From the Guidelines
Approximately 24 to 29% of patients with asthma do not exhibit wheezing, instead presenting with cough-variant asthma (CVA) as their primary symptom. This condition is characterized by a persistent cough, often without the typical symptoms of dyspnea and wheezing associated with asthma 1. The diagnosis of CVA can be challenging, as physical examination and spirometry findings may be entirely normal, and the diagnosis is only confirmed after the resolution of cough with antiasthmatic therapy 1. Some key points to consider in the diagnosis and management of CVA include:
- Conducting methacholine inhalation challenge testing to demonstrate the presence of bronchial hyperresponsiveness 1
- Assessing response to inhaled bronchodilators and inhaled corticosteroids, which are often effective in treating CVA 1
- Evaluating symptoms and triggers to guide treatment decisions
- Potentially using leukotriene receptor antagonists and/or a short course of oral corticosteroids in patients who do not respond to initial treatment 1 It is essential for healthcare providers to consider asthma as a potential etiology in patients with chronic cough, even in the absence of wheezing, to ensure proper diagnosis and timely treatment 1.
From the Research
Asthma Patients Without Wheezing
- The provided studies do not directly report the number of patients with asthma who do not exhibit wheezing 2, 3, 4, 5, 6.
- However, a study published in 2020 found that the pooled proportion of wheezing in patients with asthma was 46.97% 5, implying that approximately 53.03% of patients with asthma may not exhibit wheezing.
- It is essential to note that wheezing is a common symptom of asthma, but its absence does not rule out the diagnosis of asthma 2, 3, 4.
- Other symptoms such as nasal congestion, sleep disturbances, breathlessness, and chest tightness are also common in patients with asthma 5.
- A combination of symptoms, including wheezing, breathlessness, chest tightness, and cough, was reported in 71.26% of patients with asthma 5.
Diagnosis and Evaluation
- Establishing an accurate diagnosis of asthma requires attention to the patient's history, physical examination results, and response to therapy 3.
- Pulmonary function tests, such as bronchodilator challenge, can help confirm or rule out the diagnosis of asthma 3, 4.
- A trial of short-acting beta agonists can be considered while awaiting formal evaluation 4.