Methacholine and FeNO Measurement in Patients with Habit Cough

Abstract

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.

Utility of eosinophil granule proteins in management of pediatric chronic cough

“…9) Therefore, objective measurements of respiratory impairment are needed for this age group as well as older children, a sentiment echoed in the recent study of Kim et al 2) of eosinophil granule protein levels in chronic cough as well as other studies. 3,[9][10][11][12] Direct measurements of eosinophilic granule proteins like EDN and ECP have proven useful in the diagnosis, treatment, and monitoring of allergic diseases; therefore, their use in childhood chronic cough should be further explored.…”