Articles

Evaluation of Methacholine Challenge Test Results in Chronic Cough Patients Referring to Clinic of Pulmonary Disease

Abstract

Chronic cough is a common problem in patients visiting physicians and its prevalence in different populations range from 3 to 40%. Postnasal drip, asthma and gastroesophageal reflux are the known cause of chronic cough. Although diagnosis of asthma is usually made by clinical signs and spirometeric results, methacholine challenge test is a good diagnostic test in patients who show normal physical examination and spirometeric results. In this study, the results of methacholine challenge test in chronic cough patients are investigated. This is a cross sectional study performed on patients suffering from chronic cough (over 8 weeks), who went to Pulmonary Disease Clinic of Imam Khomeini Hospital in 2006. Postnasal drip, gastroesophageal reflux was evaluated and ruled out in all patients. Then they were tested by methacholine inhalation using low to high doses of methacholine. The results of test was defined as 20% fall in FEV1 and its relationship with age, sex, history of allergic disease, family history of asthma and smoking status was investigated. 81 patients (36 female and 45 male) entered this study who had mean age of 32.5 ± 13.06 years. 81.5% of patients had never smoked or closed contact with smokers, 6.2% were passive smokers, 8.6% were smokers and 3.7% had quit smoking. 37% had suffered from chronic cough less than 6 months, 11% for 6-11 months and 52% for more than 12 months. In 26% of patients, family history of asthma was present and 34.5% had a history of one type of allergy. In 29.5% the results of methacholine challenge test was positive, among them 45.8% showed an intense response and 54.2% a moderate response. The test results and its intensity had no statistically significant relationship with age, sex, smoking status, the duration of cough and family history of asthma, but the relationship between methacholine challenge test and the history of allergic disease was significant. Methacholine challenge test can be used as a diagnostic test in patients suffering from chronic cough of unknown origin and patients whose clinical and paraclinical finding are normal. A positive test indicates hypersensitivity of airways which can be used for planning their treatment.

Naghavi M. The Appearance of Death in 18 Provinces of Iran. Iran's Health Ministry: Tandis; 2004.

McGarvey L. Cough 6: Which investigations are most useful in the diagnosis of chronic cough? Thorax 2004; 59(4): 342-6.

Pratter MR, Bartter T, Akers S, DuBois J. An algorithmic approach to chronic cough. Ann Intern Med 1993; 119(10): 977-83.

Janson C, Chinn S, Jarvis D, Burney P. Determinants ofcough in young adults participating in the European CommunityRespiratory Health Survey. Eur Respir J 2001;18(4): 647-54.

Morice A, Kastelik J. Cough 1: Chronic cough in adults. Thorax 2003; 58(10): 901-7.

Faniran AO, Peat JK, Woolcock AJ. Measuring persistent cough in children in epidemiological studies: development of a questionnaire and assessment of prevalence in two countries. Chest 1999; 115(2): 434-9.

Palombini BC, Villanova CA, Araújo E, Gastal OL, Alt DC, Stolz DP, et al. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest 1999; 116(2): 279-84.

Kastelik JA, Aziz I, Ojoo JC, Thompson RH, Redington AE, Morice AH. Investigation and management of chronic cough using a probability-based algorithm. Eur Respir J 2005; 25(2): 235-43.

Drazen JM, Weinberger SE. Disorder of the respiratory system. In: Kasper DL, Braunwald E, Fauci AS, HauserSL, Longo DL, Jameson JL. Harrisons' Principles of Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 1495-637.

Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, et al; ERS Task Force. The diagnosis and management of chronic cough. Eur Respir J 2004; 24(3): 481-92.

Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F, et al. Standardisation of the measurement of lung volumes. Eur Respir J 2005; 26(3): 511-22.

Popa V. ATS guidelines for methacholine and exercisechallenge testing. Am J Respir Crit Care Med 2001; 163(1): 292-3.

Groneberg DA, Niimi A, Dinh QT, Cosio B, Hew M, Fischer A, et al. Increased expression of transient receptor potential vanilloid-1 in airway nerves of chronic cough. Am J Respir Crit Care Med 2004; 170(12): 1276-80.

Haque RA, Usmani OS, Barnes PJ. Chronic idiopathic cough: a discrete clinical entity? Chest 2005; 127(5): 1710-3.

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26(5): 948-68.

Lundbäck B, Stjernberg N, Rosenhall L, Lindström M, Jönsson E, Andersson S. Methacholine reactivity and asthma. Report from the Northern Sweden Obstructive Lung Disease Project. Allergy 1993; 48(2): 117-24.

Parker AL, McCool FD. Pulmonary function characteristics in patients with different patterns of methacholine airway hyperresponsiveness. Chest 2002; 121(6): 1818-23.

Koh YY, Park Y, Kim CK. The importance of maximal airway response to methacholine in the prediction of wheezing development in patients with cough-variantasthma. Allergy 2002; 57(12): 1165-70.

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 2006; 129(1 Suppl): 1S-23S.

Files
IssueVol 47, No 3 (2009) QRcode
SectionArticles
Keywords
Asthma chronic cough methacholine challenge test PC20

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Derakhshan Deilami G, Khandashpour M, Paknejad O, Pazooki M. Evaluation of Methacholine Challenge Test Results in Chronic Cough Patients Referring to Clinic of Pulmonary Disease. Acta Med Iran. 1;47(3):175-179.