How long will prolonged cough, tiredness and shortness of breath last in long-COVID/post-COVID syndrome patients?

15 Nov 2022
Respiratory conditions
  • Cough
  • COVID-19
  • Long COVID
  • Post COVID
Type of resource
IPCRG COVID-19 and respiratory Q&A

What the research says:

When considering persistent symptoms following an acute COVID-19 illness it is important to rule our other causes before assigning them as part of a post-COVID syndrome. A differential diagnosis of prolonged cough should be undertaken to rule out other potential causes such as chronic cough, asthma or an underlying malignancy.

Data on the duration of specific symptoms in long-COVID/post-COVID syndrome are limited and may be related to the underlying aetiology. For example, symptoms associated with depression, changes in activity or fitness levels or underlying organ damage may be more prolonged than post-viral persistent symptoms. However, there are limited data on the associated of specific post-COVID symptoms and the underlying causation. Further research is needed in this area.

Cough, fatigue and shortness of breath are more prevalent and persistent among people who were hospitalised with acute COVID-19 illness. At 8 months follow up (Nguyen et al 2022; >1000 patients). Fatigue was reported in 61% of patients, shortness of breath with activity in 48% of patients, shortness of breath at rest in 7% of patients and cough in 2% of patients. At 12 months follow-up (Becker et al 2021; 90 patients) fatigue was reported in 46% and shortness of breath 21%.

For those patients who do not require hospitalisation, fatigue and shortness of breath may persist beyond 6 months for some while cough will likely have resolved by 6 months for most patients. Across 5 studies of mainly outpatients >6 months follow-up (Nguyen et al 2022; >2000 patients): Fatigue was reported in 25–34% of patients, shortness of breath in 13–22% of patients and cough in 2–13% of patients.

What this means for your clinical practice:

  • For patients with persistent symptoms following an acute COVID-19 illness, thoroughly assess individual symptoms and consider other potential causes and underlying diseases
  • After diagnostic testing rules our chronic cough or other disease, patients in the post-acute phase can be reassured that their cough will likely resolve first, and fatigue and shortness of breath will resolve in three-quarters of patients within six month after having acute COVID-19 illness
  • Be vigilant for symptoms persisting beyond 12 weeks from onset of the acute illness and consider appropriate assessment and/or referrals for persistent symptoms

For more information on the management of symptoms for those with long-COVID/post-COVID syndrome see our responses to these questions:

With grateful thanks to Janwillem Kocks MD, PhD (General Practitioner and Professor of Inhalation Medicine) for and on behalf of the IPCRG practice driven answers review group.

Useful links and supporting references:

Becker C, et al. Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study. Swiss Med Weekly 2021;151:w30091.

Nguyen NN, et al. Clinical patterns of somatic symptoms in patients suffering from post-acute long COVID: a systematic review. Eur J Clin Microbiol Infect Dis 2022;41:515–45.