Asthma diagnosis and treatmentEffect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough
Section snippets
Subjects
Adults with a cough for more than 1 year were recruited from hospital respiratory clinics and from responses to an advertisement in a local newspaper. No subject had evidence of any other lung disease on the basis of history, clinical examination, chest radiography, and spirometry. Exclusion criteria were treatment with inhaled or oral corticosteroids within 3 weeks of inclusion, upper respiratory tract infection within 6 weeks of inclusion, angiotensin-converting enzyme inhibitor treatment,
Baseline subject characteristics and investigations
We screened 120 subjects with cough, 93 of whom met all the inclusion criteria and were randomized; 88 completed all study visits. Of these, 52 were recruited from the community (general practitioner referrals and advertisement in a newspaper), and 36 were referred from hospital clinics. Five subjects dropped out because of inability to attend all study visits.
A final diagnosis for the cough was obtained in 78 (89%) of the 88 patients; 74% had a single diagnosis, 24% had 2 diagnoses, and 2% had
Discussion
This is the first randomized, placebo-controlled study to demonstrate an improvement in cough severity after inhaled fluticasone compared with after placebo in patients with chronic cough for more than 1 year. The decrease in cough severity score was accompanied by a decrease in sputum ECP, eNO, and CO levels, but there was no reduction in sputum mediator levels of LTB4, Cys-LT, PGE2, IL-8, MPO, and TNF-α.
Although there was a statistically significant decrease in the cough VAS, this
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Cited by (80)
Guidelines for the management of chronic cough in adults
2023, Revue des Maladies RespiratoiresWAO-ARIA consensus on chronic cough – Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19
2022, World Allergy Organization JournalManaging Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Expert Panel Report
2020, ChestCitation Excerpt :Sample sizes for all the studies were small. Chaudhuri et al32 showed that a favorable response to inhaled corticosteroids (ICS) was predicted by sputum eosinophil count, sputum eosinophil cationic protein concentration, and Feno. In contrast, responses to montelukast and zafirlukast were not related to airway inflammation when assessed with non-invasive measures.
Could Fractional Exhaled Nitric Oxide Test be Useful in Predicting Inhaled Corticosteroid Responsiveness in Chronic Cough? A Systematic Review
2017, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Among 916 initially retrieved abstracts, 5 original articles finally met the inclusion criteria (Figure 1).17-21 Chaudhuri et al,13 the first report on this topic, was excluded because responsiveness to treatment was not reported as a dichotomous outcome and the sensitivity and specificity data could not be retrieved after contacting the corresponding author. Zhang and Lin,22 which examined the usefulness of Feno tests for ICS responsiveness, was excluded at the final selection stage because ICS was selectively administered to a subgroup of patients with cough-variant asthma or eosinophilic bronchitis, but not to an unselected group of patients with cough (Appendix Table 1).
Supported by Chest, Heart and Stroke, Scotland.