Cough-variant asthma in children and adults: case reports and review

doi:10.1016/0736-4679(90)90287-6

The Journal of Emergency Medicine

Volume 8, Issue 6, November–December 1990, Pages 727-731

https://doi.org/10.1016/0736-4679(90)90287-6 Get rights and content

Abstract

Two cases of cough-variant asthma are presented, one in an adult and one in a child. We discuss the diagnosis, treatment, and course of this common, yet often unrecognized entity. The keys to diagnosis are a typical history, clinical suspicion, and subsequent response to bronchodilator therapy. Treatment of cough-variant asthma is no different from that of classic asthma.

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Cited by (14)

Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: Background
2001, Annals of Emergency Medicine
Citation Excerpt :
No guidelines have been established for distinguishing transient from chronic bronchial hyperresponsiveness, and long-term follow-up studies suggest that abnormalities on pulmonary function testing in patients with uncomplicated acute bronchitis typically resolve after 2 to 3 weeks, although they may last as long as 2 months.15-17 The diagnosis of cough-variant asthma, in contrast, is generally reserved for patients with persistent cough ( >2 to 3 weeks’ duration), lack of wheezing, and (usually) normal results on pulmonary function tests.18,19 Cough-variant asthma should be suspected in adults with persistent cough that worsens at night or after exposure to cold or exercise; the diagnosis relies on improvement of symptoms with bronchodilator treatment or a positive result on a methacholine challenge test.
The following principles of appropriate antibiotic use for adults with acute bronchitis apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease.
- 1.
  The evaluation of adults with an acute cough illness or a presumptive diagnosis of uncomplicated acute bronchitis should focus on ruling out serious illness, particularly pneumonia. In healthy, nonelderly adults, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lung sounds, and chest radiography is usually not indicated. In patients with cough lasting 3 weeks or longer, chest radiography may be warranted in the absence of other known causes.
- 2.
  Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of duration of cough. If pertussis infection is suspected (an unusual circumstance), a diagnostic test should be performed and antimicrobial therapy initiated.
- 3.
  Patient satisfaction with care for acute bronchitis depends most on physician–patient communication rather than on antibiotic treatment.
[Gonzales R, Bartlett JG, Besser RE, Cooper RJ, Hickner JM, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Emerg Med. June 2001;37:720-727.]
Malignant cough equivalent asthma: Definition and case reports
1998, Annals of Allergy, Asthma and Immunology
Cough equivalent asthma is a cause for chronic cough and usually responds to corticosteroid therapy. Oral corticosteroids are employed in a diagnostic-therapeutic trial and inhaled corticosteroids are employed in maintenance therapy. In certain cases the cough may be especially severe and require escalated doses of oral corticosteroids for initial control. This is labeled malignant cough equivalent asthma.
To define malignant cough equivalent asthma, provide two case reports, and identify features that should alert physicians to consider the possibility of malignant cough equivalent asthma.
We report two patients who presented complaining of chronic cough that was disruptive of sleep and normal activities, and in one patient prompted an emergency room visit and later hospitalization. The patients underwent evaluation with history, physical examination, and laboratory testing as indicated. Other causes for chronic cough were ruled out by appropriate testing, or were treated, and patients did not respond to usual corticosteroid treatment for cough equivalent asthma. These patients were considered to have a more severe form of cough equivalent asthma and did respond to treatment with higher doses of oral corticosteroids.
Malignant cough equivalent asthma is a cause of chronic cough that is disruptive to sleep or normal activities, may lead to emergency room visits or hospitalization, and requires escalated doses of oral corticosteroids for initial control.
Chronic cough
1995, Medical Clinics of North America
Concomitant drugs-loaded microcapsules of roxithromycin and theophylline with pH-sensitive controlled-releasing properties
2020, International Journal of Polymeric Materials and Polymeric Biomaterials
Budesonide suspension nebulization treatment in Chinese pediatric patients with cough variant asthma: a multi-center observational study
2016, Journal of Asthma
Variant forms of asthma
2013, Revista Brasileira de Medicina

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Clinical communicationCough-variant asthma in children and adults: case reports and review

Abstract

J Pediatr.

Pediatr Clin North Am.

Chest

J Allergy Clin Immunol.

Chronic cough is a risk indicator of broncho-pulmonary disease

Eur J Respir Dis.

Chronic cough in infants and children

Laryngoscope

Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy

Am Rev Respir Dis.

Chronic cough: an approach to management

Compr Ther.

The approach to chronic cough in childhood

Ann Allergy

Variant asthma

Ann Allergy.

Exertional dyspnea and cough as preludes to acute attacks of bronchial asthma

N Engl J Med.

Clinical communication
Cough-variant asthma in children and adults: case reports and review