Chronic Cough Due to Asthma: Recommendation
Patients with cough due to asthma should initially be treated with a standard antiasthmatic regimen of inhaled bronchodilators and inhaled corticosteroids. Quality of evidence, fair; net benefit, substantial; grade of recommendation.
A potential pitfall of inhaled steroid therapy in patients with CVA is that the treatment itself may induce or exacerbate cough, which is likely due to a constituent of the aerosol, For example, the more common occurrence of cough after the inhalation of beclomethasone dipropionate, compared to after the inhalation of triamcinolone acetonide, is thought to be due to a component of the dispersant in the former mixture, For cough that is severe or only partially responsive to inhaled corticosteroids, oral therapy (ie, prednisone 40 mg or equivalent daily for 1 week), alone or followed by inhaled therapy, may be necessary, However, the possibility of inhaled steroid-induced cough, improper use of the inhaler device, or the presence of another etiology, such as gastroesophageal reflux disease, making asthma difficult to control, should be excluded before the escalation of therapy, canadian neighbor pharmacy
In those patients in whom cough remains refractory to inhaled corticosteroids, an assessment of airway inflammation is helpful, The presence of airway eosinophilia demonstrated by the evaluation of induced sputum or BAL fluid will identify those patients who may benefit from more aggressive antiinflammatory therapy (ie, higher dose inhaled corticosteroids or oral steroid therapy). In patients whose cough is refractory to inhaled corticosteroids, an assessment of airway inflammation should be performed whenever available and feasible. The demonstration of persistent airway eosinophilia during such an assessment will identify those patients who may benefit from more aggressive antiinflammatory therapy. Quality of evidence, low; net benefit, substantial; grade of recommendation. The LTRA zafirlukast has been shown to improve subjective cough scores as well as to inhibit experimentally induced cough in subjects with CVA, including a subgroup of patients whose cough had been refractory to therapy with inhaled steroids, The ability of zafirlukast to suppress cough that was previously resistant to treatment with bronchodila-tors and inhaled steroids suggests that, in patients with CVA, treatment with LTRAs might more effectively modulate the inflammatory milieu of the sensory cough receptors within the airway epithelium, The mechanism by which this antitussive effect occurs remains unclear.