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Communications to the Editor |

Eosinophilic Bronchitis as a Cause of Cough FREE TO VIEW

D. W. Cockcroft, MD, FCCP
Author and Funding Information

University of Saskatchewan Saskatchewan, Canada

Correspondence to: D. W. Cockcroft, MD, FCCP, Division of Respiratory Medicine, Royal University Hospital, 103 Hospital Dr, Ellis Hall, Saskatoon, Saskatchewan, S7N 0W8 Canada



Chest. 2000;118(1):277. doi:10.1378/chest.118.1.277
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Published online

To the Editor:

I read with interest the valuable article by Pratter et al (November 1999),1 regarding the role of sinus imaging in the management of chronic cough. Figure 2 in this article contains a useful algorithm for investigation and treatment of chronic cough. Unfortunately, one potentially important cause of cough will be missed by following this algorithm.

Eosinophilic bronchitis is a recently described syndrome.24 Subjects with eosinophilic bronchitis have cough with eosinophilic airway inflammation characteristic of that seen in asthma; however, these patients have normal lung function, negative methacholine challenges, and no evidence of variable airflow obstruction. The cough in this condition responds nicely to inhaled corticosteroids.24 This syndrome would appear to be a precursor to (or perhaps the very mildest form of) symptomatic asthma. While the “purists” would not include this within the umbrella of the label asthma, it seems reasonable to consider that this is a variant of the syndrome known as cough-variant asthma. In a recent study,,4 corticosteroid responsive eosinophilic bronchitis with negative methacholine challenge was shown to be present in 13% of subjects with chronic cough.

The authors have pointed out the poor predictive value of a positive methacholine challenge in predicting response to asthma therapy.1,5 The relative common prevalence of eosinophilic bronchitis as a cause of cough underscores that a negative methacholine challenge is also a poor predictor of nonresponse to inhaled corticosteroids.

There are two important messages. First, this questions the value of the routine use of methacholine challenges in the evaluation and management of chronic cough. It is possible that a brief diagnostic trial of high-dose inhaled corticosteroids might be a preferable tool at step 2 of the cough algorithm. Second, it suggests the potential value for standardized evaluation of sputum for inflammatory cells, particularly eosinophils, in arriving at a diagnosis and the management plan for cough.

References

Pratter, MR, Bartter, T, Lotano, R (1999) The role of sinus imaging in the treatment of chronic cough in adults.Chest116,1287-1291. [CrossRef] [PubMed]
 
Gibson, PG, Dolovich, J, Denburg, J, et al Chronic cough: eosinophilic bronchitis without asthma.Lancet1989;1,1346-1348. [PubMed]
 
Gibson, PG, Hargreave, FE, Girgis-Gabardo, A, et al Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroids.Clin Exp Allergy1995;25,127-132. [CrossRef] [PubMed]
 
Brightling, CE, Ward, R, Goh, KL, et al Eosinophilic bronchitis as a common cause of cough.Am J Respir Crit Care Med1999;160,406-410. [PubMed]
 
Mello, CH, Irwin, RS, Curley, FJ Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause.Arch Intern Med1996;156,997-1003. [CrossRef] [PubMed]
 

Figures

Tables

References

Pratter, MR, Bartter, T, Lotano, R (1999) The role of sinus imaging in the treatment of chronic cough in adults.Chest116,1287-1291. [CrossRef] [PubMed]
 
Gibson, PG, Dolovich, J, Denburg, J, et al Chronic cough: eosinophilic bronchitis without asthma.Lancet1989;1,1346-1348. [PubMed]
 
Gibson, PG, Hargreave, FE, Girgis-Gabardo, A, et al Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroids.Clin Exp Allergy1995;25,127-132. [CrossRef] [PubMed]
 
Brightling, CE, Ward, R, Goh, KL, et al Eosinophilic bronchitis as a common cause of cough.Am J Respir Crit Care Med1999;160,406-410. [PubMed]
 
Mello, CH, Irwin, RS, Curley, FJ Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause.Arch Intern Med1996;156,997-1003. [CrossRef] [PubMed]
 
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