title: Antitussive effect of the leukotriene receptor antagonist zafirlukast in subjects with cough-variant asthma.
abstract: Cough-variant asthma (CVA) occurs in a subgroup of asthmatics whose sole or predominant respiratory symptom is cough. Although bronchodilators are often sufficient to treat CVA, refractory cough may require therapy with inhaled or systemic corticosteroids. In a randomized, double-blind, placebo-controlled, crossover study, we examined the effect of a 14-day course of the leukotriene receptor antagonist zafirlukast on subjective cough score and cough-reflex sensitivity to inhaled capsaicin in eight subjects with CVA refractory to inhaled beta agonists, and in five subjects refractory to inhaled corticosteroids. Seven of eight subjects experienced significant subjective and objective improvement in cough after treatment with zafirlukast. Mean (+/- SEM) cough score improved from 7.75 +/- 0.56 to 3.25 +/- 0.84 (p = 0.0006). Cough sensitivity to capsaicin was suppressed by zafirlukast in all subjects. Patients with CVA may represent a distinct subgroup of asthmatics whose afferent cough receptors within the respiratory epithelium are hypersensitive relative to those of patients with the typical form of asthma. Zafirlukast appears to be particularly effective in treating CVA by inhibiting the sensitivity of these receptors. Leukotriene receptor antagonists may offer an alternative to corticosteroids for the treatment of CVA refractory to inhaled bronchodilators.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA. pdicpinigaitis@pol.net
authors.forename: Peter V
authors.initials: PV
authors.lastname: Dicpinigaitis
authors.forename: Jay B
authors.initials: JB
authors.lastname: Dobkin
authors.forename: Joseph
authors.initials: J
authors.lastname: Reichel
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy*; D001985:Bronchial Provocation Tests / Q000379:methods; D002211:Capsaicin; D003371:Cough / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007211:Indoles; D020024:Leukotriene Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D007211:Indoles; D020024:Leukotriene Antagonists; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds; D002211:Capsaicin; C062735:zafirlukast