Capsaicin induced cough in cryptogenic fibrosing alveolitis
M J Doherty, R Mister, M G Pearson, P M A Calverley
Aintree Chest Centre
and The University Department of Medicine, University Hospital Aintree,
Liverpool, UK
Correspondence to: Professor P Calverley, Clinical Science Centre, University Hospital, Aintree, Liverpool L9 7AL, UK pmacal{at}liverpool.ac.uk
Received 10 January 2000; Returned to authors 6 April 2000; Revised version received 20 July 2000; Accepted for publication 11 August 2000
BACKGROUND
Cough is a
common and troublesome symptom in cryptogenic fibrosing alveolitis
(CFA) but the mechanisms responsible are not known. The cough threshold
to inhaled capsaicin is increased in asthma and chronic obstructive
pulmonary disease (COPD) where lung volumes are increased, but the
relationship between cough response and symptom intensity has not been
studied in CFA where lung volumes are reduced.
METHODSCapsaicin
challenge tests were performed on 15 subjects with proven CFA and 96 healthy controls. Symptoms, as assessed by daily diary card cough score
and by visual analogue scale (VAS), were related to the capsaicin
sensitivity (C5) and compared with lung volumes. Volume restriction was
produced in a group of 12 normal healthy subjects by a plastic shell
tightly strapped to the chest wall. Capsaicin challenge tests were
performed in these subjects, both strapped and unstrapped, to determine
whether volume restriction altered the cough reflex.
RESULTSThe median C5
response in normal subjects was more than 500 µM compared with
15.6 µM in those with CFA (p<0.001). The C5 response of the CFA
patients was not related to symptoms of cough (whether measured by
diary card or by VAS), nor was it related to percentage predicted total
lung capacity (TLC) or forced vital capacity (FVC). Volume restriction
of normal subjects with chest strapping successfully restricted lung
volumes to levels similar to that of the CFA patients but did not
change the sensitivity to capsaicin.
CONCLUSIONSThe cough
reflex measured using capsaicin is markedly increased in patients with
CFA. This increase is not the result of alterations in the deposition
of inhaled particles of capsaicin brought about by volume restriction.
It could be related to reduced lung compliance leading to sensitisation
of rapidly adapting receptors, other mechanical changes, or to
destruction of pulmonary C fibres secondary to interstitial
inflammation. The capsaicin test may be a useful method of objectively
monitoring cough propensity in CFA.
Keywords: cryptogenic fibrosing alveolitis; cough threshold; capsaicin; volume restriction
© 2000 by Thorax
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