title: Noneosinophilic CD4 lymphocytic airway inflammation in menopausal women with chronic dry cough.
abstract: BACKGROUND
  Chronic dry cough without dyspnea and wheezing is a well-known condition that is considered to be clinically overrepresented in women. The etiology and morphology remain unknown in many cases despite thorough investigations.
  
  
  METHODS
  To examine inflammatory cells and the lymphocyte profile in the lower airways and blood in women with chronic cough of unknown etiology.
  
  
  METHODS
  University hospital department of respiratory medicine.
  
  
  METHODS
  Twenty-five otherwise healthy women with idiopathic cough and 11 age-matched healthy control women, all nonatopic nonsmokers.
  
  
  METHODS
  In order to characterize the cough, a careful standardized interview of the patients was made. Lung functions were tested. Cells were collected by BAL and analyzed for differential cell counts separate in the bronchial (first) wash and in the pooled peripheral washes (BAL fluid). The lymphocyte profile in BAL fluid and blood was characterized by dual-color flow cytometry.
  
  
  RESULTS
  Eleven female patients formed a specific group with a history of a dry, nonproductive cough that always started in connection with an airway infection coinciding with menopause. Neither exercise, climate, nor seasonal change influenced the cough. BAL fluid contained an increased number of T (CD3+) lymphocytes: median. Seventy-three percent of T lymphocytes were T-helper lymphocytes (CD4+). A median of 57% of the BAL fluid T cells expressed HLA-DR activation marker compared with a median of 20% in the control subjects and in the other 14 included patients with chronic cough but with minor expectoration periodically (p < 0.001 and p < 0.0001, respectively). No differences between the groups were found in the blood.
  
  
  CONCLUSIONS
  HLA-DR-activated CD4+ lymphocytic airway inflammation with a low number of eosinophils was identified in a group of nonsmoking, nonatopic otherwise healthy women patients with dry cough of life-long character. The disease appeared exclusively in connection to menopause.
authors.affiliation: The National Institute of Environmental Medicine, Division of Lung and Allergy Research, Karolinska Institutet, SE-171 77, Stockholm, Sweden. em.mund@stockholm.mail.telia.com
authors.forename: Ester
authors.initials: E
authors.lastname: Mund
authors.forename: Birger
authors.initials: B
authors.lastname: Christensson
authors.forename: Reidar
authors.initials: R
authors.lastname: Grönneberg
authors.forename: Kjell
authors.initials: K
authors.lastname: Larsson
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000276:immunology*; D001991:Bronchitis / Q000503:physiopathology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D001999:Bronchoscopy; D018791:CD4 Lymphocyte Count; D002452:Cell Count; D002908:Chronic Disease; D003371:Cough / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016131:Lymphocyte Subsets / Q000737:chemistry; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D012129:Respiratory Function Tests; D006377:T-Lymphocytes, Helper-Inducer / Q000502:physiology