Cough Variant Asthma-A name of Hidden Sufferings

Definition of Bronchial Asthma:

• Asthma is a complex clinical syndrome of chronic airway inflammation
characterized by recurrent, reversible, airway obstruction. Airway
inflammation also leads to airway hyper-reactivity, which causes
airways to narrow in response to various stimuli.
Classification of Bronchial Asthma
In general, the type of asthma is defined by:
• Medical history and physical examination
• Results of lung function tests
• Age of onset
• The type of cells involved in inflammation
• Results of allergy tests
• Lung and tissue characteristics
• Response to medications tried in the past
Types:
 Extrinsic Asthma(Allergic)
 Intrinsic Asthma(Non-Allergic)
 Mixed Asthma(Extrinsic & Intrinsic)
 Occupational Asthma
 Drug Induced
 Aspirin Induced
 Other NSAIDs Induced
 Exercise induced Asthma
 Cough Variant Asthma: Very common specially in children.
Comparison between Allergic & Non-Allergic Bronchial Asthma
Comparison between Eosinophilic Bronchitis, Classic & Cough Variant Asthma
Comparison Between Cough Variant & Exercised induced Asthma
What is Cough Variant Asthma?

• Cough-variant asthma is a type of asthma in which

the main symptom is a chronic, dry, non-productive
cough (A non-productive cough does not expel any mucus
from the respiratory tract) with often no other "classic"
asthma symptoms, such as wheezing or shortness of
breath that may lead to delay in reaching the diagnosis.
Causes:
There are not so specific cause of Cough variant asthma. In most of the
case the causes are similar to Typical Asthma. Such as:
Idiopathic
 Hereditary
 Exposure to allergens like Dust, cold, pollen etc.
 Aetiology
Cough Variant
Cough Variant Asthma Triggers
Diagnostic keys:
• Symptoms:
• Nocturnal and/or allergen induced cough.
• No H/O respiratory distress.
• Wheezing may never be heard.
• Personal of family H/O other atopic disorders.
• Response rapidly to anti-asthmatic therapy.
• Symptoms relapse when therapy withdrawn.
• Usually occurs in Childhood & Adolescence.
• H/O Diurnal variation.
The diagnosis of cough variant asthma was made according to the following criteria
proposed by the Japanese Cough Research Society:

1.Isolated chronic non-productive cough lasting more than 8 weeks.

2.Absence of a history of wheeze or dyspnoea, and no adventitious lung sounds on physical examination.

3.Absence of postnasal drip to account for the cough.

4.FEV1, FVC, and FEV1/FVC ratio within normal limits.

5.Presence of bronchial hyperresponsiveness (PC20 <10 mg/ml).

6) Relief of cough with bronchodilator therapy.

7) No abnormal findings indicative of cough aetiology on chest radiograph.

All patients with cough variant asthma had been successfully treated with bronchodilators and/or steroids.
Investigations:
•CBC(Complete Blood count)
Eosinophil count: Raised

•Serum IgE level: Raised

•Lung Function Test:

1) Spirometry:
FEV1/FVC: Usually Normal but may be raised
2) Broncho provocation Test
(Methacholine challenge Test):Positive
Methacholine challenge Test
Treatment of Cough Variant Asthma:
• Cough-variant asthma is treated in the same way that typical
asthma is treated
Treatment Approaches:
 Prevention of antigen-antibody reaction: Avoidance of antigen(allergens),
Hyposensitization.
Directly acting Bronchodialator: β-sympathomimetics,methylxanthiones,anti
cholinergic(Muscarnic receptorantagonist.
Suppression of Inflammation & Bronchial hyper-reactivity: Corticosteroids

Prevention of release of mediators: Mast cell stabilizer

Antagonism of released mediators: Leukotriene antagonists,antihistamines,

PAF antagonists.
Neutralization of IgE: Omalizumab
 Classifications:
1) Bronchodialators:
Β-sympathomimetics: Salbutamol(short acting),Salmeterol(Long
acting),Bambuterol,Terbutaline,Formoterol.
Methylxanthine: Theophylline,Aminophylline,Choline
Theophyllinate,Hydroxyethyl
theophylline,Theophyline ethanolate of
piperazine,Doxophylline.
Anticholinergic(Muscarnic receptor antagonist): Ipratropium
Bromide,Tiopropium Bromide.
Mecanism of Action of Bronchodialators:
2) Leukotriene antagonists: Monteleukast(Monas),Zafirlukast.
• 3) Mast cell Stabilizers: Sodium cromoglycate,Ketotifen.

Mechanism of Action of Mast Cell Stabilizer:

4)Corticosteroids:
Systemic: Hydrocortisone,Prednisolone,Dexamethasone,Deflazacort.
Inhalational: Beclomethasone dipropionate,Fluticasone
propionate,Budesonide,Flunisolide,Ciclesonide.

Mechanism of Action of Corticosteriod

• 5) Anti-IgE antibody: Omalizumab.
Conclusion
 If the cough variant asthma remains untreated it can be
turned into Classical Asthma later at any time.

As we have many effective management options in hand ;

To
reduce the sufferings:

“Don’t Delay, Start the treatment toDay”