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Lee, Jang, Lee, Eom, Bahn, Kim, Shin, Park, Lee, Kim, Hyun, and Jung: The Role of Inhaled Corticosteroid in the Management of Chronic Cough
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(2): 221-227.

Published online: 28 February 2006

DOI: https://doi.org/10.4046/trd.2006.60.2.221

The Role of Inhaled Corticosteroid in the Management of Chronic Cough

Kyung-Hun Lee, M.D., Seung Hun Jang, M.D., Jung-Hwa Lee, M.D., Kwang-Seok Eom, M.D., Joon-Woo Bahn, M.D., Dong-Gyu Kim, M.D., Tae Rim Shin, M.D., Sang Myon Park, M.D., Myung-Gu Lee, M.D., Chul-Hong Kim, M.D., In-Gyu Hyun, M.D., Ki-Suck Jung, M.D.

Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea.

Address for correspondence: Ki Suck Jung, M.D., Ph.D. Department of Internal Medicine, Pulmonology Allergy Center, Hallym University Sacred Heart Hospital, 896 Pyungchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea. Phone: 82-31-380-3717, Fax: 82-31-380-3973, pulmoks@hallym.ac.kr

Received 31 August 2005       Accepted 23 January 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Cough may be a consequence of bronchial hyperresponsiveness or inflammation. Empirical treatment is important in this context because it difficult to verify the obvious cause of cough using laboratory tests, Corticosteroid has a nonspecific anti-inflammatory effect, and can be used for cough management. However, its response rate has not yet been fully elucidated. This study investigated the short- term effects of inhaled corticosteroid on chronic cough

Methods

Patients with chronic cough with a normal chest radiograph and a pulmonary function test were enrolled. Cases with a prior respiratory infection within 8 weeks, a history of bronchial asthma, objective wheezing on examination, subjective symptoms of gastroesophageal reflux or taking an ACE inhibitor were excluded. On the first visit, a methacholine bronchial provocation test, spontaneous sputum eosinophil count performed twice and a paranasal sinus radiograph were checked, and the patients were treated with budesonide turbuhaler 800µg/day for ten days. The primary outcome measure was a decrease in the cough score after treatment.

Results

Sixty nine chronic coughers were finally analyzed. The final diagnoses by the routine tests were as follows: bronchial asthma 13.0%, eosinophilic bronchitis 18.8%, paranasal sinusitis 23.2% and non-diagnostic cases 53.6%. The following responses to the inhaled corticosteroid were observed: definite responders, 76.8%, possible responders, 2.9% and non-responders, 20.3%. The response rate was not affected by the final diagnosis even in the non-diagnostic cases. There were minimal adverse drug related effects during the empirical treatment.

Conclusion

Routine objective tests such as methacholine provocation, sputum eosinophil count and simple radiographs were notare not suitable for diagnosing chronic cough Therefore, empirical treatment is important. Short term inhaled corticosteroid is effective and can guide a further treatment plan for chronic cough.

Keywords: Chronic cough, Inhaled corticosteroid, Response rate

Figures and Tables

Figure 1
The distribution of diagnoses and the response rate to inhaled corticosteroid. 53.6% of the patients failed to be classified to a specific disease when sputum eosinophil count, paranasal sinus radiographs and methacholine provocation test were performed. The overall response rate to inhaled corticosteroid was around 80% in terms of cough. The response rates according to the diagnoses were not statistically different (Chi-square test, p=0.159).
trd-60-221-g001
Table 1
Degree of steroid responsiveness
trd-60-221-i001
Table 2
Clinical characteristics and inhaled corticosteroid responsiveness of the patients*
trd-60-221-i002

*Values given as mean ± SD, unless otherwise indicated.

†Definite responder, ‡Possible responder, §Non responder

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