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person wearing pajamas and coughing

Eosinophilic Bronchitis and Cough

It is back – the cough that I thought I had finally been able to shake. The one influencing nocturnal awakenings and generally being ridiculous.

Of course, it has impeccable timing and has been making an appearance at 4:14 A.M. It always seems to be in those wee morning hours. There is no experience like watching your clock and witnessing time slip away when you are just trying to get back to sleep. Maybe coughing up sputum on your jammies and then having to change yourself and your bed in the middle of the night sucks just a bit more.

What was causing my cough?

My cough had become so bothersome that it got to the point where I had to contact my respirologist to have it evaluated. Unfortunately, it was residual eosinophilic bronchitis leftover from a flare. Ugh, why had it come back?

The not so simple answer is that it likely never went away. However, it was adequately controlled at least for a short while. The best method of taming this cough is treating the underlying inflammation. This means ensuring that the eosinophils are being treated by either corticosteroids or the biologic. They work on slightly different pathways.

What is eosinophilic bronchitis?

Eosinophilic bronchitis can be defined as greater than 3% sputum eosinophilia.1 Essentially, this is an inflammation caused by eosinophils present in the sputum. My sputum eosinophils were in a happy (normal) range so I was a bit surprised to hear that the inflammation can linger. Who knew!

Fun facts about eosinophilic bronchitis

  • Eosinophilic bronchitis may or may not be associated with asthma.
  • Can be an associated with other respiratory conditions such as chronic cough, allergic rhinitis, and COPD.2
  • May be responsible for airway hyperresponsiveness and airway remodeling in asthma.
  • It generally responds to corticosteroids both inhaled and oral.
  • Has a connection to chronic cough and in some cases a linkage to cough-variant asthma.
  • Cough tends to be dry or produce a small amount of sticky sputum.2
  • In the case of asthma patients, it can occur when there are symptoms but FEV1 is normal.3
  • Chronic cough without sputum does not respond to steroids.4

What is the correlation between eosinophilic bronchitis and cough?

The role of eosinophilic bronchitis and cough is considered to be linked in airway hyperresponsiveness and airway remodeling. Essentially, having twitching airways that are reactive to irritants or allergens and eosinophilic inflammation leads to remodeling. Research is ongoing to better be able to identify the exact causes and determine if eosinophilic bronchitis’ role in asthma is isolated or in relation to other mechanisms.

My mission is trying to get and maintain eosinophilic bronchitis control. This means that I am likely headed for a change in my oral corticosteroids. I like to be on the lowest dose possible due to their significant side effects. I am hoping this will not be necessary but there is no guarantee unless this cough turns around.

Recently I heard about a study that indicated that cough is one of the most troubling symptoms that patients have. I can’t recall the source but I certainly agree with this statement. There is hope that the biologic that I just started will also play an important role in controlling my inflammation and keep cough away. I hope that this will be the case, as I miss sleeping through the night.

Have you had experience with a cough keeping you up at night or waking you up? I would love to hear about your experience. How do you get back to sleep?

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Gibson PG, Fujimura M, Niimi A. Eosinophilic bronchitis: clinical manifestations and implications for treatment. Thorax 2002;57:178-182. doi: 10.1136/thorax.57.2.178.
  2. Brightling CE, Woltmann G, Wardlaw AJ, et al. Development of irreversible airflow obstruction in a patient with eosinophilic bronchitis without asthma. Eur Respir J 1999;14:1228–30. doi: 10.1183/09031936.99.14512289.
  3. Pizzichini E, Pizzichini MMM, Efthimiadis A, et al. Indices of airway inflammation in induced sputum: Reproducibility and validity of cell and fluid phase measurements. Am. J. Respir. Crit. Care Med. 1997;52(6):498–501. doi: 10.1136/thx.52.6.498.
  4. Pizzichini MMM, Pizzichini E, Parameswaran K, et al. Non-asthmatic chronic cough: Effect of treatment with inhaled corticosteroid in patients without sputum eosinophilia. Can. Respir. J. 1999;6(4):323-30. doi: 10.1155/1999/434901.

Comments

  • BBdgh
    4 weeks ago

    I have chronic sinusitis along with eosinophil asthma and recurrent sinus infections. When I have a flare up I don’t know if it is a sinus infection or another trigger. This make it a challenge to treat.

  • John Bottrell, RRT moderator
    4 weeks ago

    I completely empathize with you. That is similar to what I have with allergies, asthma, and sinusitis. I have never been diagnosed with eosinophilic asthma. But, I often find it’s difficult to know what exactly the trigger is. Sometimes, trying to find the trigger is similar to becoming Sherlock Holmes (https://asthma.net/living/mystery-asthma-trigger/). So, definitely know what you’re going through. As, I’m sure other members of this commuity are too. Hope things are going well otherwise. John. Asthma.net site Moderator.

  • John Bottrell, RRT moderator
    1 month ago

    Another nice article. Always enjoy reading your asthma stories. Yes, I do experience nocturnal wakings due to cough recently. It took a while, but I think the culprit is nasal drainage due to chronic sinusitis. Difficult to treat especially when you don’t know what the underlying cause is. All the best. John. fellow asthmatic and asthma.net site moderator.

  • Dia SWS author
    1 month ago

    Thanks so much John. How is the nasal drainage situation? I thought may have been been the culprit for me as well.

  • John Bottrell, RRT moderator
    4 weeks ago

    To be honest, it sucks. I have learned that there’s no trigger more difficult to treat that sinusitis. I have been dealing with this for over a month and it’s actually starting to affect my overall deportment. I might even eventually get grumpy lol. Been referred to an ENT. So, hopefully that helps resolve things. Hope yours is better than mine. John.

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