II. Epidemiology
- Emerging cause of Chronic Cough in pulmonology clinics
- Responsible for 10-30% of Chronic Cough cases referred to pulmonology
III. Pathophysiology
- Corticosteroid responsive Chronic Cough in non-smokers with respiratory tract Eosinophilic inflammation
IV. Differential Diagnosis
V. Diagnosis
- Normal airway hyper-responsiveness (i.e. not Asthma)
- Normal Spirometry
- Normal airway responsiveness on Methacholine inhalation test
- Sputum Eosinophilia (i.e. not Chronic Bronchitis)
- Induced Sputum (via saline nebulization) with 3% or more Eosinophils
- No signs variable airflow obstruction
VI. Management
-
General
- Does not respond to Inhaled Bronchodilators
- Eliminate Occupational Lung Disease and inhaled allergan exposures
- First-Line
- High-dose Inhaled Corticosteroids
- Continue for at least 2 months
- High-dose Inhaled Corticosteroids
- Other measures
- Systemic Corticosteroids
- Consider brief initial course if Inhaled Corticosteroids offer inadequate response
- However, consider alternative Chronic Cough Causes if lack of steroid response
- Leukotriene Inhibitor (e.g. Montelukast)
- Inadequate response to Inhaled Corticosteroids
- Systemic Corticosteroids