High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study.
BACKGROUND
It is important to determine whether chronic cough is associated with asthma and can be helped by treatment with inhaled corticosteroids.


OBJECTIVE
To compare the effects of beclomethasone and placebo in patients with chronic cough for at least 8 weeks after excluding those with cough due to postnasal drip and gastroesophageal reflux disease.


METHODS
A prospective, randomized, double-blind, placebo-controlled study comprising 64 patients was performed for 2 weeks. The active group received metered-dose inhaler chlorofluorocarbon-beclomethasone (1,500 microg/d), and the placebo group received identical-appearing placebo inhalers. All the participants completed a respiratory questionnaire and underwent bronchoprovocation testing (BPT) with methacholine and allergy skin testing. The primary outcome measure was a decrease in daily cough scores (symptom diary and visual analog scale) during the 2-week treatment period.


RESULTS
The active group comprised 44 patients and the placebo group 20 patients. Cough duration averaged 20 weeks. At the end of treatment 82% of the active group and 15% of the placebo group had complete resolution of cough. In the active group 22 patients (50%) had positive BPT results, and in the placebo group 10 patients (50%) had positive results. There was no correlation between treatment response and responses on the respiratory questionnaire, allergy skin testing, or BPT.


CONCLUSIONS
Therapy with high-dose inhaled beclomethasone provided an excellent response in a subgroup of patients with chronic cough that did not correlate with atopy or airway hyperresponsiveness.
Ribeiro
Marcos
M
Respiratory Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil. marcospneumo@ig.com.br
Pereira
Carlos Alberto de Castro
CA
Nery
Luiz Eduardo
LE
Beppu
Osvaldo Shigueomi
OS
Silva
Clystenes Odyr Soares
CO
D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001985:Bronchial Provocation Tests; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride / Q000276:immunology; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012882:Skin Tests; D013147:Spirometry; D016896:Treatment Outcome
D000485:Allergens; D000893:Anti-Inflammatory Agents; D016210:Methacholine Chloride; D001507:Beclomethasone