Introduction

Diagnosis of protracted acute cough using patient’s history and test results and initiating the accurate therapy might be challenging for the physicians. Cough variant asthma (CVA) is a significant trigger of acute cough. The clinical improvement of these patients is mainly dependent on the subjective improvement. CVA is difficult to diagnose and may lead to classic asthma if left untreated or is mis-diagnosed. Some doctors try to prevent the CVA progression to asthma through aggressive upfront combination therapy to resolve the cough. However, after resolution of cough, some patients may need daily inhaled corticosteroids to prevent relapse.

Aim

To evaluate the efficacy of different treatment modalities using cough improvement, the only available clinical response among patients with CVA.

Method

Study Design

• Retrospective observational study

  Patient Profile

• Patients with acute persistent cough with any of the characteristics – cough more at night, with shortness of breath, interrupting speech and meals, progressive in nature, persistent and interrupting sleep were included.
• Patients presenting with gastroesophageal reflux disease (GERD)-associated cough, allergic rhinitis, bronchial asthma, smokers and atopic cough were excluded
• Patients on specific medications such as beta-blockers, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, chemotherapy, psychiatric treatment or with any other medical conditions which may have an impact on asthma symptoms
• Those who take budesonide are excluded from exclusion criteria
• Patients with any contributing factors that may alleviate the manifestations of CVA were excluded such as allergen exposure, poor air quality, air pollution, occupational exposures, smoking, respiratory infections, climate and weather changes, allergic rhinitis, GERD, medication allergies and psychological stress

Treatment Strategy

• All patients filled in a questionnaire which assessed their symptoms using 7-point Likert scale over last 2 weeks
• More favorable clinical response after formoterol-budesonide use was indicated by high scores

Endpoints

• Improvement in cough symptoms

Results

• Out of the 641 patients, 549 patients confirmed receiving budesonide-formoterol from the pharmacy, and 497 confirmed using it
• The frequency of cough symptoms improved significantly in patients after treatment with Budesonide-Formoterol as seen in Figure 1.

  Figure 1. Frequency of cough symptoms before and after using budesonide-formoterol

  

• There was a remarkable improvement in the frequency of cough symptoms like waking them up at night, persistent continuous, more at night, disturbing speech or eating, with shortness of breath after using the budesonide-formoterol inhaler; p<0.001
• Majority of the patients (86.3 %) showed improvement in their cough symptoms
• A significant yet weak positive correlation was demonstrated between the frequency of cough symptoms before and after using budesonide-formoterol (p<0.001)

Conclusion

• Significant improvement in the frequency of cough symptoms after using budesonide-formoterol was seen in patients with acute cough.
• Patients with more frequent cough symptoms at baseline were more likely to show improvement, suggesting the potential role of budesonide-formoterol in managing underlying causes of cough symptoms such as airway inflammation and bronchoconstriction.

Saudi J Biol Sci. 2023 Dec; 30(12): 103875.