Chronic cough as the sole presenting manifestation of bronchial asthma.

Six patients with chronic cough, without history of dyspnea or wheezing, had normal base-line spirometry but hyper-reactive airways, as demonstrated with methacholine. Maintenance therapy with bronchodilators promptly eliminated the cough in all patients. Three to 12 months later therapy was discontinued for three days, cough returned, and detailed pulmonary-function studies were carried out. Again, base-line values were normal, but after methacholine one-second forced expiratory volume decreased an average of 40 per cent in the patients as compared to 30 per cent in normal controls (P less than 0.001). The point of identical flow was increased by methacholine to 43.5 per cent of vital capacity in the patients, as compared to 6 per cent in normal controls (P less than 0.001), and the alveolar plateau was 4.8 deltaN2 per liter, as compared to 1.4 in normal controls (P less than 0.01). Specific airway conductance was lowered in patients and controls, but the post-methacholine value was significantly lower in the patients. On the basis of their persistently hyper-reactive airways, inducible diffuse airway bronchoconstriction and excellent response to bronchodilator therapy, these patients appear to have a variant form of asthma in which the only presenting symptom is cough.

[1]  J. Gaylor THE INTRINSIC NERVOUS MECHANISM OF THE HUMAN LUNG , 1934 .

[2]  Alice G. Elftman The afferent and parasympathetic innervation of the lungs and trachea of the dog , 1943 .

[3]  J. H. Comroe,et al.  A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease. , 1956, The Journal of clinical investigation.

[4]  R. Honjin On the nerve supply of the lung of the mouse, with special reference to the structure of the peripheral vegetative nervous system , 1956, The Journal of comparative neurology.

[5]  A. B. Dubois,et al.  The relationship between airway resistance, airway conductance and lung volume in subjects of different age and body size. , 1958, The Journal of clinical investigation.

[6]  J. Nadel,et al.  Effect of a previous deep inspiration on airway resistance in man. , 1961, Journal of applied physiology.

[7]  C. E. Reed,et al.  METHACHOLINE AEROSOL AS TEST FOR BRONCHIAL ASTHMA. , 1965, Archives of internal medicine.

[8]  R. Townley,et al.  COMPARATIVE ACTION ON ACETYL-BETA-METHYLCHOLINE, HISTAMINE, AND POLLEN ANTIGENS IN SUBJECTS WITH HAY FEVER AND PATIENTS WITH BRONCHIAL ASTHMA. , 1965, The Journal of allergy.

[9]  H. Sevelius,et al.  Antitussive effect of ethyl dibunate in patients with chronic cough , 1967, Clinical pharmacology and therapeutics.

[10]  J. Nadel,et al.  Role of autonomic nervous system and the cough reflex in the increased responsiveness of airways in patients with obstructive airway disease. , 1967, The Journal of clinical investigation.

[11]  P. Macklem,et al.  Resistance of central and peripheral airways measured by a retrograde catheter. , 1967, Journal of applied physiology.

[12]  J. Hogg,et al.  Site and nature of airway obstruction in chronic obstructive lung disease. , 1968, The New England journal of medicine.

[13]  P. Macklem,et al.  Site of airway obstruction in asthma as determined by measuring maximal expiratory flow breathing air and a helium-oxygen mixture. , 1972, The Journal of clinical investigation.

[14]  P. Macklem,et al.  Ventilation distribution in anatomical lung units. , 1974, Journal of applied physiology.

[15]  P. Macklem,et al.  The Use of a Helium-Oxygen Mixture during Maximum Expiratory Flow to Demonstrate Obstruction in Small Airways in Smokers. , 1975, The Journal of clinical investigation.

[16]  McFadden Er,et al.  Exertional dyspnea and cough as preludes to acute attacks of bronchial asthma. , 1975 .

[17]  J. Brody,et al.  Regional bronchoconstriction in asthma. 133Xenon washout scans following parenteral methacholine. , 1976, Chest.

[18]  S. Braman,et al.  Cough. A comprehensive review. , 1977, Archives of internal medicine.

[19]  W. Hall,et al.  Respiratory syncytial virus infection in adults: clinical, virologic, and serial pulmonary function studies. , 1978, Annals of internal medicine.