High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study.

BACKGROUND: It is important to determine whether chronic cough is associated with asthma and can be helped by treatment with inhaled corticosteroids. OBJECTIVE: To compare the effects of beclomethasone and placebo in patients with chronic cough for at least 8 weeks after excluding those with cough due to postnasal drip and gastroesophageal reflux disease. METHODS: A prospective, randomized, double-blind, placebo-controlled study comprising 64 patients was performed for 2 weeks. The active group received metered-dose inhaler chlorofluorocarbon-beclomethasone (1,500 microg/d), and the placebo group received identical-appearing placebo inhalers. All the participants completed a respiratory questionnaire and underwent bronchoprovocation testing (BPT) with methacholine and allergy skin testing. The primary outcome measure was a decrease in daily cough scores (symptom diary and visual analog scale) during the 2-week treatment period. RESULTS: The active group comprised 44 patients and the placebo group 20 patients. Cough duration averaged 20 weeks. At the end of treatment 82% of the active group and 15% of the placebo group had complete resolution of cough. In the active group 22 patients (50%) had positive BPT results, and in the placebo group 10 patients (50%) had positive results. There was no correlation between treatment response and responses on the respiratory questionnaire, allergy skin testing, or BPT. CONCLUSION: Therapy with high-dose inhaled beclomethasone provided an excellent response in a subgroup of patients with chronic cough that did not correlate with atopy or airway hyperresponsiveness.