Hello everyone, I am Dr. Li.
I have received a lot of messages in the background in the past few days, and everyone has focused on one question: after a few days of being positive, or a few days after turning negative, if you are still coughing or coughing violently, could it be pneumonia ? Do you want to do CT? Will it be fatal?
I can see that everyone is very nervous. It is normal for people to be nervous about unknown things, and it doesn't matter. For this reason, I will also give you some explanations based on my shallow experience and theoretical knowledge. I hope it will be helpful.
. Why do I cough when I have Yang?
This is the first question.
The latest guideline - "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia" (Trial Ninth Edition, released in March 2022) tells us that after infection with the new coronavirus, the main clinical manifestations are fever, dry cough, and fatigue. Some patients may suffer from nasal congestion, runny nose, sore throat, decreased or lost sense of smell, conjunctivitis , myalgia and diarrhea, etc. Severe patients often develop dyspnea and/or hypoxemia one week after the onset of symptoms.
The above paragraph is not many words, but it basically outlines the clinical characteristics of new coronavirus infection.
Have you seen that as long as you are infected with the new coronavirus, the main clinical manifestations are fever, dry cough, and fatigue. Regardless of whether you have mild or normal symptoms, you may have fever, dry cough, and fatigue.
This is easy to understand. The virus is raging in the upper respiratory tract. Whether it is in the throat, trachea, or lungs, as long as it causes inflammation, fluid will leak out. These things irritate the throat, trachea, and lungs, which will cause coughing, and it is mainly dry cough without much phlegm.
Therefore, after being infected with the new coronavirus, except for asymptomatic infections, will not have a cough (otherwise they would not be called asymptomatic infections), both mild and ordinary types will have coughs. The difference is that the mild type is a cough caused by inflammation spreading to the throat (and possibly the trachea), and the ordinary type has pneumonia, so of course they will also cough.
. Is cough an indicator of the severity of the disease?
is not.
Why does the patient cough? The physiological and pathological mechanisms are somewhat complicated, so I will try to explain them as simply as possible. It can be said that whenever the sensory areas such as ears, nose, pharynx, larynx, bronchi, and pleura are irritated, or the entire respiratory mucosa from the nasopharynx to the small bronchi is irritated, it may cause coughing. Coughing and coughing up phlegm is a morbid phenomenon, but it is also a self-protection phenomenon.
After infection with the new coronavirus, there will be five manifestations: asymptomatic, mild, common, severe, and critical.
Asymptomatic, of course there will be no cough, otherwise it cannot be called asymptomatic.
Mild type refers to symptoms such as fever, cough, fatigue, sore throat, etc., but the inflammation has not spread to the lungs and is only active in the upper respiratory tract (including the nose and throat). At this time, no pneumonia can be seen on chest CT. Mild disease, as the name suggests, has relatively mild symptoms, does not invade the lungs, and is even less likely to be life-threatening.
The common type refers to fever, respiratory symptoms, etc. It is similar to the mild symptoms. The key difference is that the common type has spread to the lungs and has pneumonia. The symptoms of pneumonia can be seen on a chest X-ray or CT scan. Clinicians may hear wet rales when auscultating the patient's lungs (meaning there is inflammatory leakage in the lungs).
COVID-19 , COVID-19 refers to pneumonia. Can it be called COVID-19 without pneumonia? Therefore, only when you have pneumonia can it be called ordinary type, and it deserves its name.This was even more true at the beginning of 2020, but by the end of 2022, the vast majority of people infected with the new coronavirus were asymptomatic and mild, and there were fewer common types. Therefore, people infected with the new coronavirus can no longer be called new coronavirus pneumonia, and should be more appropriately called people infected with the new coronavirus.
Can we distinguish between mild and common types based on whether the patient has a cough? Of course
will not work.
Because both forms of infection may cause coughing, if you don't arrange a chest X-ray or CT examination for the patient, you won't know who has the mild type and who has the normal type. Even if the clinician auscultates both lungs for you, he may not be able to make a reliable conclusion. But subjectively, we can still have some ways to distinguish: if there is pneumonia, in most cases there will be more obvious cough and sputum, and the fever may be prolonged, and there may even be symptoms such as chest pain. Especially if it is combined with shortness of breath and chest tightness, it is more likely to be pneumonia (common type). However, when such obvious clinical manifestations (cough and phlegm, chest tightness and shortness of breath) appear, it may no longer be the common type, but severe type.
Generally speaking, mild cases and ordinary cases cannot be distinguished based on the presence or absence of cough. Since current survey data shows that the vast majority of coughs are asymptomatic and mild, when you have a cough, it is mostly mild, not ordinary.
. The sore throat is gone and the fever is gone, but the cough is getting worse. Why?
This problem is very common.
This problem is not unique to the COVID-19 epidemic. It was very common in clinical practice before this. For example, if you have a cold, flu, or acute bronchitis , you will have symptoms such as fever, cough, sputum production, fatigue, etc. After taking the medicine, you have almost recovered. You have no fever, no muscle pain, and you are energetic, but the cough continues or even gets worse. Why is this?
This is called cough after infection.
When the acute phase symptoms of a cold (caused by rhinovirus , etc.) disappear, the cough still lingers, which is clinically called post-cold cough. Later, it was discovered that in addition to colds, other respiratory infections such as Mycoplasma pneumoniae, Chlamydia pneumoniae, etc. (including of course this new coronavirus infection) may also cause such coughs, so it is now collectively referred to as post-infection cough, and is no longer limited to coughing after a cold.
Why do people cough after infection? The reason is not very clear. It is currently believed to be a combination of factors, such as pathogen infection that may have damaged the airway mucosa, airway inflammation, airway hyperresponsiveness, increased cough sensitivity, etc.
For patients who cough after infection, there is no abnormality in chest X-ray or chest CT, because it is not pneumonia, and the cough is not due to inflammation of the lungs, but because of the above reasons. Most patients have an irritating dry cough (coughing can easily be caused by talking or eating) or a small amount of white sticky sputum, which can last for 3-8 weeks or even longer. But in general, this is self-limiting and , and it will get better on its own sooner or later.
The key is that we must know for sure that our cough is a post-infectious cough and not due to other causes. Nowadays, many people have coughs after becoming impotent. After ten or eight days, they are almost healed, but the cough is still very obvious, and it is just a cough. There is no chest tightness, shortness of breath, difficulty breathing, etc., and there are no abnormalities after a chest CT. Then this is the so-called cough after infection. Of course, it cannot be ruled out that a very small number of people have coughs caused by other diseases, such as cough variant asthma.
How to treat cough after infection? There is no magic cure. The key is to use cough medicine, antibiotics are usually not needed.For cough suppressants, you can choose first-generation antihistamines, such as chlorpheniramine , ketotifen (these drugs are not considered cough suppressants, but they can indeed relieve cough in some cases, and the principle is to reduce exudation stimulation), or other cough suppressants. If the cough suppressants are not effective, you can try oral hormones such as prednisone in the short term, but they need to be used under the guidance of a doctor.
In general, coughing after infection is very common and is a self-limiting disease, so don’t worry.
4. The cough is very severe and has lasted for a long time. I am afraid that it will become severe. What should I do?
has a solution.
First of all, I want to comfort you. If it is just a cough without obvious chest tightness, shortness of breath, shortness of breath, difficulty breathing, etc., and no other symptoms of hypoxia, and even if you have an oximeter at home and the blood oxygen saturation is normal (more than 95%), then don't worry, it is just a cough, and it is not pneumonia, let alone severe pneumonia.
As we said above, both mild and ordinary types will have coughs. Of course, severe cases will also have coughs. However, most severe cases will have difficulty breathing and shortness of breath within 1 week after the onset of the disease. If you do not have shortness of breath (respiratory rate ≥ 30 times/min) and the self-tested blood oxygen saturation at home is >95%, there is really no need to worry.
Your cough is probably a post-infection cough, not a cough caused by pneumonia, let alone severe pneumonia.
If you are worried, then go to the hospital for a chest X-ray or CT. If the CT does not show any changes in pneumonia, then you can put your heart back in your stomach. But with the current situation, it may not be easy to go to the hospital for a CT. If you are a young person, or under 60 years old, and have no obvious underlying diseases (such as cardiovascular and cerebrovascular diseases, liver and kidney insufficiency, chronic lung disease, etc.), basically all infections with the new coronavirus will be asymptomatic or mild, a few will be common, and a few will be severe. Judging from the probability, your chance of getting severe pneumonia is harder than winning the jackpot.
In addition, if you observe your own condition, you don’t have chest tightness or shortness of breath, you don’t have difficulty breathing, you don’t feel breathless when walking up the stairs, and you can wash pots and toilets with just a few moves, it means that your cardiopulmonary function is very good, and don’t be afraid of coughing.
Having said that, it is really scary. In order to have a peaceful sleep, you have to do a CT scan, or buy an oximeter and keep an eye on it.
For the elderly and those with underlying diseases, if you just have a cough, don’t worry too much. Cough is not an indicator of the severity of the disease, but chest tightness, shortness of breath, shortness of breath, and difficulty breathing are.
5. Is it necessary to buy an oximeter?
certainly not.
Young people (the guideline considers those under 60 years old) without underlying diseases generally have asymptomatic and mild symptoms after infection. Mild symptoms include fever, chills, sore throat, fatigue, muscle aches, cough, sputum, etc. The severity varies from person to person. Anyway, it will not affect the lungs, and there will be no chest tightness, shortness of breath, difficulty breathing, etc.
The severe diagnostic criteria are as follows:
Did you see that, in addition to shortness of breath, severe cases also have reduced blood oxygen saturation, ≤93% (normal people >95%). Because of this, many people will stare at their oximeter to see if the blood oxygen saturation will drop below 93%. In fact, it is not necessary. Generally speaking, if the blood oxygen saturation drops below 93%, you will have chest tightness, shortness of breath, difficulty breathing and other symptoms of hypoxia, but you will not feel anything at all.
Although there is publicity on the Internet about silent pneumonia, which means that there are no symptoms all the time, and suddenly it stops working, I don’t know where this statement comes from. I have not checked the source, and I don’t know how many such patients are infected with the new coronavirus. But judging from the usual pneumonia, the so-called “silent pneumonia” is very rare. Even if there is, it is some patients with obvious underlying diseases, especially the elderly who are bedridden, because they may not be sensitive to symptoms, so we must be especially vigilant about blood oxygen saturation. If there is such a serious pneumonia, it is impossible for the patient to have no symptoms. Even if there is no obvious cough or sputum, there will be fever. Even if there is no fever, there will be poor mental state, fatigue, loss of appetite, etc. However, these symptoms are not specific and ordinary people cannot connect them with pneumonia.
For ordinary people, people who can walk and have normal social functions, there will be no so-called "silent pneumonia". Patients who are bedridden for a long time, especially the elderly, may not notice obvious cough and phlegm, and may not complain of chest tightness, but they will definitely show signs of worsening mental state, reluctance to talk, and loss of appetite.
Of course, no matter what, if there are elderly people at home, especially those with underlying diseases, or simply those who are bedridden for a long time and need care, of course they need an oximeter, which will give them a lot of peace of mind, and at least one more observation window. The premise is to buy one with acceptable quality, and don't buy those that whine and whistle, with values that fluctuate high and low, which can easily scare people to death.
6. What are the cough medicines?
This is something that everyone is very concerned about.
The most effective cough suppressants should be morphine drugs, such as morphine, codeine, dioxycodeine, hydroxydiprol, etc. However, these drugs are now under control and are prone to problems, so they are no longer sold. These drugs act directly on the antitussive center and are addictive. They are the most effective and have the greatest side effects.
Since those addictive cough medicines are no longer available for sale, we are currently settling for the next best thing. For example, non-addictive central antitussives include , dextromethorphan, , and pentovirin.
Dextromethorphan is currently the most widely used non-addictive antitussive drug. Its antitussive strength is similar to that of codeine. It has no analgesic and hypnotic effects when used at normal dosage levels. It has no inhibitory effect on the central nervous system and does not produce addiction. It can also have a central anesthetic effect when used in large doses, so be careful.
Pentovirin is also effective.
Although dextromethorphan and pentovirine can effectively treat chronic cough, they are only about 50% effective. Moreover, for coughs caused by acute bronchitis and upper respiratory tract infection , the effect of these two drugs is numb (so-so).
For post-infectious cough, as we mentioned above, the first-generation antihistamines are preferred, such as chlorpheniramine, ketotifen, etc. You can try it. Drinking more water is also important. In addition, appropriate use of some anti-inflammatory drugs, such as montelukast sodium, may also be effective.
Traditional Chinese medicine can also relieve cough, but I am not good at it. I will not analyze it here. You can use it as appropriate.
I hope this article can give you some help.
finished.
