Methacholine and FeNO Measurement in Patients with Habit Cough

Abstract

Background Chronic cough is one of the most common symptoms in childhood. Making a definite diagnosis is a challenge for all pediatricians especially in patients when cough is without an organic cause like in habit cough.

Patients and Methods In this retrospective analysis, all electronic outpatient charts of the Division of Allergology and Pneumology, between January 1, 2010 and December 31, 2019 were reviewed in order to study all children with potential habit cough. All children underwent the following diagnostic algorithms, skin prick test (SPT), measurement of fractional exhaled nitric oxide (FeNO), spirometry and methacholine challenge test (MCT). The value of a normal MCT and FeNO measurement for diagnosing habit cough was investigated.

Results The chart review revealed 482 patients with chronic cough>4 weeks. Of these, 99 (20.5%) with suspected habit cough were collected. 13 patients had to be excluded for other diagnosis and a complete data set was available in 55 patients. 33 (60.0%) of 55 patients were SPT negative and 22 (40.0%) had sensitization to common allergens. Five patients had elevated FeNO≥20 ppb and three showed severe bronchial hyperresponsiveness<0.1 mg methacholine, challenging the diagnosis of habit cough.

Conclusion A normal FeNO and MCT can help confirm the clinical diagnosis of habit cough. However, in patients with positive MCT and/or elevated FeNO habit cough can be present. Especially in patients with elevated FeNO and severe BHR cough variant asthma and eosinophilic bronchitis have to be ruled out.

Zusammenfassung

Hintergrund Chronischer Husten ist eines der häufigsten Symptome im Kindesalter. Eine eindeutige Diagnose zu stellen ist eine Herausforderung für alle Kinderärzte, insbesondere bei Patienten, bei denen der Husten keine organische Ursache hat, wie z. B. beim habituellen Husten.

Patienten und Methoden In dieser retrospektiven Analyse wurden alle elektronischen ambulanten Patientenakten der Abteilung für Allergologie und Pneumologie zwischen dem 1. Januar 2010 und dem 31. Dezember 2019 überprüft, um alle Kinder mit potenziellem habituellem Husten zu untersuchen. Alle Kinder wurden den folgenden Untersuchungen unterzogen: Haut-Prick-Test, Messung des fraktionierten exhalierten Stickstoffmonoxids (FeNO), Spirometrie und Methacholin-Provokation. Der Stellenwert einer normalen Methacholin-Provokation und FeNO-Messung bei der Diagnosestellung eines habituellen Hustens wurde untersucht.

Ergebnisse Die Auswertung der Krankenakten ergab 482 Patienten mit chronischem Husten>4 Wochen. Davon wurden 99 (20,5%) mit Verdacht auf habituellen Husten erfasst. 13 Patienten mussten aufgrund anderer Diagnosen ausgeschlossen werden und bei 55 Patienten war ein vollständiger Datensatz verfügbar. 33 (60,0%) von 55 Patienten waren im Hautpricktest negativ und 22 (40,0%) hatten eine Sensibilisierung gegen inhalative Allergene. Fünf Patienten hatten erhöhte FeNO≥20 ppb und drei zeigten eine schwere bronchiale Hyperreagibilität<0,1 mg Methacholin, was die Diagnose eines habituellen Hustens in Frage stellt.

Schlussfolgerung Ein normales FeNO und MCT können helfen, die Diagnose eines habituellen Hustens zu bestätigen, jedoch kann auch bei positivem MCT und/oder erhöhtem FeNO ein habitueller Husten vorliegen. Besonders bei Patienten mit erhöhtem FeNO und schwerer BHR müssen ein Cough variant Asthma oder eine eosinophile Bronchitis ausgeschlossen werden.

Keywords

chronic cough - habit cough - tic cough - methacholine challenge - fractional exhaled nitric oxide

Schlüsselwörter

chronischer Husten - habitueller Husten - Hustentic - Mathacholin-Provokation - fraktioniertes exhaliertes Stickstoffmonoxid

Publication History

Article published online:
31 January 2023

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