Bronchi

Nonasthmatic Eosinophilic Bronchitis

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Nonasthmatic Eosinophilic Bronchitis, Eosinophilic Bronchitis

  • See Also
  1. Chronic Cough
  • Epidemiology
  1. Emerging cause of Chronic Cough in pulmonology clinics
  2. Responsible for 10-30% of Chronic Cough cases referred to pulmonology
  • Pathophysiology
  1. Corticosteroid responsive Chronic Cough in non-smokers with respiratory tract Eosinophilic inflammation
  • Differential Diagnosis
  1. See Chronic Cough Causes
  2. Asthma
  • Diagnosis
  1. Normal airway hyper-responsiveness (i.e. not Asthma)
    1. Normal Spirometry
    2. Normal airway responsiveness on Methacholine inhalation test
  2. Sputum Eosinophilia (i.e. not Chronic Bronchitis)
    1. Induced Sputum (via saline nebulization) with 3% or more Eosinophils
  3. No signs variable airflow obstruction
  • Management
  1. General
    1. Does not respond to Inhaled Bronchodilators
    2. Eliminate Occupational Lung Disease and inhaled allergan exposures
  2. First-Line
    1. High-dose Inhaled Corticosteroids
      1. Continue for at least 2 months
  3. Other measures
    1. Systemic Corticosteroids
      1. Consider brief initial course if Inhaled Corticosteroids offer inadequate response
      2. However, consider alternative Chronic Cough Causes if lack of steroid response
    2. Leukotriene Inhibitor (e.g. Montelukast)
      1. Inadequate response to Inhaled Corticosteroids
  • References
  1. Brightling (1999) Am J Respir Crit Care Med 160(2): 406-10 [PubMed]
  2. Brightling (2010) Lung 188(suppl 1): S13-17 [PubMed]
  3. Sonoda (2024) Am Fam Physician 110(2): 167-73 [PubMed]