Chronic Cough: Eosinophilic Bronchitis Without Asthma

Gibson, Peter G.; Denburg, Judah A.; Dolovich, J.; Ramsdale, E H; Fe, Hargreave

doi:10.1016/s0140-6736(89)92801-8

Cited by 447 publications

(282 citation statements)

References 6 publications

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“…These findings are supported by the recent report of elevated eosinophil numbers and ECP in induced sputum obtained from patients with chronic cough and GOR [26]. Eosinophilic bronchitis in nonasthmatic patients with chronic cough was first described by GIBSON et al [4] and although the cough in these patients responded to steroids, it is apparent from the present study that not all patients with chronic cough and a predominant eosinophil component to their airway inflammation require steroid therapy. The mechanism underlying GOR-associated cough has not been defined and both reflux with aspiration or a neural reflex have been considered [27].…”

Section: Discussionsupporting

confidence: 90%

“…GIBSON and coworkers [4,21] reported increased numbers of both metachromatic cells and eosinophils in expectorated sputum from nonasthmatic patients with steroid-responsive cough. Induced sputum eosinophilia has also been reported recently in atopic patients with bronchodilator-resistant cough [22].…”

Section: Discussionmentioning

confidence: 99%

“…Elevated numbers of eosinophils and metachromatic cells have been reported in expectorated sputum samples from nonasthmatic patients with a steroid-responsive cough [4]. BOULET et al [5] described increased inflammatory cell numbers in bronchoalveolar lavage (BAL) fluid and airway inflammation in bronchial biopsy samples from nonasthmatic patients with CNPC when compared with controls.…”

mentioning

confidence: 99%

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Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Böllert¹,

Paton²,

Marshall³

et al. 1999

Eur Respir J

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Mast cells and eosinophils may play a role in the pathophysiology of chronic cough in nonasthmatics. It is unknown, however, whether degranulation of these cells occurs in the airways of such patients.Thirty-five nonsmoking patients referred with a chronic nonproductive cough (mean cough duration 76.2 months) were evaluated using a comprehensive diagnostic protocol. Bronchoalveolar lavage (BAL) cell differentials and BAL histamine, tryptase and eosinophilic cationic protein (ECP) concentrations were determined. Ten nonsmoking healthy volunteers served as controls.Diagnostic subgroups were identified: eight postnasal drip syndrome (PNDS), seven cough variant asthma (CVA), seven gastro-oeseophageal reflux (GOR), seven dual aetiology and six idiopathic. Nonasthmatic coughers (NAC) were characterized as those patients without bronchial hyperresponsiveness on histamine challenge and whose cough had either responded to therapy for PNDS or GOR or failed to improve with antiasthma therapy. There was a significant increase in both eosinophil and mast cell numbers (p<0.05) and in histamine levels (p=0.027) when NAC patients were compared with controls. Tryptase and ECP levels were elevated in 7 of 23 and 6 of 23 NAC patients, respectively.In conclusion, airway inflammatory cell numbers are not only increased but also activated, suggesting an important role for airways inflammation in the pathophysiology of chronic nonproductive cough. Eur Respir J 1999; 13: 59±65.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Böllert¹,

Paton²,

Marshall³

et al. 1999

Eur Respir J

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“…Eosinophilic bronchitis is a condition presenting with chronic cough and characterized by sputum eosinophilia like asthma, but unlike asthma the patients have no objective evidence of variable airflow obstruction or airway hyperresponsiveness [1,2]. The authors [3] and others [4] have shown that eosinophilic bronchitis is the cause of cough in 10±20% of patients presenting to a respiratory specialist.…”

mentioning

confidence: 99%

Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

et al. 2000

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Eosinophilic bronchitis is a common cause of chronic cough, characterized by sputum eosinophilia similar to that seen in asthma, but unlike asthma the patients have no objective evidence of variable airflow obstruction or airway hyperresponsiveness. The reason for the different functional associations is unclear. The authors have tested the hypothesis that in eosinophilic bronchitis the inflammation is mainly localized in the upper airway.In an open study the authors measured the lower (provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20)) and upper (PC25 MIF50) airway responsiveness to histamine, lower and upper airway inflammation using induced sputum and nasal lavage, in 11 patients with eosinophilic bronchitis. The authors assessed changes in these measures and in cough reflex sensitivity to capsaicin and cough severity after 400 mg of inhaled budesonide for 4 weeks.A nasal eosinophilia was present in only three patients with one having upper airway hyperresponsiveness. Following treatment with inhaled corticosteroids the geometric mean sputum eosinophil count decreased from 12.8% to 2.9% (mean difference 4.4-fold, 95% confidence interval (CI) 2.14±10.02), the mean SEM cough visual analogue score on a 100 mm scale decreased from 27.2 6.6 mm to 12.6 5.7 mm (mean difference 14.6, 95% CI 9.1±20.1) and the cough sensitivity assessed as the capsaicin concentration required to cause two coughs (C 2 ) and five coughs (C 5 ) improved (C 2 mean difference 0.75 doubling concentrations, 95% CI 0.36±1.1; C 5 mean difference 1.3 doubling concentration, 95% CI 0.6±2.1). There was a significant positive correlation between the fold change in sputum eosinophil count and doubling dose change in C 5 after inhaled budesonide (r=0.61).It is concluded that upper airway inflammation is not prominent in eosinophilic bronchitis and that inhaled budesonide improves the sputum eosinophilia, cough severity and sensitivity suggesting a causal link between the inflammation and cough. Eur Respir J 2000; 15: 682±686.

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“…One of the most representative airway disorders responsible for chronic cough is eosinophilic bronchitis [1], including bronchial asthma, non-asthmatic eosinophilic bronchitis (NAEB) [2], atopic cough (AC) [3], and cough variant asthma (CVA) [4]. Coughs are caused by cough reflex hypersensitivity in NAEB and AC.…”

Section: Introductionmentioning

confidence: 99%

Effects of macrolides on antigen-induced increases in cough reflex sensitivity in guinea pigs

Tokuda¹,

Ohkura²,

Fujimura³

et al. 2010

Pulmonary Pharmacology & Therapeutics

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Hence, they are used for both acute and chronic inflammatory airway diseases.However, the effects of these agents on allergic airway disorders presenting with an isolated chronic cough, such as non-asthmatic eosinophilic bronchitis and eosinophilic tracheobronchitis with cough hypersensitivity (atopic cough), still remain to be elucidated.Objective: To determine if macrolides are effective in the management of chronic cough caused by eosinophilic airway inflammation. Methods:The cough reflex sensitivity to inhaled capsaicin was measured at 48 h after challenge with an aerosolized antigen in actively sensitized guinea pigs.The 14-, 15-or 16-membered macrolides (erythromycin, azythromycin, or josamycin, respectively) were given intraperitoneally every 12 h after the antigen challenge. Bronchoalveolar lavage and the resection of the tracheal tissue were performed immediately after the measurement of the cough response to capsaicin. Results:The antigen-induced increase in the number of coughs elicited by capsaicin inhalation was significantly reduced by treatments with erythromycin and azythromycin, but not with josamycin. Erythromycin dose-dependently inhibited the increases in the substance P, prostaglandin E 2 and leukotriene B 4 levels, but not the histamine levels, in the bronchoalveolar lavage fluid. However, erythromycin did not influence the antigen-induced decrease in the neutral endopeptidase (NEP) activity in the tracheal tissue.Conclusions: Both 14-and 15-membered, but not 16-membered, macrolides 3 could reduce the antigen-induced cough reflex hypersensitivity by inhibiting the antigen-induced release of the afferent sensory nerve sensitizers. These macrolides may be therapeutically useful for the treatment of isolated chronic cough based on cough reflex hypersensitivity in allergic airway diseases such as non-asthmatic eosinophilic bronchitis and atopic cough.

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Chronic Cough: Eosinophilic Bronchitis Without Asthma

Cited by 447 publications

References 6 publications

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Theophylline induces a reduction in circulating interleukin-4 and interleukin-5 in atopic asthmatics

Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis

Effects of macrolides on antigen-induced increases in cough reflex sensitivity in guinea pigs

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