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Cough variant asthma (CVA) is a subtype of asthma, which presents solely with a cough without any other symptoms such as dyspnea or wheezing.
CVA is one of the most common causes of a chronic cough. More importantly, 30 to 40 percent of CVA cases in adult patients, unless adequately treated, may progress to classic asthma. (1)(2)
CVA shares some pathophysiological features with classic asthma, such as atopy, airway hyper-responsiveness, eosinophilic airway inflammation, and various elements of airway remodeling. (2)
The chronic cough that characterizes CVA is usually dry and unproductive and often tends to worsen at night. A nonproductive cough such as this does not expel any mucus from the respiratory tract and can last six to eight weeks. (3)(4)
Causes of Cough Variant Asthma
Just like standard chronic asthma, experts are still not sure what causes CVA. However, experts believe that exposure to allergens, such as mold spores, pollen, dust, pet dander, and strong fragrances, may lead to its onset.
Coughing is a way to expel unwanted substances or irritants from the respiratory tract. However, in the case of CVA, the other possible reasons may include the following:
- An infection of the upper respiratory system, such as sinusitis or the common cold, may trigger coughing episodes.
- Using certain medications like beta-blockers for the treatment of heart failure, cardiovascular ailments, palpitations, migraines, and aspirin can lead to a CVA-induced coughing spell.
- Chronic coughing may set in after an exercise session.
- Smoking and air pollutants can also bring on a coughing episode.
- Weather conditions such as cold air, humidity, and heat or erratic changes in the weather have also been associated with this condition.
- Stress can also contribute to the flare-up of CVA.
Symptoms of Cough Variant Asthma
- The only characteristic feature of a case of CVA is an unexplained chronic cough that doesn’t seem to be rooted in any other condition or cause.
- This cough is usually dry, which means it is not accompanied by phlegm or mucus expulsion and lasts at least six to eight weeks.
- Although CVA does not present any of the other symptoms typically associated with asthma, such as fluid in the lungs, chest tightness, shortness of breath, and wheezing, it affects the airways in the same way as its more traditional counterpart does. To expand further, the bronchial tubes tend to become hyper-responsive and tighten up, making breathing increasingly difficult. Thus, it’s essential to manage CVA properly to avoid grave complications. (4)
Treating Cough Variant Asthma
CVA is treated in the same way as regular asthma, given both of them engender the same effect on the airways and the lungs, only differing in severity.
There are a number of treatment options, and the doctor may prescribe any or a combination of the following:
- Rescue inhalers that work to provide instant relief by bringing down airway inflammation quickly in the case of an asthma attack
- Inhaled corticosteroids or inhaled anti-inflammatory drugs that alleviate and prevent swelling in the bronchial tubes
- Allergy medications such as antihistamines and a mix of inhalers that include both preventive medicines and fast-responding medicines
- Preventive oral medications that work to keep the airways open
Some options might give you better results than others, and thus the treatment strategy can vary from person to person. You will have to work closely with your doctor to come up with one that suits you best.
Risk Factors Related to Cough Variant Asthma
People who have another allergic condition, regular asthma, or a relative with asthma are at a higher risk for CVA. Other risk factors include:
- Being overweight
- Smoking
- Exposure to secondhand smoke
- Frequent or prolonged exposure to environmental or occupational irritants
Complications Regarding Cough Variant Asthma
CVA is comparatively less damaging to normal lung function than a classic case of regular asthma, but the chronic dry cough that comes with it can be quite a nuisance.
Some of the common disruptions associated with it include:
- Disturbed sleep
- Light-headedness
- Fatigue
- Vomiting
- Urinary leakage and incontinence
All of these together can take a massive toll on you and have damaging consequences for both your personal and professional lives.
Moreover, prolonged negligence of this condition can give rise to chronic obstructive pulmonary disease (COPD) and can hamper your lung function to a significant degree. (5)
Poorly managed CVA can also lead to other serious complications that may be fatal, such as:
- Pneumonia
- Resistant asthma attacks that don’t respond to treatment
- Irredeemable constriction of the airways, which makes it hard to breathe in general, and not just during flare-ups
- Collapsed lung
- Complete lung failure
If CVA is not treated and managed correctly, it may progress into classic asthma. According to a study published in Current Respiratory Medicine Reviews in 2011, 30 percent to 40 percent of CVA cases in adult patients, unless adequately treated, may progress to classic asthma. (6)
Expert Answers (Q&A)
Answered by Dr. Laren Tan, MD (Pulmonologist)
Cough variant asthma is very much like asthma except the only persistent symptom when left untreated is a chronic cough.
The treatment for cough variant asthma parallels the treatment for asthma. Cough variant asthma typically involves ‘maintenance inhalers’ to decrease airway inflammation.
The trigger can vary from individual to individual, some of the more common causes are tobacco smoke, pollen, strong odors, and chemical fumes.
Avoidance of the irritant that triggers the cough should always be a top priority but there are times when its not possible or the irritant that causes the cough is unknown, in those cases inhaler use has the potential to lessen or stop the cough.
Final Word
It is easy to confuse a persistent cough induced by a CVA flare-up as an allergy or a lingering cold, but what sets this condition apart from the other two is that the cough associated with CVA does not involve coughing up sputum and does not subside until you get diagnosed and treated for it.
The fact that CVA can progress to a more severe, chronic asthma if not adequately attended to makes the need for diagnosis all the more imperative.
Early diagnosis and treatment can keep the condition under control by reducing the severity and frequency of flare ups while also saving you from a host of unwanted complications.
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