Tuberc Respir Dis.  2006 Feb;60(2):221-227.

The Role of Inhaled Corticosteroid in the Management of Chronic Cough

• Lee KH
• Jang SH
• Lee JH
• Eom KS
• Bahn JW
• Kim DG
• Shin TR
• Park SM
• Lee MG
• Kim CH
• Hyun IG
• Jung KS

Abstract

BACKGROUND: Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short-term effects of inhaled corticosteroid on chronic cough
METHODS
Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler 800 microgram/day for ten days. The primary outcome measure was a decrease in the cough score after treatment.
RESULTS
Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment.
CONCLUSION
Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.

Keyword

Chronic cough; Inhaled corticosteroid; Response rate

MeSH Terms

Asthma
Bronchial Provocation Tests
Bronchitis
Budesonide
Cough*
Diagnosis
Eosinophils
Gastroesophageal Reflux
Humans
Inflammation
Methacholine Chloride
Outcome Assessment (Health Care)
Radiography, Thoracic
Respiratory Function Tests
Respiratory Sounds
Sinusitis
Sputum
Budesonide
Methacholine Chloride

Figure

• 

  Figure 1 The distribution of diagnoses and the response rate to inhaled corticosteroid. 53.6% of the patients failed to be classified to a specific disease when sputum eosinophil count, paranasal sinus radiographs and methacholine provocation test were performed. The overall response rate to inhaled corticosteroid was around 80% in terms of cough. The response rates according to the diagnoses were not statistically different (Chi-square test, p=0.159).

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