Cough control after COVID

A cough is an important reflex action which helps us to clear foreign particles and prevent them from reaching our lungs or to clear mucus from the lungs if there is an infection.

There are many conditions which can cause a cough, the most common causes include:

Post viral infection

Coughs can be caused by an infection which affects the upper airways or the lungs and usually lasts for around two to three weeks.

Acid reflux

Acid reflux can cause a persistent cough, voice changes, chest pain and breathlessness. This happens when acid rises from the stomach, up the oesophagus to the vocal cords. This then causes irritation and coughing.

Anxiety and mouth breathing

When we feel anxious, we often breathe fast and shallow breaths though the mouth instead of the nose. This can cause a dry mouth and throat and lead to irritation which can cause coughing. The more we cough, the more anxious we may feel, and this can result in an unhelpful cough cycle.

There is also a link with anxiety and acid reflux disease.

Asthma

In Asthma, the airways become inflamed (swollen), sensitive and narrowed by mucus. These changes can cause coughing. Often symptoms are worst during the night and in the morning on waking.

Sinus problems and post-nasal drip

Excess mucus from the nose or sinus’s drips down the back of the throat. This causes irritation and the desire to cough to clear the mucus.

Smoking

Inhaling the chemicals from smoking causes inflammation and other changes in the airways. This results in irritation causing coughing.

Certain situations can also trigger coughing

• Cold temperatures.
• Pollen and other allergies.
• Perfumes.
• Aerosols.
• Dust particles.
• Physical exercise.

Persistent dry coughs

A dry cough can occur after infection with COVID. This can be debilitating and when the cough is persistent it can cause problems with breathing and speaking.

It can become exhausting and leading to sore throats, voice changes, dizziness, headaches, chest, and rib pain. It can affect everyday life including eating, sleeping, working, and exercising.

Imagine having an insect bite and when you scratch it, it feels better. This relief is usually short lived, so you scratch more. The more you scratch, the more irritated the area becomes. This is what happens with a dry cough, the more you cough, the more inflamed and irritated the tissues in the throat become. This then causes more coughing.

Over time the cough can cause micro-abrasion in your lungs and throat, which can result in further inflammation. When the vocal cords become irritated this can lead to increased mucus, which in turn can make you cough more.

Coughing can quickly become a habit, so the best advice for a dry cough is don’t cough. The technique below is an effective way to help to break this bad habit.

Buteyko cough suppression technique

1. As soon as you cough, or feel you are about to cough, put your hand over your mouth. This stops you taking a big breath through your mouth.
2. Swallow once.
3. Take a small breath in and out through your nose.
4. Hold your breath for a few seconds.
5. When you start breathing again take very slow, smooth breaths for at least 30 seconds (keep your hand over your mouth).
6. Tell yourself that you are not going to cough.
7. Finally take a smooth, normal-sized breath through your nose and take your hand away from your mouth.
8. If you still feel a tickle in your throat, repeat the technique again.

At times if you really cannot avoid a cough, try a huff instead. Imagine you are standing in front of a mirror, and you want to mist the mirror with your breath. Open your mouth to an “O” shape and quickly huff the breath out to mist the mirror. A huff is much gentler for the throat than a cough

Other things to help a dry cough

• If you have acid reflux, try to avoid foods and drinks which commonly trigger symptoms, for example spicy foods, alcohol, and caffeine. Your clinician can also advise further lifestyle changes and may complete a reflux questionnaire with you to assess whether reflux disease is a likely cause for your symptoms. Further advice will be provided in this instance.
• If you are aware that you breathe through your mouth, try to maintain nose breathing. Your clinician can show you techniques to achieve better breathing control.
• If you take a Salbutamol inhaler, try taking two puffs just before the cough suppression technique.
• If you use a steroid inhaler, ensure you gargle with water and spit out after each use.
• Keep well hydrated with fluids and try drinking sips of cool fluids throughout the day.
• Try sucking boiled sweets or ice cubes to soothe your throat.
• Pace your speaking, speak as if you are reading from a book. Breathe through your nose and speak in short sentences, briefly pausing mid-sentence and add a longer pause at the end of each sentence.
• If anxiety is contributing to your cough, try to learn and adjust your triggers.
• Avoid any other triggers, for example perfumes, cleaning products, aerosols.
• Change aerosols to roll on or pour bottles.
• Wear a scarf over your nose and mouth when going out in cold weather.
• Try warm honey and lemon drinks, these can help to soother a sore irritated throat.
• Avoid laying too flat when sleeping.

Productive coughs

Our airways are lined with a sticky substance which is called mucus. This is normal and mucus plays a part in moistening the airways and filtering the air that we breathe in.

Sometimes after an infection with COVID, you may find that you are coughing up clear or white mucus (sputum). This doesn’t usually require antibiotics. It should settle over time and can be a natural response to the infection and inflammation in the airways.

Sometimes this sputum can be thick and difficult to clear. It is important to keep your chest as clear as possible to prevent the sputum from causing further irritation and increasing the risk of chest infections.

If you need support with clearing your chest there are techniques which can help and will be shown to you by your Physiotherapist. If you are experiencing recurrent chest infections with sputum production, this may require further investigation to rule out any other respiratory condition. Please speak to your physiotherapist for further advice in this instance.

Sputum clearance exercise

This is one technique which your Physiotherapist can teach to you.

1. Relaxed nose and tummy breathing for 30 seconds.
2. 3 to 4 long slow deeper breaths.
3. Huff (then a cough if needed to clear the sputum).
4. Relaxed nose and tummy breathing for 30 seconds.
5. 3 to 4 long slow deeper breaths.

Sputum clearance device

If your sputum is particularly persistent and troublesome, your physiotherapist may provide you with a sputum clearance device like the one shown on the diagram below

Sputum clearance device consisting of:

• mouthpiece where exhaled air enters
• circular cone
• high-density steel ball inside circular cone
• perforated protective cover at exit end

Medication

If other clearance techniques have not been effective, sometimes medication can be prescribed. There are medications which can help to thin secretions and make them easier to cough up to clear your chest. Your Physiotherapist would discuss these with you if indicated.

Other ways of keeping your chest healthy

• Have your annual flu vaccine.
• Have the one-off Pneumococcal vaccine.
• Keep well hydrated, this will help to loosen sputum and make it easier to cough up.
• Keep active, even if this is a short gentle walking programme or gentle Tai Chi type movement.
• Avoid smoking.
• Avoid people with cold or flu symptoms and ongoing infections.
• Avoid cough suppressant medications if you have sputum on your chest.

When to contact 111 or see your GP

Where symptoms are more persistent, sometimes further investigations may be required. The long COVID physiotherapist or your GP would discuss this with you.

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Document control

• Document reference: DP8895/06.23.
• Date reviewed: June 2023.

Page last reviewed: September 18, 2024
Next review due: September 18, 2025

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