Suspect in patients with:
- A history of prior recurrent episodes lasting >3 weeks (too long for simple viruses).
- Dyspnea accompanies the coughing
- Nocturnal coughing prominent [also happens if orthopnea from CHF]
Main clue — any (or all) of the following Abnormal Lung Sounds (bilaterally):
- Wheezes (long, high-pitched, expiratory)
- Rhonchi (long or short, high- or low-pitched, inspiratory &/or expiratory squeaks & gurgles)
- Expiratory Phase longer than Inspiratory (“E > I”), which is opposite of a normal exam
“Cough Asthma” = Asthma with Normal Lung Sounds
- CXR will rule out other lung diseases
- PFTs or Methacholine Challenge test may help
- Clinically — Dx with trial of inhaled bronchodilator.
- “Nonasthmatic Eosinophilic Bronchitis” very similar but won’t respond to bronchodilators. Give trial of inhaled steroid.