Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study

Rybka-Frączek, Aleksandra; Dąbrowska, Marta; Grabczak, Elżbieta M.; Białek-Gosk, Katarzyna; Klimowicz, Karolina; Truba, Olga; Krenke, Rafał

doi:10.1186/s12931-021-01845-2

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…In contrast, measurement of FeNO and bronchial hyperresponsiveness is of great value to exclude or diagnose cough variant asthma especially in sensitized patients [8,10,17,26]. A recent study confirmed the high positive predictive value of bronchial hyperresponsiveness in patients with cough variant asthma [25].…”

Section: Discussionmentioning

confidence: 99%

Methacholine and FeNO Measurement in Patients with Habit Cough

et al. 2023

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Background Chronic cough is one of the most common symptoms in childhood. Making a definite diagnosis is a challenge for all pediatricians especially in patients when cough is without an organic cause like in habit cough. Patients and Methods In this retrospective analysis, all electronic outpatient charts of the Division of Allergology and Pneumology, between January 1, 2010 and December 31, 2019 were reviewed in order to study all children with potential habit cough. All children underwent the following diagnostic algorithms, skin prick test (SPT), measurement of fractional exhaled nitric oxide (FeNO), spirometry and methacholine challenge test (MCT). The value of a normal MCT and FeNO measurement for diagnosing habit cough was investigated. Results The chart review revealed 482 patients with chronic cough>4 weeks. Of these, 99 (20.5%) with suspected habit cough were collected. 13 patients had to be excluded for other diagnosis and a complete data set was available in 55 patients. 33 (60.0%) of 55 patients were SPT negative and 22 (40.0%) had sensitization to common allergens. Five patients had elevated FeNO≥20 ppb and three showed severe bronchial hyperresponsiveness<0.1 mg methacholine, challenging the diagnosis of habit cough. Conclusion A normal FeNO and MCT can help confirm the clinical diagnosis of habit cough. However, in patients with positive MCT and/or elevated FeNO habit cough can be present. Especially in patients with elevated FeNO and severe BHR cough variant asthma and eosinophilic bronchitis have to be ruled out.

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Section: Discussionmentioning

confidence: 99%

Methacholine and FeNO Measurement in Patients with Habit Cough

et al. 2023

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“…In our previous study, we did not observe correlation between PC 20 and response to anti-asthmatic therapy in patients with CVA either. 19 …”

Section: Discussionmentioning

confidence: 99%

“…In our previous study, we did not observe correlation between PC 20 and response to anti-asthmatic therapy in patients with CVA either. 19 Moreover, there is paucity of data on noneosinophilic phenotype of CVA so far. Gao et al compared classic asthma and CVA, showing more severe BHR, a lower percentage of eosinophils and higher neutrophils in induced sputum cell count in CVA, which probably indicated different airway inflammatory subtypes.…”

Section: Discussionmentioning

confidence: 99%

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Inflammatory Phenotypes of Cough Variant Asthma as Response Predictors to Anti-Asthmatic Therapy

Rybka-Frączek¹,

Dąbrowska²,

Grabczak³

et al. 2022

JIR

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Background Eosinophilic inflammatory phenotype was thought to be the most common phenotype of cough variant asthma (CVA), nevertheless other phenotypes were also reported. Purpose The study aimed to analyze the inflammatory phenotypes of CVA in relation to treatment response to the stepwise anti-asthmatic treatment. Patients and Methods The study included 45 patients with chronic cough (CC) and suspicion of CVA (normal chest X-ray, presence of bronchial hyperresponsiveness and no history of wheezing or dyspnea) in whom induced sputum was successfully collected. Based on the cellular composition of the sputum, patients were divided into major inflammatory phenotypes: eosinophilic, neutrophilic, paucigranulocytic or mixed granulocytic. A stepwise treatment, including inhaled corticosteroids with long-acting β 2 -agonist, montelukast and short-term therapy with prednisone was initiated. Good treatment response was defined as the reduction in cough severity at least 20 mm from the baseline in visual analogue scale and improvement in cough-related quality of life assessed by the Leicester cough questionnaire at least 1.3 points after any of three steps. Results Finally, 40/45 (88.9%) patients improved after therapy. Eosinophilic asthma was found in 13/40 (32.5%) patients, neutrophilic in 6/40 (15.0%) and paucigranulocytic pattern in 21/40 (52.5%) patients. No one demonstrated a mixed granulocytic phenotype. The response to the treatment was similar in all groups. However, the reduction in cough severity was inversely related to the percentage of sputum neutrophils (r = −0.44, P = 0.003). We showed that the percentage of neutrophils in sputum >46% may be considered as a predictor of poor response to anti-asthmatic therapy. Conclusion The diversity of inflammatory phenotypes with paucigranulocytic preponderance was found in subjects with CVA. The response to anti-asthmatic treatment in patients with CVA was not related to the inflammatory phenotype. High neutrophil count in sputum may predict poor response to anti-asthmatic therapy in patients with CC and bronchial hyperresponsiveness.

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“…17 A positive bronchial provocation test is the gold standard for the diagnosis of CVA. 18 The methacholine bronchial provocation test is essential in the diagnosis of chronic cough related to bronchial hyperresponsiveness, 19 and FeNO is one of the non-invasive indicators for observing airway inflammation. FeNO cannot replace the bronchial provocation test, 20 however, its detection can be employed in conjunction with other indicators to comprehensively…”

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confidence: 99%

Study on the Relationship Between Bronchoalveolar Lavage Fluid Cell Count, Th1/Th2 Cytokines and Pulmonary Function in Patients with Cough Variant Asthma

Chen¹,

Lin²,

Gu³

et al. 2022

JAA

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This study aimed to compare lung function and airway inflammation among cough variant asthma (CVA), chronic cough and classical asthma (CA) and investigate the relationship between these indicators and their possible mechanisms of action in the progression of CVA to CA. Methods: 36 patients with chronic cough, 39 patients with CA, and 57 patients with CVA were included in this study. Pulmonary function tests, bronchial provocation tests and FeNO tests were performed. The patients' bronchoalveolar lavage fluid (BALF) was collected, the cells in BALF were counted, and the levels of Th1 and Th2 cytokines were detected. Results: The neutrophils, lymphocytes, and eosinophils in BALF in the CA and CVA groups were significantly higher than those in the chronic cough group. Also, they were negatively correlated with FEV1, FVC, and FEV1/FVC and positively correlated with IgE and FeNO. The expression of Th2-related cytokines was increased in CVA and CA patients, and it was positively correlated with FEV1, FVC and FEV1/FVC and negatively correlated with IgE and FeNO, while the results of Th1-related cytokines were the opposite of those for Th2-related cytokines. Conclusion: CVA differs from asthma and chronic cough in terms of Th1/Th2 cytokines and lung function and provides a reference for understanding the disease mechanism of early clinical progression of CVA to CA.

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Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study

Cited by 8 publications

References 14 publications

Methacholine and FeNO Measurement in Patients with Habit Cough

Methacholine and FeNO Measurement in Patients with Habit Cough

Inflammatory Phenotypes of Cough Variant Asthma as Response Predictors to Anti-Asthmatic Therapy

Study on the Relationship Between Bronchoalveolar Lavage Fluid Cell Count, Th1/Th2 Cytokines and Pulmonary Function in Patients with Cough Variant Asthma

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