Outcome of cough variant asthma treated with inhaled steroids.

Background: Cough variant asthma is defined as a persistent nonproductive cough with minimal wheezing or dyspnea. The uncontrolled coughing may interfere with sleep, work, and social activities. Cough precipitating fecal or urinary incontinence can be extremely distressing. The diagnosis is established within 1 to 2 weeks by a trial of prednisone, 30 mg a day. The cough will be controlled within that time and subsequent management can consist of inhaled corticosteroids.

Objective: To evaluate the course of ten patients with cough variant asthma and their response to inhaled corticosteroids.

Methods: Retrospective analysis of the presentation, diagnosis, course, and response to oral and inhaled steroids in ten patients with cough variant asthma.

Results: Ten patients whose chief complaint was persistent debilitating cough for periods of 2 months to 20 years underwent a diagnostic and therapeutic trial of prednisone as previously described. At a mean follow-up period of 28 months all were free of debilitating cough. Eight of ten patients were still receiving inhaled steroids and two needed low dose alternate day oral steroid therapy. Two patients had complete remission of symptoms. None required daily inhaled or oral bronchodilators and there were no hospital admissions for respiratory symptoms.

Conclusions: Inhaled corticosteroid therapy after a diagnostic trial of oral steroids is effective for long-term control of cough variant asthma.