SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

9/19/05

Inhaled corticosteroid treatment for persistent cough after URI

Summary
Background - Some previously healthy individuals develop a persistent cough (PC) that may last weeks to months after an ordinary upper respiratory infection (URI). It has been postulated that the PC may be due to bronchial hyper responsiveness induced by the viral URI in such individuals.

Findings - Pornsuriyasak et al of the Ramathibodi Hospital in Bangkok, Thailand carried out a prospective, randomized double blind study comparing inhaled budesonide (BUD) 400 microg b.i.d. vs placebo in 30 non-smoking, non-asthmatic adults who had PC for over 3 weeks after a URI. The intensity of the cough related symptoms was similar in both groups at baseline.

At evaluation 2 and 4 weeks later, there was no significant difference in the degree of cough related symptoms between the BUD and placebo treated groups. There was also no difference between the 2 groups in mean changes in the FEV-1, FVC, and FEF 25-75%. A borderline positive methacholine challenge test was present in 3 patients.

Reference
 Respirology 2005;10:520-4

Editor's Comments
A common clinical impression is that the lingering dry cough in some individuals after remission of what appears to be a typical URI is due to increased "twitchiness" of the lower airways due to a local inflammatory reaction induced by the recent viral infection. One might expect such bronchial inflammation to be controlled by the BUD treatment in this study. However, no reduction of cough was seen in those treated with BUD. It is possible that the inhaled BUD did not reach the "irritated" areas in the lower airways. A trial of oral or parenteral steroids would answer that question. More likely, a steroid- responsive inflammation did not cause the cough.

An encouraging finding in this study was a progressive decrease in the mean cough related symptoms in both treatment groups during the 4 weeks of this study suggesting a gradual spontaneous clearing of the cough after the URI.

 

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