cough varient asthma

this lecture ( cough variant asthma ) has been presented by Dr. najia barg allil./ Abusetta chest center . in the event of Global astma day 2018.

1. Cough varient asthma Dr N ajia barq ellil

2. Chronic cough has been reported to be the fifth most common complaint seen by primary care physicians in the world, the third . Chronic cough in non-smoking, non-treated with ACE-inhibitor adults with normal chest radiogram could be a symptom of asthma and can be sub-classified into: cough-variant asthma, atopic cough, and eosinophilic bronchitis.

3. What is cough varient asthma? Cough -variant  asthma  is a  type of asthma  in which the main symptom is a dry, non-productive cough. (A non-productive cough does not expel any mucus from the respiratory tract.) People with cough-variant  asthma   often have no other "classic"  asthma symptoms , such as  wheezing  or shortness of breath.

4. Cough-variant  asthma  is sometimes called chronic cough to describe a cough that has lasted longer than six to eight weeks. The  coughing with asthma  can occur during the day or at night. If you have  nighttime asthma , it can interrupt  sleep . People with cough-variant asthma often notice that  coughing  increases with  exercise , called  exercise -induced asthma.  Coughing  may increase when they are exposed to  asthma triggers  or  allergy -causing substances like dust or strong fragrances, or when they are in cold air.

5. Subacute cough is defined as cough persisting for 3 to 8 weeks, and chronic cough as that persisting for more than 8 weeks.  Subacute cough is most often self-limited, but chronic cough may provide significant challenges for effective evaluation and management .

6. pathophysiology Cough variant asthma (CVA) has been recognized as a precursor of asthma or a pre-asthmatic state because of the mildly heightened bronchial responsiveness and efficacy of bronchodilator therapy. Nevertheless, the accumulating evidence indicates that the pathophysiology is different between CVA and bronchial asthma.

7. The most fundamental physiologic feature is a heightened cough response to methacholine -induced bronchoconstriction in CVA, while this response is rather reduced in bronchial asthma. The sensitivity of cough receptors located in the superficial layer of the airway wall is normal in CVA as well as bronchial asthma, but heightened in atopic cough..

8. The pathologic feature of CVA is eosinophilic inflammation of the central to peripheral airway, reflected by eosinophilia in induced sputum, biopsied bronchial mucosa, and bronchoalveolar lavage fluid. The diagnosis of CVA has been commonly made based on therapeutic diagnostic procedures, while pathophysiologic diagnosis is ideal.

9. The reason is that measurements of the sensitivity of cough receptors to inhaled capsaicin and cough response to induced bronchoconstriction are not possible at most chest clinics in the world. The efficacy of a beta2-agonist for a patient's coughing is evaluated to make a diagnosis of CVA. When the bronchodilator therapy is judged as efficacious, a tentative diagnosis of CVA is made.

10. Then , induction therapy is initiated o f solution of the cough. The induction therapy consists of beta2-agonists, leukotriene receptor antagonists, and inhaled corticosteroids. In some patients whose cough does not subside with the therapy, short-burst oral corticosteroids (1 to 3 weeks) may be added.

11. If the cough still does not subside with the therapy, the patient should be referred to cough specialists. When the cough subsides with the induction therapy, long-term management is recommended using inhaled corticosteroids, because 30% of patients develop typical bronchial asthma within several years.

12. . Problems with the therapeutic diagnosis are as follows: spontaneous relief of cough leading to a false positive result, and resistance to the therapy, leading to a false-negative result. Thus, a pathophysiologic diagnostic procedure should be established in the future

13. Causes of cough varient asthma Like "classic" or "typical" asthma, no one really knows what causes cough-variant asthma. However, coughing may start after people are exposed to allergens, or when they are breathing in cold air. Coughing may also follow an upper respiratory infection. For example,  sinusitis  with asthma is common.

14. In addition, a cough that begins after a person has begun taking beta-blockers is likely to be cough-variant asthma. Beta-blockers are drugs used to treat  high blood pressure ,  heart disease ,  heart failure ,  migraines , palpitations, and other conditions. Beta-blockers are also found in  eye  drops to treat  glaucoma  and other  eye problems . These  eye  drops can bring on asthma symptoms, including cough.  Aspirin -sensitivity is another cause of coughing with asthma.

15. Diagnosis Doctors often use the methacholine challenge test to diagnose CVA. In this test, you inhale methacholine in the form of an aerosol mist while doing spirometry . Your doctor then monitors the airways as they expand and narrow. If your lung function declines by at least 20 percent during the test, then the doctor will diagnose asthma.

16. The methacholine challenge test is often done in a special facility. If a doctor suspects CVA, they may start asthma treatment without a definitive diagnosis. If it helps manage your cough, this can confirm CVA.

17. TREATMENT in haled corticosteroids  (inhalers): One of the most important methods of CVA is to use inhaled corticosteroids, also known as inhalers. This medication controls cough, prevents the onset of wheeze, and reduces airway obstruction in people with CVA. If you have CVA or chronic asthma, it’s best to take inhalers daily as prescribed. Examples include  budesonide  ( Pulmicort ) and  fluticasone  ( Flovent ). You can learn more about which corticosteroid is best for you at  Partners Healthcare Asthma Center .

18. Oral medications : Doctors often supplement inhalers with oral pills called leukotriene modifiers. They help relieve asthma symptoms for 24 hours. Examples include  montelukast  ( Singulair ) and  zileuton  ( Zyflo ). Bronchodilators : These substances relax the muscles that tighten around the airways, leading them to open. They can act short-term or long-term. Short-term bronchodilators, such as  albuterol , are used to relieve asthma symptoms during an attack or before intense exercise. They aren’t used in the daily treatment of asthma.

19. In contrast, long-term bronchodilators are used with inhaled steroids on a daily basis to manage chronic asthma. Beta-2 agonists are another example of bronchodilators, and can be short-term or long-term acting . Nebulizers : Sometimes doctors will prescribe a nebulizer if other medications aren’t working for you. Nebulizers automatically spray medication in a mist through a mouthpiece. This allows the lungs to easily absorb the medication