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Editorials |

What Story Do the Pictures of Cough Tell Us?

Alyn H. Morice, MD
Author and Funding Information

Affiliations: Cottingham, UK
 ,  Dr. Morice is Professor of Respiratory Medicine, Head of the Division of Academic Medicine, Castle Hill Hospital.

Correspondence to: Alyn H Morice, Professor of Respiratory Medicine, Head of Division of Academic Medicine, Castle Hill Hospital, Castle Rd, Cottingham, East Yorkshire, HU16 5JQ UK; e-mail: a.h.morice@hull.ac.uk



Chest. 2006;130(2):316-317. doi:10.1378/chest.130.2.316
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On page 362 of this issue of CHEST, Richard Irwin and colleagues1 provide evidence of the histologic changes seen in the airways of patients with chronic cough. They detail the altered morphology present in this syndrome, which includes epithelial denudation, goblet cell and squamous cell metaplasia, and a characteristic mild-to-moderate chronic inflammatory infiltrate with lymphocytes and plasma cells. Evidence of acute inflammation is absent, and there is a lack of eosinophilic inflammation. This clearly differentiates these patients with chronic cough from those with asthma. Obviously, this is not to say that patients with cough-variant asthma or eosinophilic bronchitis do not have T-helper cell type 2 inflammation. The incidence of these asthma-like syndromes varies considerably in reports from specialist cough clinics.2 Instead, it infers that this relatively small sample size did not include a subgroup of chronic coughers with the characteristic histologic pattern of mast cell/eosinophilic inflammation around airway nerves rather than around smooth muscle, which is seen in patients with asthmatic cough.3

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