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Does prednisone help a cough. Prednisone for Cough: Efficacy in Treating Cough Variant Asthma

by alexxlab

What is cough variant asthma. How can prednisone help diagnose and treat persistent cough. What are the benefits of using oral corticosteroids for post-infectious cough. How effective is a diagnostic-therapeutic trial with prednisone for cough variant asthma.

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Understanding Cough Variant Asthma: A Persistent and Troublesome Condition

Cough variant asthma (CVA) is a unique form of asthma characterized by a persistent, nonproductive cough with minimal or no wheezing and dyspnea. This condition can be easily overlooked or misdiagnosed, leading to prolonged suffering for patients. CVA presents a diagnostic challenge for healthcare providers, as its symptoms can mimic other respiratory conditions.

Patients with CVA often experience:

  • A chronic, dry cough lasting for extended periods
  • Minimal or no wheezing
  • Little to no shortness of breath
  • Significant impact on quality of life

The Impact of Persistent Cough on Patients’ Lives

The severity of cough associated with CVA can have far-reaching consequences on patients’ daily lives. Some of the reported side effects and complications include:

  • Interference with social life and work
  • Sleep disturbances
  • Urinary and stool incontinence
  • Hoarseness
  • Vomiting

These symptoms can persist for extended periods, ranging from a few months to several years, significantly impacting the patient’s quality of life and overall well-being.

The Role of Prednisone in Diagnosing and Treating Cough Variant Asthma

Prednisone, an oral corticosteroid, has shown promising results in both diagnosing and treating cough variant asthma. But how exactly does prednisone help with CVA?

Prednisone works by:

  1. Reducing inflammation in the airways
  2. Suppressing the immune response that triggers cough
  3. Providing rapid relief of symptoms
  4. Serving as a diagnostic tool for CVA

The Diagnostic-Therapeutic Trial: A Dual-Purpose Approach

A short course of prednisone can serve as both a diagnostic tool and an initial treatment for CVA. This approach, known as a diagnostic-therapeutic trial, offers several advantages:

  • Quick identification of CVA as the underlying cause of persistent cough
  • Rapid symptom relief for patients
  • Guidance for long-term treatment planning
  • Avoiding unnecessary tests and treatments for other potential causes of cough

Efficacy of Prednisone in Treating Cough Variant Asthma: Clinical Evidence

Research has demonstrated the effectiveness of prednisone in treating CVA. In a study involving ten patients with persistent, nonproductive cough, the following results were observed:

  • Nine out of ten patients reported significant improvement in cough within three days of starting prednisone
  • One patient required two weeks of therapy for optimal improvement
  • All patients were subsequently controlled primarily with inhaled corticosteroids

These findings highlight the rapid and effective response to prednisone in patients with CVA, supporting its use as both a diagnostic and therapeutic tool.

Time to Symptom Improvement: What Can Patients Expect?

When using prednisone for CVA, how quickly can patients expect to see results? Based on the clinical evidence:

  • Most patients experience significant improvement within 3 days
  • Some patients may require up to 2 weeks for optimal response
  • Individual responses may vary depending on the severity and duration of symptoms

Long-Term Management of Cough Variant Asthma: Beyond Prednisone

While prednisone can be highly effective for short-term relief and diagnosis of CVA, long-term management typically involves other treatment modalities. What are the options for ongoing CVA control?

Common long-term management strategies include:

  • Inhaled corticosteroids as the primary maintenance therapy
  • Leukotriene receptor antagonists
  • Long-acting beta-agonists in combination with inhaled corticosteroids
  • Lifestyle modifications and trigger avoidance

The Transition from Oral to Inhaled Corticosteroids

After the initial diagnosis and treatment with prednisone, most patients with CVA can be effectively managed with inhaled corticosteroids. This transition offers several benefits:

  • Reduced systemic side effects compared to oral corticosteroids
  • Targeted delivery of medication to the airways
  • Improved long-term safety profile
  • Easier adherence to daily treatment regimens

Potential Side Effects and Considerations of Prednisone Use

While prednisone can be highly effective in treating CVA, it’s important to consider potential side effects and limitations. What are the risks associated with prednisone use?

Common side effects of short-term prednisone use may include:

  • Increased appetite and weight gain
  • Mood changes or irritability
  • Insomnia
  • Elevated blood sugar levels
  • Fluid retention

Long-term use of oral corticosteroids can lead to more serious side effects, which is why transitioning to inhaled corticosteroids for maintenance therapy is preferred when possible.

Balancing Benefits and Risks: Individualizing Treatment Approaches

When considering prednisone for CVA, healthcare providers must carefully weigh the potential benefits against the risks for each patient. Factors to consider include:

  • The severity and duration of symptoms
  • The patient’s overall health and comorbidities
  • Potential drug interactions
  • The likelihood of response to treatment
  • The availability of alternative diagnostic and therapeutic options

The Importance of Accurate Diagnosis in Persistent Cough Management

Accurate diagnosis is crucial for effective management of persistent cough, including CVA. Why is proper diagnosis so important in these cases?

The significance of accurate diagnosis lies in:

  • Avoiding unnecessary or ineffective treatments
  • Preventing prolonged suffering and complications
  • Guiding appropriate long-term management strategies
  • Improving overall patient outcomes and quality of life

Differential Diagnosis: Ruling Out Other Causes of Chronic Cough

Before initiating a diagnostic-therapeutic trial with prednisone, it’s essential to consider and rule out other potential causes of chronic cough. What are some other conditions that can mimic CVA?

Common differential diagnoses for chronic cough include:

  • Gastroesophageal reflux disease (GERD)
  • Postnasal drip syndrome
  • Chronic bronchitis
  • Bronchiectasis
  • Medication-induced cough (e.g., ACE inhibitors)
  • Lung cancer or other malignancies

Future Directions: Ongoing Research in Cough Variant Asthma Treatment

As our understanding of CVA continues to evolve, researchers are exploring new treatment options and diagnostic approaches. What are some areas of ongoing research in CVA management?

Current areas of investigation include:

  • Novel biomarkers for more accurate diagnosis of CVA
  • Targeted therapies with fewer systemic side effects
  • The role of biologics in managing severe or refractory cases
  • Improved understanding of the underlying pathophysiology of CVA
  • Development of standardized diagnostic criteria and treatment protocols

The OSPIC Trial: Advancing Our Understanding of Oral Corticosteroids for Post-Infectious Cough

The Oral Steroids for Post-Infectious Cough (OSPIC) trial is an ongoing study investigating the use of oral corticosteroids for post-infectious cough in adults. This double-blind, randomized, placebo-controlled trial aims to provide valuable insights into the efficacy and safety of corticosteroids in managing persistent cough following respiratory infections.

Key aspects of the OSPIC trial include:

  • Evaluation of oral corticosteroids’ effectiveness in reducing cough severity and duration
  • Assessment of potential side effects and safety considerations
  • Investigation of factors that may predict treatment response
  • Exploration of the impact of treatment on patients’ quality of life

The results of this trial could have significant implications for the management of post-infectious cough and potentially inform future treatment guidelines for conditions like CVA.

Patient Education and Self-Management Strategies for Cough Variant Asthma

Empowering patients with knowledge and self-management skills is crucial for effective long-term control of CVA. What are some key aspects of patient education and self-management?

Important components of CVA self-management include:

  • Understanding the nature of the condition and its triggers
  • Proper use of prescribed medications, including inhaler technique
  • Recognition of worsening symptoms and when to seek medical attention
  • Implementation of lifestyle modifications to reduce cough triggers
  • Regular follow-up with healthcare providers for monitoring and adjustment of treatment plans

The Role of Pulmonary Function Tests in CVA Diagnosis and Management

Pulmonary function tests (PFTs) can play a valuable role in the diagnosis and management of CVA. How do these tests contribute to patient care?

PFTs in CVA management:

  • Help confirm the diagnosis by demonstrating reversible airway obstruction
  • Provide objective measures of lung function and treatment response
  • Aid in differentiating CVA from other respiratory conditions
  • Guide treatment decisions and medication adjustments
  • Monitor disease progression and long-term control

While not all patients with CVA will show significant abnormalities on PFTs, these tests can provide valuable information when used in conjunction with clinical history and response to treatment.

Integrating Cough Variant Asthma Management into Primary Care Practice

Effective management of CVA often begins in the primary care setting. How can primary care physicians optimize their approach to diagnosing and treating this condition?

Strategies for integrating CVA management into primary care include:

  • Maintaining a high index of suspicion for CVA in patients with chronic cough
  • Implementing standardized diagnostic protocols, including the use of diagnostic-therapeutic trials
  • Developing collaborative relationships with pulmonology specialists for complex cases
  • Providing ongoing patient education and support for self-management
  • Regularly updating knowledge and skills related to asthma management

The Impact of Telemedicine on CVA Diagnosis and Treatment

The rise of telemedicine has introduced new opportunities and challenges in managing conditions like CVA. How has telemedicine affected the diagnosis and treatment of this condition?

Telemedicine in CVA management:

  • Provides increased access to care, especially for patients in remote areas
  • Allows for more frequent follow-up and medication adjustments
  • Facilitates patient education and self-management support
  • Presents challenges in performing physical examinations and diagnostic tests
  • May require adaptations to traditional diagnostic and treatment protocols

As telemedicine continues to evolve, it will likely play an increasingly important role in the management of chronic respiratory conditions like CVA.

Conclusion: The Evolving Landscape of Cough Variant Asthma Management

The management of cough variant asthma continues to evolve, with prednisone playing a crucial role in both diagnosis and initial treatment. The diagnostic-therapeutic trial approach offers a valuable tool for quickly identifying and addressing CVA, potentially shortening the duration of symptoms and improving patients’ quality of life.

Key takeaways from current research and clinical practice include:

  • The effectiveness of short-term prednisone use in diagnosing and treating CVA
  • The importance of transitioning to inhaled corticosteroids for long-term management
  • The need for individualized treatment approaches that balance benefits and risks
  • The value of ongoing research, such as the OSPIC trial, in advancing our understanding of corticosteroid use in persistent cough
  • The critical role of patient education and self-management in achieving optimal outcomes

As our understanding of CVA continues to grow, healthcare providers must stay informed about the latest developments in diagnosis and treatment. By combining evidence-based practices with personalized care approaches, we can improve outcomes for patients suffering from this challenging condition.

Cough variant asthma: usefulness of a diagnostic-therapeutic trial with prednisone

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Clinical Trial

. 1992 Dec;69(6):505-9.

T Doan 
1
, R Patterson, P A Greenberger

Affiliations

Affiliation

  • 1 Department of Medicine, Northwestern University Medical School, Chicago, Illinois.

  • PMID:

    1471782

Clinical Trial

T Doan et al.

Ann Allergy.

1992 Dec.

. 1992 Dec;69(6):505-9.

Authors

T Doan 
1
, R Patterson, P A Greenberger

Affiliation

  • 1 Department of Medicine, Northwestern University Medical School, Chicago, Illinois.

  • PMID:

    1471782

Abstract

Cough variant asthma is characterized as a persistent, nonproductive cough with minimal or no wheezing and dyspnea. The diagnosis can be overlooked or misdisagnosed. We describe the severity of cough, the misery of some patients who have this syndrome and the usefulness of a diagnostic-therapeutic trial in ten patients with cough variant asthma. We evaluated ten patients whose chief complaint was persistent nonproductive cough. During the course of evaluation, all patients received a diagnostic-therapeutic trial of prednisone for cough variant asthma after other major causes of cough had been excluded. The duration of cough ranged from 2 months to 20 years. Some patients had significant side effects from coughing including interference with social life, work and sleep, urinary incontinence, stool incontinence, hoarseness, and vomiting. After a diagnostic-therapeutic trial with prednisone, nine patients reported significant improvement of cough in three days. One patient required 2 weeks of therapy for optimal improvement. All were subsequently controlled primarily with inhaled conticosteroids. The diagnosis of cough variant asthma may not be made for a prolonged time. A short course of prednisone as a diagnostic-therapeutic trial can establish a diagnosis and be followed by an effective method of control of cough by inhaled corticosteroids.

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Short Courses of Oral Corticosteroids: Lack of Benefit and Potential Harms for Common Acute Conditions

MARK H. EBELL, MD, MS, University of Georgia College of Public Health, Athens, Georgia

Primary care physicians generally agree that we should be more thoughtful and selective about the use of antibiotics in patients with upper and lower respiratory tract infections, and about the use of opioids for conditions such as back pain. However, prescriptions for antibiotics remain common in patients with acute respiratory infections.1 Patients are increasingly seeking care for acute infections at urgent care centers, which prescribe antibiotics for respiratory infections more often than primary care practices.1 Physicians also commonly prescribe short courses of oral corticosteroids, with one study finding the most common indication to be acute respiratory tract infection.2

Meta-analyses have suggested that corticosteroids may have a small benefit for acute cough and sore throat, but they included studies that were small or had a high risk of bias. 3,4 The best evidence comes from several well-designed and adequately powered randomized trials. In the first, 565 children in the United Kingdom with mild to moderate sore throat were randomized to oral dexamethasone, 10 mg, or placebo.5 The only benefit was a small reduction in symptoms at two days, but no improvements at other times or for other outcomes. The authors’ overall assessment was that this small benefit was not worth the potential harm. Regarding cough, a recent trial identified 401 adults with acute cough but no history of asthma, and randomized them to prednisolone, 40 mg once daily, or placebo.6 The researchers found no clinically significant difference between groups in cough severity or duration, antibiotic use, peak flow rates, or patient satisfaction. This was true even for patients with wheezing on initial presentation. Regarding back pain, a study randomized 269 adults with sciatica to a 15-day course of prednisone, 60 mg once daily tapering to 20 mg once daily, or placebo, and found no reduction in pain, function, or other outcomes. 7 However, adverse effects such as insomnia, nervousness, and increased appetite were more common in the prednisone group.

Thus, the best evidence to date does not support a significant benefit for corticosteroids in patients with cough, sore throat, or back pain. However, there may be harms. A recent study identified 1.5 million U.S. adults who had been continuously enrolled in a health insurance plan for two years.2 Linking pharmacy records with new diagnoses, the authors found that 21% of patients received a short course (less than 30 days) of a systemic corticosteroid during the study period, and one-half received a six-day course of methylprednisolone. The median dose was 20 mg of prednisone, and the most common indications were respiratory infection, back or neck pain, and allergies. Patients receiving an oral corticosteroid in the previous year and those receiving an inhaled or intranasal corticosteroid were excluded, as were organ transplant recipients and patients with malignancies. The researchers found a clinically and statistically significant increase in the risk of serious complications during the five to 30 days after the corticosteroid was prescribed; this risk declined over the subsequent two months. The relative risks over that initial month were 5.3 for sepsis, 3.3 for venous thromboembolism, and 1.9 for fracture. The absolute increases were 0.8 additional episodes of sepsis, 2.2 additional episodes of venous thromboembolism, and 7.1 additional fractures per 1,000 person-years, or approximately one additional serious complication per 100 person-years. Because the greatest risk occurs in the first month after the corticosteroid is prescribed, this corresponds to roughly one additional serious complication per 1,000 short courses of a corticosteroid.

A short course of oral corticosteroids is appropriate for many patients with acute exacerbation of asthma or chronic obstructive pulmonary disease, and for selected patients with peritonsillar abscess,8 severe pharyngitis (characterized by pain with swallowing and moderate to severe pharyngeal erythema),9 and community-acquired pneumonia requiring hospitalization. 10,11 However, widespread use of corticosteroids in patients with non-pneumonia lower respiratory tract infection, nonsevere sore throat, or low back pain is inappropriate and not worth the risk of rare but potentially serious harms.

Editor’s Note: Dr. Ebell is AFP‘s Deputy Editor for Evidence-Based Medicine.

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Good afternoon.

We have a new problem. Got off prednisone. Two days later, a severe cough began. Attacks for 10-20 minutes, coughing strongly, as if he cannot cough up, repeat almost every 2-3 hours, breathes often, tongue and gums do not turn blue, tears in his eyes. When the attack passes, he behaves as usual … Attacks do not depend on activity and time of day. The doctor recommended eufelin 1/6 t. 2 times a day. I give the second day, attacks are not rarer. [8]

BiGurik