Methacholine responsiveness of bronchial and extrathoracic airway in patients with chronic cough

J. J. Shim, Hyeong Kim Je Hyeong Kim, Yong Lee Sung Yong Lee, Hwan Kwan Young Hwan Kwan, Ra Lee So Ra Lee, Yeub Lee Sang Yeub Lee, Kyung Suh Jung Kyung Suh, Youn Cho Jae Youn Cho, Ho In Kwang Ho In, Hwa Yoo Se Hwa Yoo, Ho Kang Kyung Ho Kang

Research output: Contribution to journalArticlepeer-review


Background: Chronic cough, defined as a cough persisting for three weeks or longer, is a common symptom for which outpatient care is sought. The most common etiologies of chronic cough are postnasal drip, asthma, and gastroesophageal reflux. Methacholine challenge is a useful diagnostic study in the evaluation of chronic cough, particularly useful in chronic cough patients with asthmatic symptom. Patients with chronic cough may have dysfunction of bronchial and extrathoracic airways. To evaluate if dysfunction of the bronchial and extrathoracic airways causes chronic cough, we assessed bronchial (BHR) and extrathoracic airway (EAHR) responsiveness to inhaled methacholine in patients with chronic cough. Method: 111 patients with chronic cough were enrolled in our study. Enrolled patients had no recorded diagnosis of asthma, bronchopulmonary disease, hypertension, heart disease or systemic disease and no current treatment with bronchodilator or corticosteroid. Enrolled patients consisted of 46 patients with cough alone, 24 patients with wheeze, 22 patients with dyspnea; 19 patients with wheeze and dyspnea. The inhaled methacholine concentrations causing a 20% fall in forced expiratory volume in 1 s (PC20 FEV1) and 25% fall in maximal mid - inspiratory flow (PC25 MIF50) were used as bronchial and extrathoracic hyperresponsiveness. Results: There were four response patterns to methacholine challenge study: BHR in 27 patients, EAHR in 16 patients, combined BHR and EAHR in 8 patients, and no hyperresponsiveness in 60 patients. In patients with cough alone, there were BHR in 3 patients, EAHR in 9 patients, and combined BHR and EAHR in 2 patients. In patients with wheeze and/or dyspnea, there were BHR in 24 patients, EAHR in 7 patients, and BHR and EAHR in 6 patients. Compared with patients with wheeze and/or dyspnea, patients with cough alone had more common EAHR than BHR. In patients with wheeze and/or dyspnea, BHR was more common than EAHR. Conclusion: These results show that among patients with hyperresponsiveness to methacholine, those with dyspnea and/or wheezing had mainly bronchial hyperresponsiveness, whereas those with chronic cough alone had mainly extrathoracic airway hyperresponsiveness.

Original languageEnglish
Pages (from-to)853-860
Number of pages8
JournalTuberculosis and Respiratory Diseases
Issue number4
Publication statusPublished - 1997
Externally publishedYes


  • Airway hyperresponsiveness
  • Chronic cough

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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