Exertional Dyspnea and Cough as Preludes to Acute Attacks of Bronchial Asthma

Er, McFadden

doi:10.1056/nejm197503132921103

Cited by 174 publications

(63 citation statements)

References 26 publications

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“…A similar diurnal variation in cough count in young adults during natural colds has been described using a nonambulatory recording system [22]. This diurnal variation of cough frequency, particularly in asthmatics, may appear surprising as nocturnal coughing is regarded a classical feature of asthma [1,2]. However, our patients were in a relatively stable clinical state and not with an impending exacerbation of asthma, and were on maintenance anti-inflammatory therapy, usually inhaled corticosteroids.…”

Section: Discussionsupporting

confidence: 73%

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Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder

Hsu¹,

Stone²,

et al. 1994

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C Co ou ug gh hi in ng g f fr re eq qu ue en nc cy y i in n p pa at ti ie en nt ts s w wi it th h p pe er rs si is st te en nt t c co ou ug gh h: : a as ss se es ss sm me en nt t u us si in ng g a a 2 24 4 h ho ou ur r a am mb bu ul la at to or ry y r re ec co or rd de er r ABSTRACT: Cough is an important symptom of many respiratory disorders. We determined the frequency and diurnal variation of cough in normal subjects and in patients with asthma or with persistent cough of unknown cause. We used a portable, solid-state, multiple-channel recorder to record cough sounds over a 24 h period. The audio-signal was recorded from a unidirectional microphone strapped over the chest wall, and electromyographic (EMG) signals from the lower respiratory muscles were simultaneously registered with surface electrodes. The recorded digital data were examined on an IBM-compatible computer, and the typical signals induced by cough (as assessed by voluntary or experimentally-induced cough) were counted.In 12 normal subjects, only 0-16 coughs were recorded over 24 h. In 21 stable asthmatics with a history of chronic cough ("asthma") the median number was 282 (ranges: 45-1,577), and in 14 patients with the predominant symptom of daily dry coughs ("chronic coughers") the median number was 794 (64-3,639). In both groups of patients, there was a diurnal variation of coughs, such that the least numbers occurred between 2 and 5 a.m. (<3% of total). In the asthma group, there was no significant correlation between forced expiratory volume in one second (FEV 1 ) (% predicted) or diurnal variation of peak expiratory flow and cough frequency. In the chronic coughers, there was a significant correlation between daytime cough numbers and daytime cough symptom scores but not for the night-time values.Our data show that cough frequency is not determined by the severity of asthma in relatively stable asthmatics on inhaled steroids, and is reduced during sleep in both asthmatics and chronic cough patients. This portable cough recorder may be useful in the assessment of drug therapy for chronic cough.

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Section: Discussionsupporting

confidence: 73%

“…It may be the only presenting symptom of asthma [1], as it may be the earliest symptom, particularly during the night, to indicate worsening of asthma [2]. In addition, cough may be a persistent symptom without any identifiable causes [3].…”

mentioning

confidence: 99%

Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder

Hsu¹,

Stone²,

et al. 1994

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“…As bronchodilators are effective against cough in CVA, this may be a possible pathogenetic mechanism [9]. MCFADDEN [27] described a group of asthmatics for whom cough was the predominant symptom at exacerbation. Pulmonary function tests revealed narrowing of the central airways, whereas another group of asthmatics, who predominantly complained of dyspnoea, had narrowing of the peripheral airways.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic inflammation in cough variant asthma

Niimi¹,

Amitani²,

Suzuki³

et al. 1998

Eur Respir J

160

159

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Eosinophils are considered to play a central pathogenetic role in asthma. We previously reported that sputum eosinophilia was observed in patients with cough variant asthma (CVA), as well as in "classic" asthma with wheezing. This study was undertaken to further investigate the involvement of eosinophils in CVA. The serum eosinophil cationic protein (ECP) level, the percentage of eosinophils in bronchoalveolar lavage (BAL) fluid, and the number of eosinophils in bronchial biopsy specimen were examined in 14 patients with CVA, 21 with classic asthma, and in seven healthy controls. For the two asthmatic groups, the clinical severity was classified with scores of 1-3. Pulmonary function and bronchial responsiveness were not significantly different between the patients with classic asthma and those with CVA. BAL, tissue eosinophil and serum ECP were all significantly increased in both classic asthma and CVA when compared with the controls but were not different between classic asthma and CVA. In both groups of asthmatics, the clinical severity significantly correlated with serum ECP and tissue eosinophils. In conclusion, eosinophilic inflammation is involved in cough variant asthma as well as in classic asthma. Anti-inflammatory treatment may be essential in patients with CVA, as in those with classic asthma.

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“…These subjects improved with oral corticosteroid therapy and the term ''cough variant asthma'' was coined. A careful medical history in subjects with cough may disclose wheeze and sometimes a significant reversibility of FEV1 with bronchodilators [21]. Attention has also been paid to subjects with chronic cough and without asthma, having an eosinophilic bronchial inflammation [14,15,22,23].…”

Section: Discussionmentioning

confidence: 99%

Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function

Rytilä

Ghaly²,

Varghese³

et al. 2008

European Respiratory Journal

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A total of 144 patients with lower airway symptoms suggestive of asthma, but who did not fulfil the functional criteria of asthma, were included in a randomised, double-blind, placebo-controlled 8-week ''proof-of-concept'' study with mometasone furoate (MF), 400 mg once daily. The primary efficacy variable was the mean change from baseline in six morning and evening weekly symptom scores: cough, sputum production, wheeze, shortness of breath, chest tightness and exercise-induced cough/wheeze. Total symptom scores were calculated after treatment for 4 and 8 weeks.Compared with placebo, MF improved total morning symptom score at 8 weeks. Changes in total evening symptom scores did not differ between treatments. MF improved all individual symptom scores more than placebo, although the differences in changes between treatments were not always statistically significant. Morning and evening peak expiratory flow rates increased with MF compared with placebo. MF reduced eosinophils and the levels of eosinophilic cationic protein in induced sputum.The results show that symptoms suggestive of asthma exist in patients without significant b 2 -agonist reversibility or diurnal variability in peak flow. Once-daily MF may benefit some of these patients and a short course with inhaled corticosteroids may be tried. Responders should be better identified in further studies.

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Exertional Dyspnea and Cough as Preludes to Acute Attacks of Bronchial Asthma

Cited by 174 publications

References 26 publications

Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder

Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder

Eosinophilic inflammation in cough variant asthma

Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function

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