Eosinophilic bronchitis – Chronic cough with a treatable trait
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Jan 31, 2024
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Abstract
Eosinophilia in sputum is an important finding in patients with chronic cough, as it identifies a treatable trait with available therapy that is well tolerated and can be effective. While most patients have airway hyperresponsiveness or airway obstruction which define asthma, an important number of cases lack these features of bronchoconstriction but sputum induction still demonstrates excess eosinophilia, indicating eosinophilic bronchitis without asthma. Unfortunately, this test is largely limited to research centers and speciality cough clinics, but associated measures of allergic airway inflammation can be used to support the diagnosis. While the mechanisms that initiate and drive non-asthmatic eosinophilic bronchitis (NAEB) are not well understood, there is emerging evidence that eosinophils and inflammatory mediators are important contributors of nerve sensitivity, a hallmark of chronic cough. Inhaled steroids form the major treatment used in non-asthmatic eosinophilic bronchitis (NAEB). Novel targeted therapies for asthma known as biologics are likely to be tried in the common and debilitating condition of chronic cough, while their efficacy in NAEB is yet to be seen.
Keywords:
Eosinophilic bronchitis, Chronic cough, Chronic cough with a treatable trait
Article Details
How to Cite
BRISTER, Danica Lee.
Eosinophilic bronchitis – Chronic cough with a treatable trait.
Medical Research Archives, [S.l.], v. 12, n. 1, jan. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5052>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v12i1.5052.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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20. Mazzone SB, McLennan L, McGovern AE, Egan GF, Farrell MJ. Representation of Capsaicin-evoked Urge-to-Cough in the Human Brain Using Functional Magnetic Resonance Imaging. https://doi-org.libaccess.lib.mcmaster.ca/101164/rccm200612-1856OC. 2012;176(4):327-332. doi:10.1164/RCCM.200612-1856OC
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22. Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999;160(2):406-410. doi:10.1164/AJRCCM.160.2.9810100
23. Brightling CE. Chronic Cough Due to Nonasthmatic Eosinophilic Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(1):116S-121S. doi:10.1378/CHEST.129.1_SUPPL.116S
24. Diab N, Patel M, O’Byrne P, Satia I. Narrative Review of the Mechanisms and Treatment of Cough in Asthma, Cough Variant Asthma, and Non-asthmatic Eosinophilic Bronchitis. Lung. 2022; 200(6):707-716. doi:10.1007/S00408-022-00575-6/TABLES/1
25. Escamilla-Gil JM, Fernandez-Nieto M, Acevedo N. Understanding the Cellular Sources of the Fractional Exhaled Nitric Oxide (FeNO) and Its Role as a Biomarker of Type 2 Inflammation in Asthma. Biomed Res Int. 2022;2022. doi:10.1155/2022/5753524
26. Oh MJ, Lee JY, Lee BJ, Choi DC. Exhaled Nitric Oxide Measurement Is Useful for the Exclusion of Nonasthmatic Eosinophilic Bronchitis in Patients With Chronic Cough. Chest. 2008; 134(5):990-995. doi:10.1378/CHEST.07-2541
27. Ambrosino P, Accardo M, Mosella M, et al. Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis. Ann Med. 2021;53(1):1659-1672. doi:10.1080/07853890.2021.1979242
28. Berlyne GS, Parameswaran K, Kamada D, Efthimiadis A, Hargreave FE. A comparison of exhaled nitric oxide and induced sputum as markers of airway inflammation. Journal of Allergy and Clinical Immunology. 2000; 106(4):638-644. doi:10.1067/MAI.2000.109622
29. Donohue JF, Jain N. Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates. Respir Med. 2013;107(7):943-952. doi:10.1016/J.RMED.2013.02.018
30. Chaudhuri R, McMahon AD, Thomson LJ, et al. Effect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough. Journal of Allergy and Clinical Immunology. 2004;113(6):1063-1070. doi:10.1016/J.JACI.2004.03.019
31. Wiszniewska M, Dellis P, van Kampen V, et al. Characterization of Occupational Eosinophilic Bronchitis in a Multicenter Cohort of Subjects with Work-Related Asthma Symptoms. J Allergy Clin Immunol Pract. 2021;9(2):937-944.e4. doi:10.1016/J.JAIP.2020.08.056
32. Study Details | Tezepelumab and Methacholine Airway Hyperresponsiveness in Participants With Mild Allergic Asthma | ClinicalTrials.gov. Accessed November 26, 2023. https://clinicaltrials.gov/study/NCT05740748?intr=Tezepelumab&rank=7
33. Study Details | Mepolizumab for the Treatment of Chronic Cough With Eosinophilic Airways Diseases | ClinicalTrials.gov. Accessed November 26, 2023. https://clinicaltrials.gov/study/NCT04765722?cond=Chronic%20cough&intr=Mepolizumab&rank=1
34. Berry MA, Hargadon B, McKenna S, et al. Observational study of the natural history of eosinophilic bronchitis. Clin Exp Allergy. 2005; 35(5):598-601. doi:10.1111/J.1365-2222.2005.02222.X
35. Park SW, Lee YM, Jang AS, et al. Development of chronic airway obstruction in patients with eosinophilic bronchitis: A prospective follow-up study. Chest. 2004;125 (6):1998-2004. doi:10.1378/chest.125.6.1998
36. French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158(15):1657. doi:10.1001/ARCHINTE.158.15.1657
37. Satia I, Mayhew AJ, Sohel N, et al. Prevalence, incidence and characteristics of chronic cough among adults from the Canadian Longitudinal Study on Aging. ERJ Open Res. 2021;7(2):00160-02021. doi:10.1183/23120541.00160-2021
38. Satia I, Mayhew AJ, Sohel N, et al. Impact of mental health and personality traits on the incidence of chronic cough in the Canadian Longitudinal Study on Aging. ERJ Open Res. 2022;8(2). doi:10.1183/23120541.00119-2022
39. Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15(3):348-356. doi:10.1513/ANNALSATS.201703-259OC.
2. Burt CW, Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001-2002. Vital and Health Statistics, Series 13: Data on Health Resources Utilization. 2006;13(159). Accessed January 29, 2023. https://pubmed.ncbi.nlm.nih.gov/16471269/
3. Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. European Respiratory Journal. 2020; 55(1). doi:10.1183/13993003.01136-2019
4. Parker SM, Smith JA, Birring SS, et al. British Thoracic Society Clinical Statement on chronic cough in adults. doi:10.1136/thorax-2023-220592
5. Brightling CE, Bradding P, Symon FA, Holgate ST, Wardlaw AJ, Pavord ID. Mast-cell infiltration of airway smooth muscle in asthma. N Engl J Med. 2002;346(22):1699-1705. doi:10.1056/NEJMOA012705
6. Brightling CE, Symon FA, Birring SS, Bradding P, Wardlaw AJ, Pavord ID. Comparison of airway immunopathology of eosinophilic bronchitis and asthma. Thorax. 2003;58(6):528-532. doi:10.1136/THORAX.58.6.528
7. Brightling CE, Symon FA, Birring SS, Bradding P, Wardlaw AJ, Pavord ID. Comparison of airway immunopathology of eosinophilic bronchitis and asthma. Thorax. 2003;58(6):528-532. doi:10.1136/THORAX.58.6.528
8. Sastre B, Fernández-Nieto M, Mollá R, et al. Increased prostaglandin E2 levels in the airway of patients with eosinophilic bronchitis. Allergy: European Journal of Allergy and Clinical Immunology. 2008;63(1):58-66. doi:10.1111/j.1398-9995.2007.01515.x
9. Brightling CE, Symon FA, Birring SS, Bradding P, Pavord ID, Wardlaw AJ. TH2 cytokine expression in bronchoalveolar lavage fluid T lymphocytes and bronchial submucosa is a feature of asthma and eosinophilic bronchitis. Journal of Allergy and Clinical Immunology. 2002;110(6):899-905. doi:10.1067/mai.2002.129698
10. Berry MA, Parker D, Neale N, et al. Sputum and bronchial submucosal IL-13 expression in asthma and eosinophilic bronchitis. Journal of Allergy and Clinical Immunology. 2004;114(5):1106-1109. doi:10.1016/j.jaci.2004.08.032
11. Lai K, Liu B, Xu D, et al. Will nonasthmatic eosinophilic bronchitis develop into chronic airway obstruction?: a prospective, observational study. Chest. 2015;148(4):887-894. doi:10.1378/CHEST.14-2351
12. Zhan C, Xu R, Li B, et al. Eosinophil Progenitors in Patients With Non-Asthmatic Eosinophilic Bronchitis, Eosinophilic Asthma, and Normal Controls. Front Immunol. 2022;13. doi:10.3389/fimmu.2022.737968
13. Niimi A. Narrative Review: how long should patients with cough variant asthma or non-asthmatic eosinophilic bronchitis be treated? J Thorac Dis. 2021;13(5):3197-3214. doi:10.21037/jtd-20-2026
14. Canning BJ. Afferent nerves regulating the cough reflex: Mechanisms and Mediators of Cough in Disease. Otolaryngol Clin North Am. 2010;43(1):15. doi:10.1016/J.OTC.2009.11.012
15. Satia I, Watson R, Scime T, et al. Allergen challenge increases capsaicin-evoked cough responses in patients with allergic asthma. Journal of Allergy and Clinical Immunology. 2019;144(3):788-795.e1. doi:10.1016/j.jaci.2018.11.050
16. Smith JA, Satia I, Badri H, Marsden P. Mini-review: Hypertussivity and allotussivity in chronic cough endotypes. Neurosci Lett. 2023;792. doi:10.1016/J.NEULET.2022.136934
17. Grabczak EM, Dabrowska M, Birring SS, Krenke R. Looking ahead to novel therapies for chronic cough. Part 1–peripheral sensory nerve targeted treatments. Expert Rev Respir Med. 2020;14(12):1217-1233. doi:10.1080/17476348.2020.1811686
18. Satia I, Nagashima A, Usmani OS. Exploring the role of nerves in asthma; insights from the study of cough. Biochem Pharmacol. 2020;179. doi:10.1016/j.bcp.2020.113901
19. Drake MG, Scott GD, Blum ED, et al. Eosinophils increase airway sensory nerve density in mice and in human asthma. Sci Transl Med. 2018;10(457). doi:10.1126/SCITRANSLMED.AAR8477
20. Mazzone SB, McLennan L, McGovern AE, Egan GF, Farrell MJ. Representation of Capsaicin-evoked Urge-to-Cough in the Human Brain Using Functional Magnetic Resonance Imaging. https://doi-org.libaccess.lib.mcmaster.ca/101164/rccm200612-1856OC. 2012;176(4):327-332. doi:10.1164/RCCM.200612-1856OC
21. Hilton E, Satia I, Holt K, Woodcock AA, Belcher J, Smith JA. The Effect of Pain Conditioning on Experimentally Evoked Cough: Evidence of Impaired Endogenous Inhibitory Control Mechanisms in Refractory Chronic Cough. Eur Respir J. 2020;56(6). doi:10.1183/13993003.01387-2020
22. Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID. Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999;160(2):406-410. doi:10.1164/AJRCCM.160.2.9810100
23. Brightling CE. Chronic Cough Due to Nonasthmatic Eosinophilic Bronchitis: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(1):116S-121S. doi:10.1378/CHEST.129.1_SUPPL.116S
24. Diab N, Patel M, O’Byrne P, Satia I. Narrative Review of the Mechanisms and Treatment of Cough in Asthma, Cough Variant Asthma, and Non-asthmatic Eosinophilic Bronchitis. Lung. 2022; 200(6):707-716. doi:10.1007/S00408-022-00575-6/TABLES/1
25. Escamilla-Gil JM, Fernandez-Nieto M, Acevedo N. Understanding the Cellular Sources of the Fractional Exhaled Nitric Oxide (FeNO) and Its Role as a Biomarker of Type 2 Inflammation in Asthma. Biomed Res Int. 2022;2022. doi:10.1155/2022/5753524
26. Oh MJ, Lee JY, Lee BJ, Choi DC. Exhaled Nitric Oxide Measurement Is Useful for the Exclusion of Nonasthmatic Eosinophilic Bronchitis in Patients With Chronic Cough. Chest. 2008; 134(5):990-995. doi:10.1378/CHEST.07-2541
27. Ambrosino P, Accardo M, Mosella M, et al. Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis. Ann Med. 2021;53(1):1659-1672. doi:10.1080/07853890.2021.1979242
28. Berlyne GS, Parameswaran K, Kamada D, Efthimiadis A, Hargreave FE. A comparison of exhaled nitric oxide and induced sputum as markers of airway inflammation. Journal of Allergy and Clinical Immunology. 2000; 106(4):638-644. doi:10.1067/MAI.2000.109622
29. Donohue JF, Jain N. Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates. Respir Med. 2013;107(7):943-952. doi:10.1016/J.RMED.2013.02.018
30. Chaudhuri R, McMahon AD, Thomson LJ, et al. Effect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough. Journal of Allergy and Clinical Immunology. 2004;113(6):1063-1070. doi:10.1016/J.JACI.2004.03.019
31. Wiszniewska M, Dellis P, van Kampen V, et al. Characterization of Occupational Eosinophilic Bronchitis in a Multicenter Cohort of Subjects with Work-Related Asthma Symptoms. J Allergy Clin Immunol Pract. 2021;9(2):937-944.e4. doi:10.1016/J.JAIP.2020.08.056
32. Study Details | Tezepelumab and Methacholine Airway Hyperresponsiveness in Participants With Mild Allergic Asthma | ClinicalTrials.gov. Accessed November 26, 2023. https://clinicaltrials.gov/study/NCT05740748?intr=Tezepelumab&rank=7
33. Study Details | Mepolizumab for the Treatment of Chronic Cough With Eosinophilic Airways Diseases | ClinicalTrials.gov. Accessed November 26, 2023. https://clinicaltrials.gov/study/NCT04765722?cond=Chronic%20cough&intr=Mepolizumab&rank=1
34. Berry MA, Hargadon B, McKenna S, et al. Observational study of the natural history of eosinophilic bronchitis. Clin Exp Allergy. 2005; 35(5):598-601. doi:10.1111/J.1365-2222.2005.02222.X
35. Park SW, Lee YM, Jang AS, et al. Development of chronic airway obstruction in patients with eosinophilic bronchitis: A prospective follow-up study. Chest. 2004;125 (6):1998-2004. doi:10.1378/chest.125.6.1998
36. French CL, Irwin RS, Curley FJ, Krikorian CJ. Impact of chronic cough on quality of life. Arch Intern Med. 1998;158(15):1657. doi:10.1001/ARCHINTE.158.15.1657
37. Satia I, Mayhew AJ, Sohel N, et al. Prevalence, incidence and characteristics of chronic cough among adults from the Canadian Longitudinal Study on Aging. ERJ Open Res. 2021;7(2):00160-02021. doi:10.1183/23120541.00160-2021
38. Satia I, Mayhew AJ, Sohel N, et al. Impact of mental health and personality traits on the incidence of chronic cough in the Canadian Longitudinal Study on Aging. ERJ Open Res. 2022;8(2). doi:10.1183/23120541.00119-2022
39. Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15(3):348-356. doi:10.1513/ANNALSATS.201703-259OC.