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Confronting COVID-19-associated cough and the post-COVID syndrome: role of viral neurotropism, neuroinflammation, and neuroimmune responses

Research output: Contribution to journalReview articlepeer-review

Woo Jung Song, Christopher K.M. Hui, James H. Hull, Surinder S. Birring, Lorcan McGarvey, Stuart B. Mazzone, Kian Fan Chung

Original languageEnglish
Pages (from-to)533-544
Number of pages12
JournalThe lancet. Respiratory medicine
Volume9
Issue number5
DOIs
Published1 May 2021

Bibliographical note

Publisher Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved. Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine

King's Authors

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.

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