title: A preliminary study of PEFR monitoring in patients with chronic cough.
abstract: It is important to make a differential diagnosis of cough variant asthma in patients with chronic cough. To examine whether or not peak expiratory flow rate (PEFR) is useful for the differential diagnosis of cough variant asthma in such patients, diurnal variation rates of PEFR were calculated in 23 patients who presented with dry cough lasting four or more weeks and who showed no abnormalities on chest radiographs. None of the patients had wheezes, and pulmonary function testing at the time of visit to the hospital revealed no abnormalities. During the control period, the mean diurnal variation rate of PEFR in 23 patients was 16.3 +/- 7.9%. Six, nine and eight patients had PEFR diurnal variations rates of <10% (Group 1), 10-19% (Group 2), and > or = 20% (Group 3), respectively. At week 3 of treatment with bronchodilators, only Group 3 showed a significant decrease in PEFR diurnal variation rate from 25.7% to 10.1%. The cough score decreased significantly in Group 3 only. These patients had enhanced bronchial hyperresponsiveness and showed eosinophils in induced sputum, leading to the diagnosis of cough variant asthma (CVA). After making the diagnosis of CVA, an inhaled corticosteroid or a Th2 cytokine production inhibitor suplatast tosilate was administered to patients; consequently, they showed no recurrence of cough. PEFR monitoring allowed the detection of morning dip and was suggested to be potentially useful for the differential diagnosis of cough variant asthma in patients with chronic cough.
authors.affiliation: Department of Pulmonary Medicine, Tokushima Prefectural Central Hospital, Kuramoto-cho 1-10-3, Tokushima, Tokushima 770-8539, Japan. tmkksano@mb2.tcn.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: H
authors.initials: H
authors.lastname: Ueda
authors.forename: H
authors.initials: H
authors.lastname: Bando
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis / Q000503:physiopathology; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D003371:Cough / Q000175:diagnosis / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000502:physiology*; D012129:Respiratory Function Tests
chemical_list: D007073:Immunoglobulin E
references.citation: Br J Dis Chest. 1977 Apr;71(2):73-86
references.pmid: 861158
references.citation: N Engl J Med. 1975 Mar 13;292(11):555-9
references.pmid: 1110670
references.citation: Chest. 1997 Sep;112(3):862-3
references.pmid: 9315837
references.citation: Arerugi. 1982 Oct;31(10):1074-6
references.pmid: 7168651
references.citation: Am Rev Respir Dis. 1991 Feb;143(2):323-30
references.pmid: 1990947
references.citation: Lancet. 2000 Jul 22;356(9226):273-8
references.pmid: 11071181
references.citation: Thorax. 1980 Oct;35(10):732-8
references.pmid: 7466721
references.citation: Chest. 1998 Aug;114(2 Suppl Managing):133S-181S
references.pmid: 9725800
references.citation: Lancet. 1989 Jun 17;1(8651):1346-8
references.pmid: 2567371
references.citation: Eur J Clin Pharmacol. 2002 Jun;58(3):171-6
references.pmid: 12107601
references.citation: Eur J Respir Dis. 1980 Oct;61(5):298-302
references.pmid: 7193594
references.citation: J Allergy Clin Immunol. 2003 Jan;111(1):197-8
references.pmid: 12532121
references.citation: Am Rev Respir Dis. 1990 Mar;141(3):640-7
references.pmid: 2178528
references.citation: Thorax. 1982 Jun;37(6):423-9
references.pmid: 6890243
references.citation: Respiration. 1980;40(3):128-35
references.pmid: 7444191
references.citation: Lung. 2003;181(4):227-35
references.pmid: 14692563
references.citation: N Engl J Med. 1979 Mar 22;300(12):633-7
references.pmid: 763286
references.citation: Life Sci. 1995;56(19):1647-54
references.pmid: 7723593
references.citation: J Asthma. 1994;31(6):463-72
references.pmid: 7961323
references.citation: J Asthma. 1998;35(2):225-9
references.pmid: 9576149
references.citation: Chest. 1972 Mar;61(3):262-6
references.pmid: 5021171
references.citation: Thorax. 1998 Nov;53(11):953-6
references.pmid: 10193394
references.citation: Jpn J Pharmacol. 1993 Jan;61(1):31-9
references.pmid: 8382323
references.citation: Agents Actions Suppl. 1991;34:369-78
references.pmid: 1665310
references.citation: Br J Dis Chest. 1979 Oct;73(4):357-66
references.pmid: 576035