Skip to main content
SpringerLink
Log in

Cough Response to High-Dose Inhaled Corticosteroids in Patients with Chronic Cough and Fractional Exhaled Nitric Oxide Levels ≥ 25 ppb: A Prospective Study

  • BRIEF REPORT
  • COUGH
  • Published:
Lung Aims and scope Submit manuscript

Abstract

This study aimed to investigate the effects of high-dose inhaled corticosteroids (ICS) on chronic cough patients with elevated fractional exhaled nitric oxide (FeNO) levels. In a prospective study, adults with chronic cough and FeNO ≥ 25 ppb, without any other apparent etiology, received fluticasone furoate (200 mcg) for three weeks. Outcomes were evaluated using FeNO levels, cough severity, and Leicester Cough Questionnaire (LCQ) before and after treatment. Of the fifty participants (average age: 58.4 years; 58% female), the treatment responder rate (≥ 1.3-point increase in LCQ) was 68%, with a significant improvement in cough and LCQ scores and FeNO levels post-treatment. However, improvements in cough did not significantly correlate with changes in FeNO levels. These findings support the guideline recommendations for a short-term ICS trial in adults with chronic cough and elevated FeNO levels, but the lack of correlations between FeNO levels and cough raises questions about their direct mechanistic link.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Morice AH, Millqvist E, Bieksiene K et al (2020) ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 55(1):1901136

    Article  CAS  PubMed  Google Scholar 

  2. Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB (2022) Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 8(1):45

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lee JH, Lee JH, Park SY, Koskela HO, Song WJ (2023) Is fractional exhaled nitric oxide a treatable trait in chronic cough: a narrative review. J Thorac Dis 15(10):5844–5855

    Article  PubMed  PubMed Central  Google Scholar 

  4. Song WJ, Kim HJ, Shim JS et al (2017) Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: a systematic review and meta-analysis. J Allergy Clin Immunol 140(3):701–709

    Article  CAS  PubMed  Google Scholar 

  5. Sutherland L, Shaw K, Parrish C, Singleton N, McKeever TM, Stewart I, Shaw D, Martin MJ, Harrison T (2021) A low exhaled nitric oxide level excludes a short-term benefit from inhaled corticosteroids in suspected asthma: a randomized placebo-controlled trial. Respirology 26(7):666–672

    Article  PubMed  Google Scholar 

  6. Ambrosino P, Accardo M, Mosella M, Papa A, Fuschillo S, Spedicato GA, Motta A, Maniscalco M (2021) Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis. Ann Med 53(1):1659–1672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Song DJ, Song WJ, Kwon JW et al (2018) KAAACI evidence-based clinical practice guidelines for chronic cough in adults and children in Korea. Allergy Asthma Immunol Res 10(6):591–613

    Article  PubMed  PubMed Central  Google Scholar 

  8. Parker SM, Smith JA, Birring SS et al (2023) British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 78(Suppl 6):s3–s19

    Article  PubMed  Google Scholar 

  9. Lee SE, Lee JH, Kim HJ, Lee BJ, Cho SH, Price D, Morice AH, Song WJ (2019) Inhaled corticosteroids and placebo treatment effects in adult patients with cough: a systematic review and meta-analysis. Allergy Asthma Immunol Res 11(6):856–870

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Raj AA, Pavord DI, Birring SS (2009) Clinical cough IV: what is the minimal important difference for the Leicester Cough Questionnaire? Handb Exp Pharmacol 187:311–320

    Article  Google Scholar 

  11. Rhatigan K, Hirons B, Kesavan H, Turner RD, Ebelthite C, Hull JH, Jolley CJ, Birring SS, Cho PSP (2023) Patient global impression of severity scale in chronic cough: validation and formulation of symptom severity categories. J Allergy Clin Immunol Pract 11(12):3706–3712

    Article  PubMed  Google Scholar 

  12. Lai K, Zhan W, Wu F et al (2021) Clinical and inflammatory characteristics of the Chinese APAC cough variant asthma cohort. Front Med (Lausanne) 8:807385

    Article  PubMed  Google Scholar 

  13. Lee Y, Lee JH, Park SY, Lee JH, Kim JH, Kim HJ, Kim SH, Chung KF, Song WJ (2023) Roles of real-world evidence in severe asthma treatment: challenges and opportunities. ERJ Open Res 9(2):00248–02022

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morice AH, Jakes AD, Faruqi S et al (2014) A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response. Eur Respir J 44(5):1149–1155

    Article  PubMed  Google Scholar 

  15. Kang N, Won HK, Lee JH et al (2023) Health-related quality of life and its determinants in chronic cough: the Korean chronic cough registry study. Allergy Asthma Immunol Res 15(3):348–360

    Article  PubMed  PubMed Central  Google Scholar 

  16. Oh JY, Kang SY, Kang N, Won HK, Jo EJ, Lee SE, Lee JH, Shim JS, Kim YC, Yoo Y (2024) Characterization of codeine treatment responders among patients with refractory or unexplained chronic cough: a prospective real-world cohort study. Lung 202(2):97–106

    Article  PubMed  Google Scholar 

  17. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10(5):447–485

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rytilä P, Ghaly L, Varghese S, Chung W, Selroos O, Haahtela T (2008) Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function. Eur Respir J 32(4):989–996

    Article  PubMed  Google Scholar 

  19. Ponsioen BP, Hop WC, Vermue NA, Dekhuijzen PN, Bohnen AM (2005) Efficacy of fluticasone on cough: a randomised controlled trial. Eur Respir J 25(1):147–152

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was supported by a grant from the Korean Academy of Asthma, Allergy and Clinical Immunology. The grantor had no role in the study design, data collection, analysis, result interpretation, decision to publish, or manuscript preparation.

Author information

Author notes

  1. Ji-Ho Lee and Sung-Yoon Kang have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

    Ji-Ho Lee & Iseul Yu

  2. Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

    Sung-Yoon Kang

  3. University of Ulsan College of Medicine, Seoul, Korea

    Kyung Eun Park & Woo-Jung Song

  4. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Ji-Yoon Oh, Ji-Hyang Lee & Woo-Jung Song

  5. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

    So-Young Park

  6. Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea

    Min-Hye Kim

  7. Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea

    Eun-Jung Jo

  8. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

    Ji-Yong Moon

  9. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

    Sae-Hoon Kim

  10. Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea

    Sang-Hoon Kim

  11. Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Byung-Jae Lee

Authors
  1. Ji-Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sung-Yoon Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iseul Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyung Eun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji-Yoon Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ji-Hyang Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. So-Young Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Min-Hye Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eun-Jung Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ji-Yong Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sae-Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sang-Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Byung-Jae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Woo-Jung Song
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Korean Academy of Asthma Allergy, Clinical Immunology Working Group on Chronic Cough

Contributions

SHK, BJL, and WJS contributed to the study design. JHL, SYK, and WJS wrote the main manuscript text and prepared figure 1. IY, JYO, JHL, SYP, MHK, EJJ, JYM, and SHK contributed to the data collection. KEP was responsible for the statistical analysis. All authors reviewed the manuscript.

Corresponding author

Correspondence to Woo-Jung Song.

Ethics declarations

Competing Interest

WJS declares grants from Merck Sharp & Dohme Corp. and AstraZeneca, consulting fees from Merck, AstraZeneca, Shionogi, Bellus, and GSK, and lecture fees from Merck, AstraZeneca, GSK, Sanofi, and Novartis. Other authors declare that no conflicts of interest exist.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JH., Kang, SY., Yu, I. et al. Cough Response to High-Dose Inhaled Corticosteroids in Patients with Chronic Cough and Fractional Exhaled Nitric Oxide Levels ≥ 25 ppb: A Prospective Study. Lung (2024). https://doi.org/10.1007/s00408-024-00698-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00408-024-00698-y

Keywords

Search

Navigation