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Abstract: Cough variant asthma is a specific type of asthma with chronic cough as the main or only clinical manifestation, characterized by irritant dry cough and nocturnal cough, with symptomatic episodes mostly evident when exposed to allergens, cold air and irritant gases. The diagnosis of cough variant asthma was confirmed by pulmonary function excitation test, and the cough symptoms improved significantly after standardized anti-asthma treatment.
Basic information】Female, 37 years old
Disease Type】Cough variant asthma
Hospital】Wuhan University People’s Hospital
Date of consultation】April 2022
Treatment plan】Allergen avoidance + inhaler treatment (budesonide formoterol inhalation powder) + oral medication (montelukast sodium tablets, compound methocarbamol capsules)
Treatment period】6 days of inpatient treatment and outpatient follow up
Effectiveness】The disease has been controlled and the cough symptoms have been significantly relieved.
I. Initial consultation
Ms. Zhang has had a dry cough with no obvious cause for the past 4 months, mainly at night. When exposed to cold air and irritating gases, the cough worsens significantly, and when the cough is severe, there may be chest tightness, no coughing of sputum or hemoptysis, but no fever, night sweats, acid reflux, heartburn, abdominal pain, abdominal distension and other discomforts, and no significant relief of cough symptoms with self-treatment with anti-cough and anti-inflammatory drugs. He had a history of allergic rhinitis for more than 10 years, and was allergic to pollen and dust mites.
In view of the patient’s previous history of allergic rhinitis for many years and the obvious cough at the time of admission, which was mostly dry, sensitive to irritating gases and cold air, and allergic to pollen and dust mites, the patient was considered to have a high probability of cough variant asthma and was admitted to the hospital to improve further examination.
II. Treatment history
After the patient was admitted to the hospital, further investigations were actively completed, including chest CT, routine blood tests, serum IGE, allergens, exhaled nitric oxide, and pulmonary function excitation tests, and the diagnosis of cough variant asthma was confirmed. After the diagnosis was confirmed, I informed the patient of the precautions related to allergic rhinitis. The patient was instructed to avoid contact with allergens, cold air, toxic and harmful particles and irritating gases, and was given budesonide formoterol inhalation powder for inhalation, as well as oral montelukast sodium tablets and compound metronomic capsules for treatment.
Third, the treatment effect
After adopting these treatment measures, the patient’s cough symptoms improved significantly and chest tightness was completely relieved. The patient’s condition improved and he was discharged successfully after 6 days of hospitalization. The patient was instructed to avoid contact with allergens, cold air and irritating gases after discharge, and to pay attention to the regular use of the inhaler budesonide formoterol inhalation powder nebulizer. After 3 months of treatment, the patient came for a recheck of pulmonary function to assess the improvement of airway hyperresponsiveness and was found to have improved from the previous situation, and the cough symptoms had largely disappeared.
IV. Notes
We are glad that the patient is improving after treatment. However, since cough variant asthma and allergic rhinitis are often prone to recurrence in daily life, patients should pay attention to rest, avoid contact with allergens, avoid strain and cold, and avoid inhaling cold air and toxic and harmful particles and irritating gases. Diet-wise, patients should avoid spicy and stimulating foods, and try to avoid the intake of seafood, mangoes and other allergy-prone foods, while using inhaler therapy as needed. If the disease recurs again, the patient should go to the hospital in time to avoid delaying the disease.
V. Personal insight
Cough variant asthma is an asthma with cough as the main or only symptom, which is a special type of asthma characterized by irritating dry cough and nocturnal cough. In this case, the patient’s symptoms were obvious when she was exposed to allergens, cold air and irritating gases, and the attack symptoms were more typical, so she was given targeted medication to keep away from allergens, and her symptoms were quickly improved. However, it should be noted that in case of recurrent prolonged dry cough with normal chest imaging, prompt improvement of pulmonary function provocation or diastolic tests is required.