Eosinophilic inflammation in cough variant asthma

Niimi, Akio; Amitani, Ryoichi; Suzuki, Kazuyuki; Tanaka, Eisaku; Murayama, Takako; Kuze, Fumiyuki

doi:10.1183/09031936.98.11051064

Cited by 162 publications

(175 citation statements)

References 24 publications

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“…FUJIMURA et al [20] found high rates of sputum eosinophilia suggesting that their group of adults with chronic cough may have been asthmatic [20]. NIIMI et al [21] found that percentages of eosinophils and ECP in the cough group were similar to that of confirmed asthmatics and significantly higher than controls. MCGARVEY et al [22] using a comprehensive diagnostic protocol for chronic nonproductive cough in adults, divided patients according to aetiology of cough.…”

Section: Normalmentioning

confidence: 98%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

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Isolated chronic cough in childhood is a common complaint. Although the symptom cough is included in the definition of childhood asthma, there is debate as to whether the majority of these children have asthma. The authors studied children with isolated chronic cough looking for evidence of airway inflammation typical of asthma, with increased numbers of airway eosinophils as assessed from bronchoalveolar lavage (BAL).The investigations were carried out on 23 children (median age: 6.7 yrs; (range: 1.7±12.75 yrs), attending the Royal Belfast Hospital for Sick Children for elective surgery, who also had a chronic unexplained cough. Written informed consent was obtained from the parent(s) and a nonbronchoscopic BAL was performed. BAL samples were analysed for total and differential white cell counts and also for the inflammatory mediators, eosinophil cationic protein (ECP) and histamine. Results were compared with a group of normal nonatopic children and also a group of atopic asthmatic children, who had been recruited for other studies on airway inflammation.There was a small but statistically significant increase in BAL percentage eosinophils in the children with chronic cough compared with nonasthmatic controls (0.28% versus 0.10%, p=0.03). However, the children with cough had lower percentage eosinophils than the atopic asthmatic controls (0.28% versus 0.66%, p=0.01). Three out of 23 children with chronic cough had BAL eosinophils greater than the normal upper 95% reference interval in BAL. There was a small but statistically significant increase in percentage neutrophils in the children with cough compared with the nonasthmatic controls (5.85% versus 3.21%, p=0.03). Four out of the 23 children had BAL neutrophils greater than the normal upper 95% reference interval in BAL.The authors conclude that only a minority of children with chronic unexplained cough have asthmatic-type airway inflammation. It is speculated that the increased percentage neutrophils in bronchoalveolar lavage from children with cough could relate to underlying persistent airways infection.

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Section: Normalmentioning

confidence: 98%

Chronic cough in children: bronchoalveolar lavage findings

Fitch¹,

Brown²,

Schock³

et al. 2000

Eur Respir J

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“…An elevated number of eosinophils and metachromatic cells are found in sputum samples of patients with asthma, CVA and EB [102,103]. Recognition of airway eosinophilic inflammation may assist in the assessment of the cause of chronic cough, as well as in the selection of treatment options.…”

Section: Sputum Analysismentioning

confidence: 99%

The diagnosis and management of chronic cough

Morice¹

2004

Eur Respir J

468

360

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“…In the recent years there has been an increase in our understanding of the pathophysiology of cough-variant asthma, nonasthmatic eosinophilic bronchitis and atopic cough [Brightling et al 2003[Brightling et al , 2002[Brightling et al , 2000a[Brightling et al , 2000bBrightling and Pavord, 2000;Niimi et al 2000Niimi et al , 1998]. These three conditions have similar immunopathological characteristics with classic asthma in the form of an eosinophilic-driven inflammatory process.…”

Section: Pathophysiology Of Atypical Asthmamentioning

confidence: 99%

“…Whilst eosinophilic inflammation forms a common pathophysiological characteristic of classic asthma, cough-variant asthma, nonasthmatic eosinophilic bronchitis and atopic cough are distinct due to the differences in the location of the inflammatory cells and the thickness of the subepithelial layer reported in these conditions, hence the likely reasons for the phenotypical disparity observed [Brightling et al 2002;Niimi et al 1998]. …”

Section: Pathophysiology Of Atypical Asthmamentioning

confidence: 99%

Unusual asthma syndromes and their management

Morjaria

Kastelik

2011

Therapeutic Advances in Chronic Disease

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Asthma usually presents with symptoms of wheeze, dyspnoea and cough. However, clinicians should be aware of atypical presentation of this disorder when cough is the main or only symptom in conditions such as cough-variant asthma, nonasthmatic eosinophilic bronchitis and atopic cough. Early diagnosis and treatment of these conditions with inhaled corticosteroids improves symptoms in the majority of patients. Up to 10% of patients with asthma remain poorly controlled in spite of optimal standard therapy. These patients have been encompassed under the term 'treatment-refractory asthma' (TRA), have the greatest morbidity and are responsible for more than 50% of healthcare costs. In this review we discuss investigations, management and pathophysiology of the various phenotypes of atypical presentations of asthma as well as novel biological agents licensed and those that have been reported in clinical trials in terms of their efficacy and safety in TRA.

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Eosinophilic inflammation in cough variant asthma

Cited by 162 publications

References 24 publications

Chronic cough in children: bronchoalveolar lavage findings

Chronic cough in children: bronchoalveolar lavage findings

The diagnosis and management of chronic cough

Unusual asthma syndromes and their management

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