Dr.Kamini Silvarajan MD/AAAM

Editorial Board: Dr.Kamini Silvarajan MD/AAAM

Cough Variant Asthma


Cough Variant Asthma

This article is a continuation from each description of the Types Of Asthma.

Symptoms Of Cough Variant Asthma

While normal cough may follow the usual symptoms associated with asthma in Cough Variant Asthma but cough alone may be a precursor(a thing that comes before another of the same kind; a forerunner) to or the sole symptom in an asthmatic. So when cough is the only asthma symptom, this is known as Cough Variant (a form or version of something that differs in some respect from other forms of the same thing or from a standard) Asthma or CVA.

Basically,the main symptom of CVA is a chronic, non-productive cough.

CV Asthma patients have cough as the main or the only symptom of their asthma. CVA type of asthmatic patients are a small percentage of total asthma patients. CVA patients are, however, a distinct group rather than only being thought of as coughing asthmatics.

However,CVA patients have some differences from patients with typical asthma. For instance, while normal asthmatics do not differ from in their cough reflex, CVA patients have a more sensitive cough reflex(an action – without conscious thought or an automatic response to a stimulus). In a manner, CVA patients have a smaller reaction to *methacholine challenge testing under Bronchoprovocation Challenge Testing (shall discuss about this in one of the article after the types of asthma articles) compared to other asthmatics.

Diagnosis Of Cough Variant Asthma or CVA

Since cough is a common symptom for asthma, your healthcare provider or doctor may order a spirometry test (https://whatasthmais.com/asthma-diagnosis/) .Once the spirometry test shows reversible obstruction, your medical professionals may start a therapeutic trial (- is when a medical professional makes a diagnosis and starts treatment based on symptoms alone, without significant additional testing) for asthma. But, asthmatics may have a normal lung exam and spirometry causing a diagnostic dilemma where your medical professionals may suspect, but is unable to prove or confirm you have asthma.

Therefore, your medical professionals may perform methacholine [parasympathomimetic drug (trademark Mecholyl) that stimulates secretions and smooth muscle activity] challenge testing* in order to show bronchial hyperresponsiveness and diagnose asthma. If a methacholine challenge test does not produce hyperresponsiveness, it is unlikely that asthma is the cause of a cough. A definitive diagnosis can be made if the cough symptoms respond after asthma treatment.

Treating Cough Variant Asthma

Treating CVA is almost the same as for asthma. Some improvement of cough may be seen as quickly as one week with asthma bronchodilators like Albuterol, but may not completely resolve for up to eight weeks after starting an inhaled steroid like Flovent.

If the cough does not fully resolves, your medical professionals may attempt a more potent steroid like oral prednisone. At the same time your medical professionals may do special tests to identify eosinophils, a marker of inflammation, in your lung. If eosinophils are found present in the lung, administration of Zafirlukast has been shown to improve cough among patients with CVA and has been beneficial in CVA patients without a good response to inhaled steroids.

Minor group of asthma patients may experience worsening of the cough with inhaled steroids due to the aerosols used in the inhaler device. Under all attempt, if the cough worsens, it is important that it is not GERD.


– Gastroesophageal reflux disease is one of the most common conditions that may lead to uncontrolled asthma. GERD occurs when acid from your stomach leaks back into your esophagus (the part of the alimentary canal that connects the throat to the stomach) and causes symptoms due to irritation. While the link between GERD and asthma is not totally clear, treating GERD may improve your asthma.