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Cough Variant Asthma: Lessons Learned from Deep Inspirations

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Abstract

The pathophysiology of cough variant asthma is poorly understood. In particular, the mechanisms that cause different symptoms in typical asthma (in which wheeze predominates) compared with cough variant asthma (in which cough predominates) have not been determined. Traditional explanations include higher wheezing thresholds, differences in cough sensitivity, and/or differences in small airway function. Recent studies using high-dose methacholine challenge testing suggest that altered small-airway function plays a role. Preservation or loss of the bronchoprotective effect of a deep inspiration may be a fundamental pathophysiologic difference between asthma, cough variant asthma, methacholine-induced cough with normal sensitivity, and eosinophilic bronchitis.

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Acknowledgments

The authors thank Ms. Caroline Hensman, MLT, Kingston General Hospital, Kingston, Canada, for processing sputum samples, and Dr. Charles Leduc, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Canada, for his assistance in obtaining the photomicrograph of sputum eosinophilia.

Conflict of interest

The research studies discussed in this review were funded by The Ontario Thoracic Society of the Ontario Lung Association, Physicians’ Services Incorporated Foundation, and the Queen’s University’s William Spear/Start Memorial Fund. In the past three years, MD Lougheed’s research has been funded by Queen’s University (William M. Spear Endowment/Start Memorial Fund), the Government of Ontario (Asthma Plan of Action), AllerGen Network for Centres of Excellence, the Ontario Lung Association/Ontario Thoracic Society, Canadian Institutes of Health Research (CIHR), and the Canadian Cystic Fibrosis Foundation. Pharmaxis Ltd. has provided dry powder mannitol (Aridol®) for research funded by Queen’s University and the Ontario Lung Association. S. E. Turcotte has received an Ontario Graduate Scholarship and a CIHR Canada Graduate Scholarship Master’s Award. M. D. Lougheed has been a site investigator for multicentre clinical trials funded by Ception Therapeutics Inc., MedImmune, and MPEX Pharmaceuticals. S. E. Turcotte and A. T. Fisher have no conflicts of interest or financial ties to declare.

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Authors and Affiliations

  1. Department of Medicine, Queen’s University, 102 Stuart Street, Kingston, ON, K7L 2V6, Canada

    M. Diane Lougheed, Scott E. Turcotte & Thomas Fisher

  2. Department of Biomedical and Molecular Sciences (Physiology), Queen’s University, 102 Stuart Street, Kingston, ON, K7L 2V6, Canada

    M. Diane Lougheed & Scott E. Turcotte

  3. Division of Respirology, Kingston General Hospital, Kingston, ON, Canada

    M. Diane Lougheed

  4. Asthma Research Unit, Clinical Research Centre, Kingston General Hospital, Kingston, ON, Canada

    M. Diane Lougheed, Scott E. Turcotte & Thomas Fisher

Authors
  1. M. Diane Lougheed
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  2. Scott E. Turcotte
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  3. Thomas Fisher
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Correspondence to M. Diane Lougheed.

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Lougheed, M.D., Turcotte, S.E. & Fisher, T. Cough Variant Asthma: Lessons Learned from Deep Inspirations. Lung 190, 17–22 (2012). https://doi.org/10.1007/s00408-011-9348-6

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  • DOI: https://doi.org/10.1007/s00408-011-9348-6

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