The Spectrum of Non-asthmatic Airway Diseases Contributing to Cough in the Adult

Abstract

Purpose of review: Cough becomes a pathologic reflex when the airways are inflamed and overwhelmed with excessive mucus. The goal of this review is to discuss acute and chronic cough syndromes caused by non-asthmatic airway diseases.

Recent findings: Acute cough syndrome is short-lived and self-limited. Acute bronchitis and diffuse acute infectious bronchiolitis (DAIB) are examples. The former is usually caused by a viral illness; the latter by Mycoplasma pneumoniae, influenza, and Haemophilus influenzae. Causes of chronic cough in the adult include chronic bronchitis, non-infectious bronchiolitis, and non-cystic fibrosis bronchiectasis.

Summary: Supportive measures are recommended for acute bronchitis and antibiotic use is discouraged. Antibiotics may be needed for DAIB. Smoking cessation and bronchodilators can control cough in chronic bronchitis. Therapeutic approaches for non-infectious bronchiolitis depend on the varied etiology. The hallmark of bronchiectasis is a chronic infection of the airways, and antibiotics, mucus clearance measures, and bronchodilators are all supportive.

Keywords: Acute bronchiolitis; Acute bronchitis; Bronchiectasis; Chronic bronchitis; Chronic cough; Non-infectious bronchiolitis.

Fig. 1

Fifty-two-year-old woman presented with a week history of cough, which initially failed antibiotic treatment. CT chest is notable for centrilobular nodules (panel a arrows) and tree-in-bud opacities (panel b, arrow) consistent with viral bronchiolitis

Fig. 2

Thirty-two-year-old man presented with recurrent bronchial infection since childhood, diagnosed with immotile cilia syndrome. He complains of daily cough with mucopurulent sputum and requires multiple courses of antibiotics each year. CT chest was notable for bronchial wall thickening (short arrow) with cystic spaces (long arrow) of dilated and destroyed airways consistent with bronchiectasis

Fig. 3

Forty-five-year-old man presented with persistent wheeze and cough. He is skin test positive to Aspergillus fumigatus. Labs were notable for elevated IgE of 2000 IU with evidence of serum-precipitating antibodies to Aspergillus fumigatus. CT chest revealed central bronchiectasis (panel a, white arrow) and mucoid impaction (panel b, white arrow). Labs and imaging were consistent with a diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The patient was treated with steroids and anti-fungal medication, and his symptoms improved