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• W2166013105 abstract "I read with interest the valuable article by Pratter et al (November 1999),1Pratter MR Bartter T Lotano R. The role of sinus imaging in the treatment of chronic cough in adults..Chest. 1999; 116: 1287-1291Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar regarding the role of sinus imaging in the management of chronic cough. Figure 2 in this article contains a useful algorithm for investigation and treatment of chronic cough. Unfortunately, one potentially important cause of cough will be missed by following this algorithm. Eosinophilic bronchitis is a recently described syndrome.2Gibson PG Dolovich J Denburg J et al.Chronic cough: eosinophilic bronchitis without asthma..Lancet. 1989; 1: 1346-1348Abstract PubMed Scopus (406) Google Scholar, 3Gibson PG Hargreave FE Girgis-Gabardo A et al.Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroids..Clin Exp Allergy. 1995; 25: 127-132Crossref PubMed Scopus (155) Google Scholar, 4Brightling CE Ward R Goh KL et al.Eosinophilic bronchitis as a common cause of cough..Am J Respir Crit Care Med. 1999; 160: 406-410Crossref PubMed Scopus (380) Google Scholar Subjects with eosinophilic bronchitis have cough with eosinophilic airway inflammation characteristic of that seen in asthma; however, these patients have normal lung function, negative methacholine challenges, and no evidence of variable airflow obstruction. The cough in this condition responds nicely to inhaled corticosteroids.2Gibson PG Dolovich J Denburg J et al.Chronic cough: eosinophilic bronchitis without asthma..Lancet. 1989; 1: 1346-1348Abstract PubMed Scopus (406) Google Scholar, 3Gibson PG Hargreave FE Girgis-Gabardo A et al.Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroids..Clin Exp Allergy. 1995; 25: 127-132Crossref PubMed Scopus (155) Google Scholar, 4Brightling CE Ward R Goh KL et al.Eosinophilic bronchitis as a common cause of cough..Am J Respir Crit Care Med. 1999; 160: 406-410Crossref PubMed Scopus (380) Google Scholar This syndrome would appear to be a precursor to (or perhaps the very mildest form of) symptomatic asthma. While the ”purists” would not include this within the umbrella of the label asthma, it seems reasonable to consider that this is a variant of the syndrome known as cough-variant asthma. In a recent study,4Brightling CE Ward R Goh KL et al.Eosinophilic bronchitis as a common cause of cough..Am J Respir Crit Care Med. 1999; 160: 406-410Crossref PubMed Scopus (380) Google Scholar corticosteroid responsive eosinophilic bronchitis with negative methacholine challenge was shown to be present in 13% of subjects with chronic cough. The authors have pointed out the poor predictive value of a positive methacholine challenge in predicting response to asthma therapy.1Pratter MR Bartter T Lotano R. The role of sinus imaging in the treatment of chronic cough in adults..Chest. 1999; 116: 1287-1291Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar,5Mello CH Irwin RS Curley FJ. Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause..Arch Intern Med. 1996; 156: 997-1003Crossref PubMed Google Scholar The relative common prevalence of eosinophilic bronchitis as a cause of cough underscores that a negative methacholine challenge is also a poor predictor of nonresponse to inhaled corticosteroids. There are two important messages. First, this questions the value of the routine use of methacholine challenges in the evaluation and management of chronic cough. It is possible that a brief diagnostic trial of high-dose inhaled corticosteroids might be a preferable tool at step 2 of the cough algorithm. Second, it suggests the potential value for standardized evaluation of sputum for inflammatory cells, particularly eosinophils, in arriving at a diagnosis and the management plan for cough." @default.
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• W2166013105 date "2000-07-01" @default.
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• W2166013105 title "Eosinophilic Bronchitis as a Cause of Cough" @default.
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• W2166013105 doi "https://doi.org/10.1378/chest.118.1.277" @default.
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