothersome symptom for the patient,” Dicpinigaitis said.

A persistent cough after a respiratory virus is often a “sign of a lingering inflammatory response to that initial illness,” Buhr said. How long someone has the cough can depend on the virus. People who get RSV can “cough for weeks,” he said.

“You can kind of think about it almost like when you get a sunburn. Your skin is much more irritated and sensitive,” Buhr said. “This is a similar concept on the inside of your lungs, but it’s an injury related to the infection.”

Consult a doctor for coughs that last more than a few weeks. “It’s usually not something serious,” Buhr said. “But we also don’t want you to suffer through it unnecessarily.”

If you have a high fever, shortness of breath or trouble breathing, dizziness or confusion, or other signs that any symptoms are getting worse, Bhuyan said she recommends patients contact their doctor right away.

“The key one is if their symptoms are actually getting worse,” Bhuyan said. “At that point, they might be developing a pneumonia or a bacterial infection, or another kind of infection.”

And if a person has been coughing for more than eight weeks, “it becomes much more likely” that the cough isn’t just because of a viral infection and the “treatable underlying cause” needs to be diagnosed, said Dicpinigaitis. He said some of his patients have been persistently coughing for years. Those chronic coughs, coughs that last more than eight weeks, are often due to one of three conditions: asthma, acid reflux (known as gastroesophageal reflux disease or GERD) and postnasal drip syndrome, he said.

Has covid made us more susceptible to coughs?

Gina Lee, 42, who lives in Swarthmore, Pa., had recovered from a bout of covid in September and said she developed a cough at the end of December after visiting her sister in Baltimore. “We went to the aquarium and I was very stupid and forgot to bring a mask,” Lee said.

Lee said she wondered if her lingering cough, from which she just recently recovered, could be related to having covid in the fall. “Is it an uptick because of covid? Or is it just everyone’s more aware of it?” she said.

Doctors say it’s possible that a bad case of covid could affect how quickly a person bounces back from subsequent colds or other respiratory viruses. It takes longer for some patients to heal from a covid infection and, when someone’s recovering, it’s possible that other viruses will have an easier time infecting the airway, Stephen said.

“Covid has really changed things,” Stephen said. “The fact that it causes a pretty significant bronchitis, I think, in a lot of people, it’s changing the immunology of their lungs.”

Covid-19 has also been “a bit of an eye-opener,” said Ziyad Al-Aly, chief of research and development at the VA St. Louis Healthcare System and a clinical epidemiologist at Washington University in St. Louis.

“We have a newfound appreciation that viruses that we trivialized actually can have serious effects,” Al-Aly said, adding that the flu and RSV can both lead to a lingering cough. “I don’t think any of this is new. I think our awareness and our documentation of it is new.”

How can I soothe a persistent cough?

There’s “no magic bullet” to treating a lingering cough, said Powell. Hydration and hot beverages help and will probably provide the same relief as over-the-counter medications and cough syrups.

Dicpinigaitis said any “thick and sweet” syrup may suppress your cough by soothing the nerves in the back of your throat. Some patients may need other treatments that have a “direct impact on the cough itself” if the cough continues, Powell said.

“If drinking tea with honey makes you feel better, and it’s soothing, that’s great,” Powell said.

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