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. 2005 Aug 25:1:5.
doi: 10.1186/1745-9974-1-5.

Change in bronchial responsiveness and cough reflex sensitivity in patients with cough variant asthma: effect of inhaled corticosteroids

Masaki Fujimura  1 , Johsuke Hara, Shigeharu Myou
Affiliations

Change in bronchial responsiveness and cough reflex sensitivity in patients with cough variant asthma: effect of inhaled corticosteroids

Masaki Fujimura et al. Cough. .

Abstract

Background: Cough variant asthma (CVA) is a cause of chronic cough and a precursor of typical asthma. We retrospectively examined the longitudinal change in bronchial responsiveness and cough reflex sensitivity in CVA patients with respect to the effect of long-term inhaled corticosteroids (ICS).

Methods: Provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (PC20-FEV1) and provocative concentration of capsaicin eliciting 5 or more coughs (C5) were measured before treatment and during a follow up period following relief of cough (median; 2.0 (range; 0.5 to 8.0) years after the initial visit) in a total of 20 patients with CVA (7 males and 13 females, mean +/- SD age of 49.9 +/- 12.9 years).

Results: Three of 8 patients not taking long-term ICS developed typical asthma compared to none of 12 patients taking ICS (p = 0.0171). PC20-FEV1 significantly (p < 0.0001) increased from 1.80 (GSEM, 1.35) to 10.7 (GSEM, 1.63) mg/ml in patients taking ICS but did not change in patients not taking ICS [2.10 (GSEM, 1.47) compared to 2.13 (GSEM, 1.52) mg/ml]. Cough threshold did not change in patients whether taking or not taking ICS.

Conclusion: Long-term ICS reduces bronchial hyperresponsiveness in CVA as recognized in typical asthma. Cough reflex sensitivity is not involved in the mechanism of cough in CVA.

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Figures

Figure 1
Figure 1
Longitudinal change in bronchial responsiveness in 3 patients with cough variant asthma who developed typical asthma while did not taking inhaled corticosteroids. PC20-FEV1, provocative concentration of methacholine causing a 20% or greater fall in forced expiratory volume in 1 second (FEV1), was determined by a mouth tidal breathing method. Bronchial responsiveness was not obviously increased following onset of typical asthma. ICS, inhaled corticosteroids. Arrows indicate onset of typical asthma.
Figure 2
Figure 2
Longitudinal change in bronchial responsiveness in patients with cough variant asthma taking or not taking long-term inhaled corticosteroids. Closed triangles indicate patients developing typical asthma. ***p < 0.0001.
Figure 3
Figure 3
Longitudinal change in cough reflex sensitivity in patients with cough variant asthma taking or not taking long-term inhaled corticosteroids. Closed triangles indicate patients developing typical asthma.
Figure 4
Figure 4
Longitudinal change in forced expiratory volume in one second (FEV1) in patients with cough variant asthma taking or not taking long-term inhaled corticosteroids. Closed triangles indicate patients developing typical asthma.
Figure 5
Figure 5
Relationship between duration of illness before induction of inhaled corticosteroids and degree of improvement of bronchial hyperresponsiveness in patients with cough variant asthma taking long-term inhaled corticosteroids.
Figure 6
Figure 6
Relationship between duration of inhaled corticosteroid treatment and degree of improvement of bronchial hyperresponsiveness in patients with cough variant asthma taking long-term inhaled corticosteroids.
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