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Inhaled corticosteroids may decrease the severity of chronic cough
  1. T D Yan
  1. Cleveland Clinic Foundation, Cleveland, USA;

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This double blind, randomised, placebo controlled, crossover study was performed in 88 patients who had chronic cough for more than 1 year. Patients were treated with inhaled fluticasone 500 μg or matching placebo twice daily for 14 days with a 2 week washout phase in between. There was a statistically significant decrease in the cough visual analogue scale (VAS) between the fluticasone and placebo groups (difference in differences  =  1; 95% CI 0.4 to 1.5, p<0.001). The mean percentage change in cough VAS in the fluticasone group was 22.3%. Inflammatory mediators were measured at baseline and after treatment. Some inflammatory mediators decreased with inhaled fluticasone (eosinophilic cationic protein, exhaled nitric oxide, and carbon monoxide) while others were unchanged.

This study shows that inhaled steroids can be used empirically to treat chronic cough present for more than 1 year, resulting in a modest clinical improvement. As expected, mediators related to eosinophilic inflammation predict corticosteroid responsiveness. This study suggests that drugs designed to target other inflammatory mediators might also be beneficial.

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