Codeine for treatment of cough variant asthma

Abstract

Cough variant asthma (CVA) is a special phenotype of asthma. Despite standart regimens, the treatment and control of CVA is difficult and can cause complications. Some patients have persistant symptoms despite inhaler bronchodilator and steroid therapy. Central cough supressants, such as codeine and dextromethorphan are recommended for symptomatic relief of cough in patients with chronic bronchitis but there is limited scientific data about their usage in asthma patients. We evaluate 16 CVA-phenotype asthmatic patients who had to use codeine, who were unresponsive to conventional asthma medications. We analysed demographic characteristics, atopy history, codeine dose and drug side effects retrospectively.Among 16 patients, 13 were female. Mean age was 57,4 ±15,3 years. Two patients were smoking cigarette. 11/16 (68,75%) patients had complain of allergic rhinitis, one had a dermatitis, 5 of them had a urticaria, 3 of them had metal allergy. The most suspected triggers of cough were infection (68,7%), speaking (%56,2), cold air (50%), pollen, cleaning solvents and emotional stress.Median duration of codeine theraphy was 24 months (3-87 months). In 13 of 16 (81,2%) patients codeine was beneficial to control cough.Median daily dose of codeine was 25 mg (10-60 mg) .Optimal antitussive effect of codeine was observed in a few days. 3 of 16 patients had constipation as an side effect of codeine bu none of them had to give up treatment. Addiction to drug was not observed. For the patients with CVA whose cough is unresponsive to the standard therapies (resistant cough), codeine can be an alternative treatment option. Although the duration of treatment is unclear, with no side-effects we suggest that it can be used as long as there is a benefit.