Ahtheemathurra Ballasingam : 0009-0006-0006-7768

Farida Islahudin : 0000-0002-4450-4361

Siti Azdiah Abdul Aziz : 0000-0003-0846-3598

Mohd Makmor-Bakry : 0000-0002-0592-0645


Background: Post-acute COVID-19 is known to affect multiple organs. It is essential to determine factors that affect post-acute COVID-19 syndrome and medications needed by patients for optimized care.

Methods: A prospective cohort study was conducted among patients recruited by stratified sampling from two COVID-19 hospitals in Malaysia. Patients were followed up for 6 months using a standard questionnaire to identify demographics, symptoms, medications taken, and factors associated with post-acute COVID-19 syndrome.

Results: A total of 388 were successfully followed up. The most frequently reported symptom was respiratory symptoms (N = 168, 43.30%), of which cough (N = 134, 34.54%) was the most common. After 12 weeks of follow-up, respiratory syndrome (N = 56,14.43%) was frequently reported, of which cough (N = 41, 10.57%) was the most common. For respiratory syndrome, patients were commonly managed with diphenhydramine cough suppressants (N = 6, 1.55%, month 4) and metered dose inhaler (MDI) salbutamol (N = 7, 1.8%, month 4). The risk factors for post-acute COVID-19 syndrome were increased by 1.02 times (95% CI: 1.01, 1.04) with each advanced year of age and 2.87 times (95%CI: 1.51–5.48) in the presence of co-morbidities.

Conclusions: Post-acute COVID-19 causes multiorgan involvement, and symptoms may remain for months, with patients taking various medications. Patients with risk factors should be monitored closely for post-acute COVID-19 symptoms.


  1. Jayaraj VJ, Ng CW, Bulgiba A, Appannan MR, Rampal S. Estimating the infection burden of COVID-19 in Malaysia. PLoS Neglect Trop D. 2022;16:e0010887.
  2. Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, et al. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19. Cochrane Db Syst Rev. 2022;5:CD013665.
  3. Cascella M, Del Gaudio A, Vittori A, Bimonte S, Del Prete P, Forte CA, et al. COVID-pain: Acute and late-onset painful clinical manifestations in COVID-19 - molecular mechanisms and research perspectives. J Pain Res. 2021;14:2403–12.
  4. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26:1017–32.
  5. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601–15.
  6. Müller SA, Isaaka L, Mumm R, Scheidt-Nave C, Heldt K, Schuster A, et al. Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: A systematic review. Lancet Glob Health. 2023;11:e1713–24.
  7. Greer N, Bart B, Billington CJ, Diem SJ, Ensrud KE, Kaka A, et al. COVID-19 postacute care major organ damage: A systematic review. BMJ Open. 2022;12:e061245.
  8. Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026.
  9. Kim Y, Bitna-Ha, Kim SW, Chang HH, Kwon KT, Bae S, et al. Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea. BMC Infect Dis. 2022;22:93.
  10. Tsampasian V, Elghazaly H, Chattopadhyay R, Debski M, Naing TKP, Garg P, et al. Risk factors associated with post-COVID-19 condition: A systematic review and meta-analysis. JAMA Intern Med. 2023;183:566–80.
  11. Nanjundeswaraswamy TS, Divakar S. Determination of sample size and sampling methods in applied research. Proc Eng Sci. 2021;3:25–32.
  12. Chang HH, Chiang JH, Wang CS, Chiu PF, Abdel-Kader K, Chen H, et al. Predicting mortality using machine learning algorithms in patients who require renal replacement therapy in the critical care unit. J Clin Med. 2022;11:5289.
  13. Yang S, Berdine G. The receiver operating characteristic (ROC) curve. Southwest Respir Crit Care Chron. 2017;5:34–6.
  14. Wang L, Foer D, Zhang Y, Karlson EW, Bates DW, Zhou L. Post-acute COVID-19 respiratory symptoms in patients with asthma: An electronic health records-based study. J Aller Cl Imm-Pract. 2023;11:825–35.e3.
  15. Wu Q, Ailshire J, Crimmins E. Long COVID and symptom trajectory in a representative sample of Americans. Res Sq [Preprint]. 2022:rs.3.rs-1440503.
  16. Khodeir MM, Shabana HA, Rasheed Z, Alkhamiss AS, Khodeir M, Alkhowailed MS, et al. COVID-19: Post-recovery long-term symptoms among patients in Saudi Arabia. PLoS One. 2021;16:e0260259.
  17. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: Major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21:133–46.
  18. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Db Syst Rev. 2014;2014:CD001831.
  19. Laccourreye O, Werner A, Giroud JP, Couloigner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolary. 2015;132:31–4.
  20. Mansell V, Hall Dykgraaf S, Kidd M, Goodyear-Smith F. Long COVID and older people. Lancet Healthy Longev. 2022;3:e849–54.
  21. Guaraldi G, Milic J, Cesari M, Leibovici L, Mandreoli F, Missier P, et al. The interplay of post-acute COVID-19 syndrome and aging: A biological, clinical and public health approach. Ageing Res Rev. 2022;81:101686.
  22. Hussien H, Nastasa A, Apetrii M, Nistor I, Petrovic M, Covic A. Different aspects of frailty and COVID-19: Points to consider in the current pandemic and future ones. BMC Geriatr. 2021;21:389.
  23. Shanbehzadeh S, Zanjari N, Yassin M, Yassin Z, Tavahomi M. Association between long COVID, functional activity, and health-related quality of life in older adults. BMC Geriatr. 2023;23:40.
  24. Notarte KI, de Oliveira MHS, Peligro PJ, Velasco JV, Macaranas I, Ver AT, et al. Age, Sex and previous comorbidities as risk factors not associated with SARS-CoV-2 infection for long COVID-19: A systematic review and meta-analysis. J Clin Med. 2022;11:7314.
  25. Galal I, Hussein AARM, Amin MT, Saad MM, Zayan HEE, Abdelsayed MZ, et al. Determinants of persistent post-COVID-19 symptoms: Value of a novel COVID-19 symptom score. Egypt J Bronchol. 2021;15:10.
  26. Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med. 2023;29:334–43.
  27. Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis. J Med Virol. 2022;94:253–62.
  28. Tleyjeh IM, Saddik B, AlSwaidan N, AlAnazi A, Ramakrishnan RK, Alhazmi D, et al. Prevalence and predictors of Post-Acute COVID-19 Syndrome (PACS) after hospital discharge: A cohort study with 4 months median follow-up. PLoS One. 2021;16:e0260568.

Creative Commons License

Creative Commons Attribution-Share Alike 3.0 License
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.