Treatment of cough in asthma
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Standard Pharmacological Treatments for Cough in Asthma
Inhaled corticosteroids (ICS) are the primary treatment for cough associated with asthma, with strong evidence supporting their effectiveness in controlling cough symptoms and improving patient outcomes 410. For patients whose cough persists despite medium-dose ICS combined with long-acting β2-agonists (LABA), stepping up to higher-dose ICS/LABA or switching to a triple therapy that includes indacaterol, glycopyrronium, and mometasone (IND/GLY/MF) is being investigated as a potentially more effective approach for cough relief and improved quality of life . Leukotriene receptor antagonists are also recommended as a secondary option if ICS alone is insufficient .
Alternative and Adjunctive Therapies for Asthma-Related Cough
Acupuncture and Traditional Chinese Medicine
Acupuncture has shown promise in treating cough-variant asthma, with studies indicating it can enhance overall clinical effectiveness, reduce relapse rates after stopping medication, relieve cough and related symptoms, and improve lung function and immune markers. However, the quality of evidence is limited, and more rigorous trials are needed . Traditional Chinese medicine (TCM) approaches, such as treating underlying "qi deficiency" and "phlegm heat," focus on both symptom relief and addressing root causes, with strategies tailored to acute and remission stages .
Chinese herbal medicines, including formulas like Modified Dingchuan Decoction (MDD) and Suhuang Zhike (SHZK) capsules, have demonstrated benefits in reducing cough frequency, improving airway inflammation, and regulating lung microbiota in both animal models and clinical trials. These treatments may serve as effective adjuncts to standard anti-inflammatory medications, especially for patients with persistent or recurrent cough 567.
Advanced and Biologic Therapies
For severe or refractory cases, biologic therapies such as mepolizumab have been shown to significantly reduce cough frequency and improve asthma control in patients with eosinophilic asthma . Bronchial thermoplasty, a procedure that reduces airway smooth muscle, has also been found to improve cough severity and cough-related quality of life in patients with severe, uncontrolled asthma .
Monitoring and Assessment
Objective assessment tools, such as ambulatory cough monitoring and validated questionnaires, are valuable for tracking treatment response and guiding therapy adjustments in patients with asthma-related cough . These tools can help clinicians identify early improvements and optimize management strategies.
Conclusion
The treatment of cough in asthma primarily relies on inhaled corticosteroids, with escalation to combination therapies or leukotriene receptor antagonists for persistent symptoms. Alternative therapies, including acupuncture and Chinese herbal medicine, may offer additional benefits, particularly for cough-variant asthma. For severe or refractory cases, biologic agents and bronchial thermoplasty are emerging options. Ongoing research and objective monitoring are essential to further refine and personalize cough management in asthma.
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