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Cough and asthma
1Grants Medical College, Mumbai. ykakr@vsnl.com
Insights
Cough is a common respiratory symptom, often linked to asthma, but can also signal other conditions. Recognizing diverse causes is key for accurate diagnosis and treatment.
Area of Science:
- Pediatrics
- Pulmonology
- Allergy & Immunology
Background:
- Cough is a frequent complaint in clinical practice, essential for respiratory tract function.
- Chronic or recurrent cough can indicate various diseases, with asthma being a primary cause.
- Asthma often presents with cough, wheeze, and breathlessness, though symptoms can vary, especially in children.
Purpose of the Study:
- To explore the multifaceted nature of cough as a symptom.
- To differentiate cough as a symptom of asthma versus other potential etiologies.
- To highlight the diagnostic challenges posed by cough variant asthma.
Main Methods:
- Review of clinical presentations of cough in pediatric patients.
- Analysis of the relationship between cough, wheezing, and asthma diagnosis.
- Discussion of differential diagnoses for persistent cough.
Main Results:
- Asthma can manifest with cough as the sole or predominant symptom, even without wheezing.
- Cough variant asthma exhibits airway hyperresponsiveness characteristic of asthma but lacks audible wheezing.
- Diverse conditions like gastroesophageal reflux, sinusitis, and tropical eosinophilia can mimic asthma-related cough.
Conclusions:
- Cough is a significant indicator of bronchial hyperresponsiveness, not exclusively asthma.
- Accurate diagnosis requires considering various etiologies beyond asthma for persistent cough.
- Further diagnostic testing is crucial when cough symptoms mimic asthma.
Abstract:
Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them. Cough, wheeze and breathlessness are classical features of asthma syndrome. Many diseases may lead to this syndrome. Asthmatic children present with cough of variable intensities and patterns. At times, wheeze and breathlessness may not be clinically apparent. It was well known that all that wheezes is not asthma but now it is well understood that every asthmatic child does not wheeze. In an acute attack of asthma, cough often starts at the end of wheezing episode. It leads to expulsion of thick, stringy mucus often in the form of casts. Though cough is a minor symptom during acute attack, it ensures removal of secretions and avoid complications. Cough is a prominent symptom in persistent asthma especially between acute exacerbations. Episodic nocturnal cough may be the only symptom of chronic asthma. Children with cough variant asthma do not wheeze. It is postulated that they have milder degree of airway hyperresponsiveness and higher wheezing threshold. However, they show all the characteristics of asthma on laboratory tests. Cough represents bronchial hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many diverse etiologies such as gastroesophageal reflux, enlarged adenoids, sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and relevant tests may be necessary for proper diagnosis.