Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

Brightling, Christopher E.; Ward, Richard J.; Wardlaw, Andrew J.; Pavord, Ian D.

doi:10.1034/j.1399-3003.2000.15d10.x

Cited by 154 publications

(115 citation statements)

References 17 publications

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“…The recognition that some cough patients have no airway dysfunction (specifically no bronchial hyperresponsiveness) but have airway eosinophila and a steroid-responsive cough led to the term ''nonasthmatic eosinophilic bronchitis''. This latter phenotype accounts for between 10% and 15% of cases of chronic cough [44,45] and, since anti-inflammatory treatment with inhaled corticosteroids or leukotriene antagonists is associated with improvement of the cough and a reduction in airway eosinophils [46,47], is an important differential diagnosis in the patient with chronic cough.…”

Section: Cough and Eosinophilsmentioning

confidence: 99%

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

et al. 2014

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In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions.There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough.The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area. @ERSpublications Cough hypersensitivity syndrome was clearly endorsed by opinion leaders as a valid and useful concept

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Section: Cough and Eosinophilsmentioning

confidence: 99%

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

et al. 2014

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“…There is not any PEF variability, and NO levels in expiratory air are increased [31,34]. Coughing responds to inhaled and/ or oral corticosteroid treatment quite well [35].…”

Section: Clinical Featuresmentioning

confidence: 98%

“…Present findings in the literature suggest that cough reflex sensitivity in NAEB contributes to cough and eosinophilic inflammation is associated with increased cough reflex sensitivity. The severity of coughing, increased cough reflex sensitivity (C5 <3.9 mM) and sputum eosinophil ratio are reduced by inhaled and/or oral corticosteroid therapy [34,36]. However; in another study which was conducted by Park et al [37] and in which long-term follow-ups of the patients were made, the recurrence of sputum eosinophilia (3%) in the asymptomatic period in a group of patients suggested that chronic cough in NAEB patients was not always associated with eosinophilic inflammation.…”

Section: Clinical Featuresmentioning

confidence: 99%

Non-astmatic Eosinophilic Bronchitis

Yıldız

Dülger

2018

Turk Thorac J

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Non-asthmatic eosinophilic bronchitis (NAEB) is a chronic disease and was first described in a small group of patients by Gibson et al. [1,2] in a relatively recent date. Without bronchospasm, it is defined as eosinophilic inflammation of the respiratory tract and is usually associated with eosinophilia in sputum. It is one of the most important causes of chronic cough [3].When a cough lasting longer than 8 weeks is detected in clinical practice; if chest X-ray is normal, this situation is defined as chronic cough. Chronic cough is a common cause of complaints all over the world, especially at the centers giving outpatient care, and is responsible for about 40% of the applications [4][5][6]. However, the cause(s) leading to this condition can be detected in 75-90% [7][8][9]. NAEB is a disease that should be remembered in the differential diagnosis of chronic cough but it is often ignored [10]. Because the systematic examination of bronchial inflammation can be made rarely, it is probably diagnosed less than it exists [11]. When the other causes that may lead to chronic cough are eliminated in patients applying with the complaint of chronic cough, NAEB should be taken into consideration [12][13][14][15][16][17][18][19].The purpose of this article is to make it possible to consider the differential diagnosis of patients with chronic cough by drawing attention to NAEB, and to compile and present the literature data that is relatively limited. ETIOLOGYAlthough the etiology of NAEB is not clear yet, environmental or occupational factors may be responsible for this situation in some of the patients. In a significant proportion of the diagnosed patients, occupational dust exposure was considered to be possibly etiologically responsible. For this reason, the possibility of occupation-related causes should be considered in patients with chronic cough due to NAEB [20]. Especially resin hardener, welding fume and formaldehyde exposures have been shown to lead to NAEB [21][22][23][24]. Non-asthmatic eosinophilic bronchitis (NAEB) is eosinophilic inflammation of the respiratory tract, without any bronchospasm. In this article, we want to draw attention to the NAEB. It should also be considered in differential diagnosis of chronic cough. Eosinophilia is present in all induced or spontaneous sputum samples of NAEB patients. NAEB patients and asthmatic patients have similar airway inflammation. Remarkably, NAEB mainly occurs in the lower airways. Unlike asthma, mast cells in NAEB are active in the bronchial epithelium. Diagnosis is based on the clinical, radiological, and spirometric measurements of other causes of chronic cough (Post-nasal discharge syndrome, asthma, gastroesophageal reflux etc.) and the assessment of inflammation in the lower respiratory tract. Airway inflammation can be assessed by sputum induction. The main treatment is anti-inflammatory therapy with inhaled corticosteroids and taking protective measures if inflammation is due to occupational exposure or allergen inhalation. If NAEB is untreated, it may be ...

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“…One of the most representative airway disorders responsible for chronic cough is eosinophilic bronchitis [1], including bronchial asthma, non-asthmatic eosinophilic bronchitis (NAEB) [2], atopic cough (AC) [3], and cough variant asthma (CVA) [4]. Coughs are caused by cough reflex hypersensitivity in NAEB and AC.…”

Section: Introductionmentioning

confidence: 99%

Effects of macrolides on antigen-induced increases in cough reflex sensitivity in guinea pigs

Tokuda¹,

Ohkura²,

Fujimura³

et al. 2010

Pulmonary Pharmacology & Therapeutics

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Hence, they are used for both acute and chronic inflammatory airway diseases.However, the effects of these agents on allergic airway disorders presenting with an isolated chronic cough, such as non-asthmatic eosinophilic bronchitis and eosinophilic tracheobronchitis with cough hypersensitivity (atopic cough), still remain to be elucidated.Objective: To determine if macrolides are effective in the management of chronic cough caused by eosinophilic airway inflammation. Methods:The cough reflex sensitivity to inhaled capsaicin was measured at 48 h after challenge with an aerosolized antigen in actively sensitized guinea pigs.The 14-, 15-or 16-membered macrolides (erythromycin, azythromycin, or josamycin, respectively) were given intraperitoneally every 12 h after the antigen challenge. Bronchoalveolar lavage and the resection of the tracheal tissue were performed immediately after the measurement of the cough response to capsaicin. Results:The antigen-induced increase in the number of coughs elicited by capsaicin inhalation was significantly reduced by treatments with erythromycin and azythromycin, but not with josamycin. Erythromycin dose-dependently inhibited the increases in the substance P, prostaglandin E 2 and leukotriene B 4 levels, but not the histamine levels, in the bronchoalveolar lavage fluid. However, erythromycin did not influence the antigen-induced decrease in the neutral endopeptidase (NEP) activity in the tracheal tissue.Conclusions: Both 14-and 15-membered, but not 16-membered, macrolides 3 could reduce the antigen-induced cough reflex hypersensitivity by inhibiting the antigen-induced release of the afferent sensory nerve sensitizers. These macrolides may be therapeutically useful for the treatment of isolated chronic cough based on cough reflex hypersensitivity in allergic airway diseases such as non-asthmatic eosinophilic bronchitis and atopic cough.

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Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

Cited by 154 publications

References 17 publications

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

Non-astmatic Eosinophilic Bronchitis

Effects of macrolides on antigen-induced increases in cough reflex sensitivity in guinea pigs

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