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Original Research: ASTHMA |

Airway Wall Thickening in Patients With Cough Variant Asthma and Nonasthmatic Chronic Cough*

Hisako Matsumoto, MD, PhD; Akio Niimi, MD, PhD; Rollin P. Tabuena, MD; Masaya Takemura, MD; Tetsuya Ueda, MD; Masafumi Yamaguchi, MD; Hirofumi Matsuoka, MD; Makiko Jinnai, MD; Kazuo Chin, MD, PhD; Michiaki Mishima, MD, PhD
Author and Funding Information

*From the Departments of Respiratory Medicine (Drs. Matsumoto, Niimi, Takemura, Ueda, Yamaguchi, Matsuoka, Jinnai, Chin, and Mishima), Kyoto University, Kyoto, Japan; and Iloilo Mission Hospital (Dr. Tabuena), Department of Internal Medicine, Iloilo City, Philippines.

Correspondence to: Hisako Matsumoto, MD, PhD, Department of Respiratory Medicine, Kyoto University, Sakyo-ku, Kyoto, 606-8507, Japan; e-mail: hmatsumo@kuhp.kyoto-u.ac.jp



Chest. 2007;131(4):1042-1049. doi:10.1378/chest.06-1025
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Background: Chronic cough, which may be of asthmatic or nonasthmatic origin, is an important clinical issue. Airway inflammation, and remodeling demonstrated by subbasement membrane thickening has been associated with cough variant asthma (CVA) as well as with nonasthmatic chronic cough (NAC). CT studies have shown airway wall thickening in patients with asthma who wheeze. We examined airway wall thickness by CT in adult patients with chronic cough and examined its pathophysiologic implication.

Methods: Nonsmoking, steroid-naïve patients with CVA (n = 27), NAC (n = 26), and healthy control subjects (n = 15) were studied. Airway dimensions were assessed by a validated CT technique, in which we measured airway wall area (WA) corrected by body surface area (BSA), the ratio of WA to outer wall area (percentage of wall area [WA%]), absolute wall thickness (T)/√BSA, and airway luminal area/BSA of a segmental bronchus. Correlations between CT parameters and clinical indexes such as disease duration and cough sensitivity were examined.

Results: In patients with CVA, WA/BSA, WA%, and T/√BSA were all significantly greater than those in control subjects. In patients with NAC, WA/BSA and T/√BSA were significantly greater than in control subjects. The increase of WA/BSA and T/√BSA of NAC patients was less than that of CVA patients. In a subset of patients with NAC, WA% correlated with capsaicin cough sensitivity (n = 9, r = 0.75, p = 0.034).

Conclusions: Walls of central airways are thickened in patients with CVA, and also to a lesser degree in patients with NAC. Airway wall thickening in NAC may be associated with cough hypersensitivity.

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