Asthma (as cause of Chronic Cough)

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.