Upper-Airway Cough Syndrome with Latent Eosinophilic Bronchitis
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Upper-airway cough syndrome often coexists with other diseases that elicit chronic cough. However, the concomitant conditions are not always relevant to chronic cough, which complicates the cause diagnosis of chronic cough. The objective of this study was to explore the diagnosis and clinical implication of upper-airway cough syndrome with latent eosinophilic bronchitis. Eleven patients with upper-airway cough syndrome and latent eosinophilic bronchitis were retrospectively analyzed for their clinical manifestations, changes of eosinophilia in induced sputum, and cough threshold with capsaicin defined as capsaicin concentration that elicits two or more coughs (C2) and five or more coughs (C5) between pretreatment and post-treatment. All patients reported a history of allergic rhinitis, showed persistent dry cough or small amounts of viscid sputum with a time course of 2–60 months (median = 7 months), and presented with symptoms and signs of rhinitis, normal lung function, and airway responsiveness. Initial eosinophil percentage in induced sputum was 3.5–8.0%. Cough disappeared after 2–5 (3 ± 1) weeks of only oral antihistamine. With successful treatment, cough threshold C2 increased from 1.73 ± 1.45 to 4.43 ± 4.50 μmol/L (t = 2.64, P = 0.025) and C5 increased from 2.79 ± 2.16 to 10.10 ± 8.22 μmol/L (t = 3.10, P = 0.011). However, there was no significant change of eosinophil percentage in induced sputum (4.8 ± 1.5% vs. 4.4 ± 1.4%, t = 0.84, P = 0.427). Upper-airway cough syndrome with latent eosinophilic bronchitis is a unique condition. The recognition of the entity may avoid unnecessary use of corticosteroids.
KeywordsChronic cough Upper-airway cough syndrome Eosinophilic bronchitis Cough sensitivity Antihistamine
This study was partially supported by a grant for Development of Science and Technology from the Committee of Science and Technology of Shanghai (No. 074119628) and a grant for Research from Shanghai Municipal Health Bureau (No. 2007098).
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