Clinical experience with low-dose itraconazole in chronic idiopathic cough.

Haruhiko Ogawa,Koichi Makimura,Yasuo Takeuchi,Masaki Fujimura

doi:10.1186/1745-9974-9-1

Haruhiko Ogawa, Koichi Makimura + Show 2 more

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https://doi.org/10.1186/1745-9974-9-1

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Abstract

BackgroundThe presence of basidiomycetous (BM) fungi in induced sputum is an important clinical finding in chronic idiopathic cough (CIC). However, the efficacy of anti-fungal therapy for CIC has not been evaluated.MethodsWe selected 10 patients with CIC and carried out allergological examinations for Bjerkandera adusta, a BM fungus that has been shown to enhance cough severity. The efficacy of low-dose itraconazole (ITCZ) therapy (50 mg/day) for 14 days as an adjunctive therapy was estimated with use of Cough Visual Analog Scale (Cough VAS) and the Japanese version of the Leicester Cough Questionnaire (J-LCQ). We evaluated whether there was a recognizable clinical or allergological pattern that could predict the efficacy of ITCZ therapy in CIC patients.ResultsSignificant changes in Cough VAS and minimal important difference in domains of the J-LCQ were observed in 3 and 5 CIC patients, respectively. The Δ cough scale was correlated with changes in domains of the J-LCQ (total (r = –0.73, P < 0.05), psychological (r = –0.73, P < 0.05), and social (r = –0.71, P < 0.05), respectively. There were significant differences in the change in total score (P < 0.05) and in the domain of social (P < 0.05) and Δ cough scale (P < 0.05) between positive and negative results of immediate skin test for B. adusta. Positive results for improvement of cough-related laryngeal sensation which was represented as a sensation of mucus in the throat (SMIT) were observed in 6 patients in the BM colonization-positive group (85.7%) and none in the BM colonization-negative group (0%). There was a significant difference in the positive ratio for improvement of SMIT between the two groups.ConclusionsAt present, it is not possible to conclude whether ITCZ therapy provides sufficient relief in CIC patients. However, this study suggested both the possible applicability of low-dose ITCZ therapy for treatment of CIC patients with regard to BM allergy and the necessity of development of a new assessment questionnaire for cough-related laryngeal sensations.Trial registrationUMIN-CTR (reference number R000005872; UMIN000004933).

Highlights

The presence of basidiomycetous (BM) fungi in induced sputum is an important clinical finding in chronic idiopathic cough (CIC)
We recently encountered a cluster of patients with allergic fungal cough (AFC), which is intractable and is characterized by sensitization to Bjerkandera adusta [9], among a new clinical disease concept termed fungusassociated chronic cough (FACC) [10] with the following manifestations: (1) chronic cough; (2) the presence of environmental fungi, basidiomycetous (BM) fungi, in the sputum; and (3) good clinical response to antifungal drugs
As the presence of BM fungi in induced sputum has been shown to be an important factor in distinguishing the clinical manifestations of CIC from those of nonCIC [13], we describe here our clinical experience in 10 CIC patients treated with low-dose itraconazole (ITCZ)

Summary

Introduction

The presence of basidiomycetous (BM) fungi in induced sputum is an important clinical finding in chronic idiopathic cough (CIC). We recently encountered a cluster of patients with allergic fungal cough (AFC), which is intractable and is characterized by sensitization to Bjerkandera adusta [9], among a new clinical disease concept termed fungusassociated chronic cough (FACC) [10] with the following manifestations: (1) chronic cough; (2) the presence of environmental fungi, basidiomycetous (BM) fungi, in the sputum; and (3) good clinical response to antifungal drugs. As the presence of BM fungi in induced sputum has been shown to be an important factor in distinguishing the clinical manifestations of CIC from those of nonCIC [13], we describe here our clinical experience in 10 CIC patients treated with low-dose itraconazole (ITCZ). We attempted to clarify the problems raised in the process of evaluating the clinical efficacy of low-dose ITCZ, especially with regard to both colonization of BM fungi and sensitization to B. adusta.

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