Nonasthmatic Chronic Cough: No Effect of Treatment with an Inhaled Corticosteriod in Patients without Sputum Eosinophilia

Abstract

Patients with nonasthmatic chronic cough enrolled in this study had evidence of a mild neutrophilia and/or microvascular leakage. Chronic cough did not respond to treatment with budesonide, perhaps because the cause was not associated with sputum eosinophilia.

Treatment of Unexplained Chronic Cough

“…Each of the included participants had a negative result on induced sputum testing for eosinophils. Pizzichini et al 39 found no beneficial effect of inhaled budesonide on cough symptoms in their population of nonasthmatic, noneosinophilic subjects with UCC.…”

“…BHR and induced sputum testing were included in the study by Pizzichini et al 39 A positive BHR test result was an exclusion criterion. Each of the included participants had a negative result on induced sputum testing for eosinophils.…”

Sputum Cell Counts and Exhaled Nitric Oxide in Patients with Gastroesophageal Reflux, and Cough or Asthma

“…The reflux of gastric contents into the esophagus is believed to cause cough and worsen asthma by a vagally mediated neurogenic reflex mechanism (3,4), by microaspiration causing airway inflammation (5) or simply by an increase in ventilation (6). Airway neutrophilia (7,8), eosinophilia (9,10) and an increase in metachromatic cells (11) have been described in the sputum (7)(8)(9), bronchoalveolar lavage fluid (10) and mucosal biopsies (11) of patients with nonasthmatic cough and possible GER. Similar features are observed in patients with asthma (12).…”

Diffuse idiopathic pulmonary neuroendocrine hyperplasia, chronic eosinophilic pneumonia, and asthma

“…Sputum and bronchoalveolar lavage fluid examination did not grow any pathogenic organisms. Substance P in sputum supernatant (measured by radioimmunoassay using antisubstance P antibody (Peninsula Laboratories, San Carlos, CA, USA), as previously described [4]) was elevated at 1,210 pg?mL -1 (normal ,400 pg?mL -1 ). Spirometry showed a mixed obstructive and nonobstructive ventilatory pattern without variable airflow obstruction (table 1).…”

“…An in vitro pharmacodynamic model in Bacillus anthracis has suggested that an optimised once-daily dose of linezolid might prevent emergence of drug resistance, in addition to conferring antibacterial efficacy [4]. Linezolid has a reasonably low mutant prevention concentration that would theoretically help to restrict the development of mycobacterial resistance [5].…”