Post Covid Cough with Phlegm: Causes, Complications, and Management

Medically reviewed: 3, January 2024

Post Covid Cough with Phlegm: Introduction

Post COVID cough with phlegm is a symptom that occurs very often among those who did have coronavirus in the past. The COVID-19 pandemic, which originated in 2019, has had a profound impact on the global population, affecting countless individuals across the globe. It has unleashed a multitude of respiratory symptoms, including but not limited to fever, coughing, difficulty breathing, and a loss of taste or smell. While the majority of those infected with the virus typically recover within a matter of weeks, there are cases in which individuals continue to experience lingering or recurring symptoms long after the virus has been eradicated from their system.

One of the most common and bothersome symptoms is a cough with phlegm, commonly known by doctors as a productive or wet cough.

A cough with phlegm is a natural response of the lungs and airways to clear the excess mucus and debris that may accumulate due to the infection or inflammation caused by COVID-19.

On the other hand, it is crucial to note that a cough accompanied by phlegm could potentially signify a more severe underlying issue, including but not limited to a secondary bacterial infection, an injury to the lungs, or a chronic respiratory disease. It is therefore imperative to gain a comprehensive understanding of the various causes, potential complications, and effective management approaches for a post-COVID cough accompanied by phlegm.

Furthermore, individuals experiencing such symptoms should not hesitate to seek prompt medical attention if the cough persists or demonstrates any signs of deterioration over an extended period.

Causes of Post Covid Cough with Phlegm

There are several possible causes of a post covid cough with phlegm, depending on the stage and also severity of the coronavirus infection, the individual’s immune system, and the presence of other medical conditions. Some of the common causes are:

COVID-19 infection

The SARS-CoV-2 virus, which causes COVID-19, can infect the cells that line the respiratory tract, from the nose and throat to the lungs. This can trigger an immune response that produces inflammation, mucus, and cytokines, which are chemical messengers that regulate the immune system. The mucus and cytokines can help fight the virus, but they can also cause irritation and damage to the respiratory tissues, leading to a cough with phlegm.

The cough accompanied by the presence of phlegm has the potential to persist for a significant duration, ranging from several weeks to even a few months following the initial infection, as the lungs and airways heal and recover from the viral assault.

Secondary bacterial infection after coronavirus

Sometimes, a viral infection like COVID-19 can weaken the immune system and make the respiratory tract more susceptible to a bacterial infection. This can cause a superimposed pneumonia, which is an infection of the lung tissue, or a bronchitis, which is an infection of the bronchial tubes. A bacterial infection can cause more inflammation and mucus production, as well as pus, blood, or green or yellow phlegm, which indicate a bacterial infection. A bacterial infection can also cause fever, chills, chest pain, or shortness of breath, and may require antibiotics to treat.

Lung injury after covid

COVID-19 can cause a severe lung injury, especially in people who have a severe infection, underlying lung diseases, or require mechanical ventilation. A lung injury can cause scarring or fibrosis of the lung tissue, which reduces the lung capacity and function. A lung injury can also cause bronchiectasis, which is a permanent dilation of the bronchial tubes, or bronchiolitis obliterans, which is a narrowing of the small airways.

Chronic inflammation and excessive mucus production can be triggered by these various conditions. These conditions have the potential to result in ongoing inflammation and the continuous production of mucus, as well as recurrent infections, leading to a cough with phlegm. A lung injury can also cause dyspnea, which is difficulty breathing, or hypoxemia, which is low oxygen levels in the blood, and may require oxygen therapy or lung transplantation to treat.

Chronic lung disease

COVID-19 can exacerbate or trigger a chronic lung disease refers to long-term respiratory conditions, including but not limited to asthma and chronic obstructive pulmonary disease (COPD), or interstitial lung disease. These diseases can cause chronic inflammation and mucus production, as well as airflow obstruction, which can impair the lung function and cause a cough with phlegm. These diseases can also cause wheezing, which is a whistling sound when breathing, or crackles, which are bubbling sounds in the lungs, and may require inhalers, steroids, or other medications to treat.

Complications of Post Covid Cough with Phlegm

A post covid cough with phlegm can cause various complications, both physical and psychological, that can affect the quality of life and well-being of the individual. Some of the common complications are:

Respiratory failure

A post covid cough with phlegm can show a severe lung damage or infection, which can compromise the gas exchange and oxygen delivery to the body. This can cause respiratory failure, which is a life-threatening condition that requires immediate medical attention. Respiratory failure can cause cyanosis, which is a bluish discoloration of the skin or lips, or altered mental status, which is a change in the level of consciousness or alertness, and may require mechanical ventilation or extracorporeal membrane oxygenation (ECMO) to support the breathing.

Pulmonary embolism

A post covid cough with phlegm can indicate a hypercoagulable state, which is an increased tendency of the blood to clot. This can cause a pulmonary embolism, which is a blockage of a blood vessel in the lungs by a blood clot.
This particular condition has the capability to diminish the circulation of blood and the provision of oxygen to the respiratory system, consequently leading to discomfort in the chest and a sensation of being unable to breathe adequately, or hemoptysis, which is coughing up blood. A pulmonary embolism can be fatal if not treated promptly, and may require anticoagulants, thrombolytics, or surgery to remove the clot.

Cardiac complications

A post covid cough with phlegm can indicate a cardiac involvement, which is a damage or dysfunction of the heart due to COVID-19. This can cause various cardiac complications, such as myocarditis, which is an inflammation of the heart muscle, pericarditis, which is an inflammation of the sac around the heart, or arrhythmias, which are abnormal heart rhythms. These complications can cause chest pain, palpitations, or syncope, which is fainting, and may require medications, devices, or surgery to treat.

Psychological distress

A post covid cough with phlegm can cause psychological distress, examples of mental health conditions include anxiety, depression, and PTSD. This can be due to the fear of the infection, the stigma of the cough, the isolation from the society, or the uncertainty of the recovery. Psychological distress can affect the mood, sleep, appetite, or concentration, and may require counseling, psychotherapy, or antidepressants to treat.

Management of Post Covid Cough with Phlegm

The management of a post covid cough with phlegm depends on the cause, severity, and duration of the cough, as well as the individual’s preferences and goals. The management may include:

Medications against wet cough

There are various medications that can help relieve a post covid cough with phlegm, such as:

• Expectorants, such as guaifenesin, which can thin and loosen the phlegm, and then make it easier for the patient to cough up
• Mucolytics, such as acetylcysteine, which can break down the mucus, and make it less sticky and viscous
• Bronchodilators, such as albuterol, which can relax the muscles around the airways, and improve the airflow and breathing
• Anti-inflammatories, such as ibuprofen, which can significantly reduce the inflammation and sensation of pain in the lungs and airways
• Antibiotics, such as azithromycin, which can treat a bacterial infection, and prevent or treat a secondary pneumonia
• Antivirals, such as remdesivir, which can inhibit the replication of the SARS-CoV-2 virus, and reduce the viral load and severity of the infection
• Anticoagulants, such as heparin, which can prevent or treat a blood clot, and reduce the risk of a pulmonary embolism
• Antidepressants, such as fluoxetine, which can treat a psychological distress, and improve the mood and well-being

Home remedies for post covid cough with phlegm

There are various home remedies that can help soothe a post covid cough with phlegm, such as:

• Hydration, which can keep the body and the respiratory tract moist, and prevent the mucus from becoming thick and dry
• Steam inhalation, which can humidify the airways, and loosen the mucus and phlegm
• Honey, which can coat the throat, and reduce the irritation and inflammation caused by the cough
• Ginger, which can act as a natural expectorant, and stimulate the mucus secretion and clearance
• Turmeric, which can act as a natural anti-inflammatory, and reduce the swelling and pain in the lungs and airways
• Salt water gargle, which can cleanse the throat, and remove the mucus and bacteria

Exercises for post covid wet cough with phlegm

There are exercises that can help improve a post covid cough with phlegm, such as:

• Different types of breathing exercises, including pursed-lip and diaphragmatic breathing, and incentive spirometry, which have been proven to enhance the strength of the muscles involved in respiration. Additionally, these exercises have been found to have a positive impact on lung function and capacity, leading to improved overall respiratory health.
• Coughing exercises, such as huffing, which can help expel the mucus and phlegm from the lungs and airways
• Chest physiotherapy, such as percussion, vibration, or postural drainage, which can help mobilize the mucus and phlegm from the lungs and airways
• Physical activity, such as walking, cycling, or swimming, which can enhance the blood circulation and oxygen delivery to the lungs and body, and improve the overall health and fitness

Also there is time to think about your lifestyle habits. There are various lifestyle modifications that can help prevent or reduce a post covid symptoms and restore the breathing function and capacity of lungs.