Korean J Intern Med.  2019 May;34(3):559-568. 10.3904/kjim.2017.291.

Efficacy and predictors of response to inhaled corticosteroid treatment for chronic cough

• Hong JY
• Kim JH
• Park S
• Hwang YI
• Jung KS
• Jang SH

• KMID: 2448348
• DOI: http://doi.org/10.3904/kjim.2017.291

Abstract

BACKGROUND/AIMS
Inhaled corticosteroids (ICS) are a treatment of choice for eosinophilic airway diseases, but their efficacy for other causes of chronic cough is controversial.
METHODS
We conducted a prospective observational study to determine the ICS efficacy and clinical predictors of response to ICS in patients with upper airway cough syndrome (UACS) or unexplained chronic cough (UCC). Sixty-eight patients with UACS and 33 patients with UCC (duration of cough ≥ 8 weeks) were treated with ICS: 250 µg of fluticasone propionate or 400 µg of budesonide twice a day at physician's discretion. They were followed after 2 weeks to assess persistent cough which was measured as 0% to 100% compared with baseline cough frequency.
RESULTS
The median grade of persistent cough after 2-week ICS treatment was 40% (interquartile range [IQR], 10 to 70) in UACS and was 50% (IQR, 20 to 70) in UCC. The only adverse event was infrequent, mild hoarse voice (five UACS and one UCC). Long duration of cough (≥ 52 weeks) and cough not aggravated by cold air exposure were predictors of a poorer response to short course ICS treatment (logistic regression analysis, p = 0.018 and p = 0.031, respectively). However, prolonged treatment with ICS more than 2 weeks was more effective in patients with long cough duration (≥ 52 weeks).
CONCLUSIONS
Short course ICS treatment has modest efficacy on UACS and UCC without significant adverse events. Duration of cough and cough triggered by cold air exposure were the clinical factors associated with ICS response. Extended treatment with ICS may be beneficial in patients with long duration of cough.

Keyword

Cough; Adrenal cortex hormones; Treatment outcome

MeSH Terms

Adrenal Cortex Hormones
Budesonide
Cough*
Eosinophils
Fluticasone
Humans
Observational Study
Prospective Studies
Treatment Outcome
Voice
Adrenal Cortex Hormones
Budesonide
Fluticasone