Isolated persistent nocturnal cough: a trial of high dose inhaled corticosteroids

ABSTRACT

Children with cough, unassociated with wheeze or other evidence of systemic disease, are commonly seen in pediatric practice. In the distant past, the association between cough and wheeze was unrecognized, but in recent years, children with cough alone have increasingly been diagnosed as having asthma. The aim of this study was to investigate whether a short course of high dose inhaled steroid, an effective treatment of asthma, is better than placebo in the treatment of isolated persistent nocturnal cough. The study was carried out on a total of 39 children, aged 2-10 years [mean 6.19 +/- 2.12] suffering from persistent nocturnal cough for more than three weeks without other symptoms or signs. We excluded all children living in evident damp areas, those exposed to passive smoking, with current respiratory tract infections, a history of wheeze or fever, and those with an identifiable cause for their cough such as persistent nasal discharge, or whooping cough. All children at the start had not received treatment with corticosteroids for one month before the study. Total serum IgE and Radioallergosorbent test [RAST] for eight commonly encountered allergens were done for all cases. Basic nighttime cough counting was done to all cases using a recorder and a microphone. Children were then divided at random info two groups, the first group [19 children] was given a high dose inhaled corticosteroid, and fluticasone dipropionate [FP] for two weeks, and the second group [20 children] was given a placebo via a metered dose inhaler and a spacer. We counted the number of coughs during the nights 7 and 14 in both groups. Analysis of the results showed the following [1] No significant difference between both groups as regards the age, sex, total serum IgE, the frequency of positive RAST tests, and the number of basic night time coughs. [2] A significant reduction in the number of coughs during the nights 7 and 14 when compared to the basic night cough, in both groups of patients. [3] The number of coughs was significantly lower in the inhalation steroid group when compared to the placebo group in both 7th and 14th night of the study. [4] 73.7% of children on inhaled steroids had more than 75% improvement of their cough at the night 14, compared to only 10% of children on placebo, the difference was statistically highly significant, [5] No correlation was found between the total IgE level or positive RAST tests and the occurrence of more than 75% improvement in the inhalation steroid group