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Canadian Respiratory Journal
Volume 6, Issue 4, Pages 323-330
Original Article

Nonasthmatic Chronic Cough: No Effect of Treatment with an Inhaled Corticosteriod in Patients without Sputum Eosinophilia

Marcia MM Pizzichini,1 Emilio Pizzichini,1 Krishnan Parameswaran,2 Lynda Clelland,2 Ann Efthimiadis,2 Jerry Dolovich,2 and Frederick E Hargreave2

1Respiratory Division (NUPAIVA), Department of Internal Medicine, University of Santa Catarina (UFSC), Florianópolis, Brazil
2Asthma Research Group, Departments of Medicine and Paediatrics, St Joseph’s Hospital and McMaster University, Hamilton, Ontario, Canada

Copyright © 1999 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Inhaled corticosteroids are effective in suppressing a chronic cough without asthma associated with sputum eosinophilia.

OBJECTIVE: To investigate the inflammatory characteristics in the induced sputum of patients with a chronic cough without asthma or known cause and the effects of budesonide treatment on chronic cough in those patients.

PATIENTS AND METHODS: Forty-four adults (mean [minimum, maximum] age of 45 years [20,75], 28 women, 17 atopic subjects and 32 nonsmokers]), with a daily bothersome cough for at least one year and who had no evidence of asthma or other known cause for the cough, were consecutively enrolled. The trial was a randomized, double-blind, controlled parallel group trial of budesonide 400 mg twice daily for two weeks versus placebo. Patients then received open administration of the same dose of budesonide for a further two weeks. Sputum was induced before and at the end of each treatment period. Cough severity was documented by a visual analogue scale.

RESULTS: Thirty-nine (89%) patients produced mucoid sputum after induction on at least one study visit. At baseline, the majority (59%) had a mild elevation in the median proportion of neutrophils (65%). All had elevated fluid phase levels of fibrinogen (3200 µg/L) and albumin (880 µg/L), and high levels of interleukin-8 and substance P. Interleukin-8 correlated with neutrophils (rho=0.72, P<0.001), fibrinogen (rho=0.65, P<0.001), albumin (rho=0.67, P=0.001) and eosinophil cationic protein (rho=0.60, P=0.001). Substance P correlated with albumin (rho=0.60, P=0.006). No subject had an increase in eosino-phils. Treatment with budesonide did not affect cough or sputum measurements.

CONCLUSIONS: Patients with nonasthmatic chronic cough enrolled in this study had evidence of a mild neutrophilia and/or microvascular leakage. Chronic cough did not respond to treatment with budesonide, perhaps because the cause was not associated with sputum eosinophilia.