Recognizing chronic cough as a distinct problem in severe asthma

Published online January 10, 2025

Cough is a common symptom of asthma. However, the prevalence and clinical significance of chronic cough in patients with severe asthma receiving treatment remain relatively unknown. Traditionally, cough was viewed primarily as a symptom of asthma itself, yet it continues to be one of the most challenging symptoms to manage in asthma patients. Moreover, previous asthma guidelines and clinical trials rarely included cough-specific measurements, creating a significant gap in our understanding and management of cough in severe asthma.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Lee et al. examined the relationship between chronic cough and clinical outcomes in patients with severe asthma. They analyzed 6-month longitudinal follow-up data from the Korean Severe Asthma Registry, a nationwide multicenter registry of patients receiving guideline-based treatment at asthma referral centers. Chronic cough was defined as having moderate to severe cough at both baseline and six-month follow-up visits. The researchers investigated the relationship between chronic cough and various clinical outcomes, including medication use, asthma exacerbations, asthma control status, and quality of life.

The findings revealed that more than 40% of patients with severe asthma had chronic cough. These patients were significantly more likely to have uncontrolled asthma throughout the study period and experienced asthma exacerbations 1.7 times more frequently than those without chronic cough. Patients with severe asthma and chronic cough were prescribed oral corticosteroids twice as often for rescue treatment and anti-inflammatory relievers more than three times as often as those without chronic cough. Notably, despite these intensive treatments, subjects with chronic cough still experienced worse quality of life and poorer asthma control, suggesting that conventional asthma controllers might not effectively relieve cough in these patients.

Based on this real-world study, the authors emphasized the importance of recognizing cough as a distinct problem in asthma management. They highlighted the need to develop more effective strategies for assessing and managing cough to improve long-term outcomes and quality of life for patients with severe asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Full Article