Eur Respir J 2005; 26:181
Copyright ©ERS Journals Ltd 2005
Efficacy of fluticasone on cough
F. Hargreave and
K. Parameswaran
Firestone Institute for Respiratory Health, McMaster University and St. Joseph's HealthCare, Hamilton, ON, Canada
To the Editors:
In the original article by Ponsioen et al. 1, there is no mention of the predictive value of the type of airway inflammation that is associated with cough, or whether there was any benefit from inhaled corticosteroid treatment.
There is increasing evidence that eosinophilic airway inflammation, i.e. an eosinophilic bronchitis, which can be identified from spontaneous or induced sputum cell counts, predicts the benefit from corticosteroid treatment in chronic cough, asthma and chronic obstructive pulmonary disease and that a lack of eosinophilia indicates an absence of any benefit 2–6.
An eosinophilic bronchitis occurs in only 10–30% of patients referred to a specialist with an isolated chronic cough 7–9. Hence, in an unselected population of patients with cough, the majority of whom will not have eosinophilic bronchitis, the benefit from inhaled steroid treatment is likely to be small, as indicated in the study by Ponsioen et al. 1, or absent. Measurement of airway inflammation is necessary to interpret the results of treatment with anti-inflammatory medications.
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