What is the treatment for eosinophilic bronchitis?

Treatment of Eosinophilic Bronchitis

The first-line treatment for eosinophilic bronchitis is inhaled corticosteroids, which significantly improve symptoms and reduce sputum eosinophil counts. 1 This treatment approach directly addresses the underlying eosinophilic airway inflammation that causes persistent cough in these patients.

Treatment Algorithm

1. Identify and eliminate triggers

   • Assess for occupational exposures or inhaled allergens
   • When a causal allergen or occupational sensitizer is identified, avoidance is the best treatment 1
   • Consider workplace assessment if occupation-related cause is suspected

2. First-line pharmacological therapy

   • Inhaled corticosteroids
     • Example: Budesonide 400 μg inhaled twice daily for at least 4 weeks 1
     • Patients typically show symptomatic improvement and significant reduction in sputum eosinophil counts
     • Capsaicin cough sensitivity improves toward normal with treatment

3. For persistent or severe symptoms

   • Increase to high-dose inhaled corticosteroids
   • If symptoms remain troublesome despite high-dose inhaled steroids, add oral corticosteroids 1
   • Parenteral corticosteroids may be considered in refractory cases 2

Evidence for Treatment Efficacy

Inhaled corticosteroids have demonstrated effectiveness in multiple studies:

• Significant correlation between treatment-induced reduction in cough sensitivity and decrease in sputum eosinophil count 1
• Treatment with inhaled steroids leads to subjective improvement in cough severity and significant decrease in sputum eosinophil percentage (from 29.1% to 7.4%) 3
• In contrast, patients with chronic cough without sputum eosinophilia do not show improvement with inhaled corticosteroids 1

Clinical Course and Monitoring

Eosinophilic bronchitis may follow a chronic course requiring ongoing monitoring:

• Follow-up sputum analysis can help guide treatment decisions
• Increases in sputum eosinophil percentage often correlate with symptom aggravation 3
• Long-term data suggests that eosinophilic bronchitis generally has a benign course 4

Important Caveats

• Duration of therapy: There are no clear guidelines on how long to continue inhaled corticosteroid treatment after symptoms resolve 1
• Potential for progression: In some patients (approximately 9%), eosinophilic bronchitis may progress to asthma with airway hyperresponsiveness 1
• Risk of remodeling: Airway wall remodeling can occur in eosinophilic bronchitis, potentially leading to fixed airflow obstruction in some cases 1, 4
• Treatment resistance: In cases with persistent eosinophilia despite standard inhaled corticosteroid therapy, high-dose systemic corticosteroids may be effective 2

Differential Diagnosis Considerations

Eosinophilic bronchitis accounts for approximately 10-13% of chronic cough cases 1, 3 and must be distinguished from:

• Cough variant asthma (which has airway hyperresponsiveness)
• Post-nasal drip syndrome
• Chronic bronchitis

Diagnosis requires demonstration of sputum eosinophilia (>3%) with normal spirometry, normal peak flow variability, and no airway hyperresponsiveness 3.

The treatment approach for eosinophilic bronchitis focuses on controlling the underlying inflammation to improve quality of life and prevent potential progression to more severe respiratory conditions.