Response to inhaled corticosteroids in patients with non-asthmatic eosinophilic bronchitis

Treatment of NAEB is based on inhaled corticosteroids (ICS) but their efficacy is not well documented The aim of the study was to: characterize patients with NAEB-related CC; analyze the response to ICS in patients with NAEB Non-smoking adults with CC diagnosed in our department between Jan 2017 and Dec 2019 were investigated NAEB related CC was diagnosed in patients presented with: > 3% sputum eosinophils; normal spirometry and chest X-ray; PC20 >16 mg/dl in methacholine challenge test All patients with NAEB were treated with budesonide 400 mcg or ciclesonide 320 mcg qd. Response to ICS was measured by comparison of cough severity (measured by visual analogue scale, VAS) and quality of life (measured by Leicester Cough Questionnaire, LCQ) before and after 2 months of ICS therapy NAEB was diagnosed as the cause of CC in 14 of 240 adult patients with CC managed in the analyzed period. There were 10F, 4M; median age 56.5 yrs, IQR 48.8-66.8 with median sputum eosinophil count 6% (IQR 4.3-6.8). None of these patients presented with blood eosinophilia. Median FeNO was 15.8 ppb (IQR 14.7-29.9). Atopy was present in 2 patients Pre-treatment cough severity was 66 mm (IQR 61-71) and 10.7 points (IQR 8.4-12.1) as assessed by VAS and LCQ, respectively and dropped to 40 mm (IQR 29-63 mm, p=0.023) after 2 months of ICS intake, with nonsignificant increase in LCQ score (12.8 points, IQR 11.3-14.7). Only in 55% subjects the reduction of cough severity was ≥20 mm NAEB-related CC is usually intense and negatively affects patients’ quality of life. Neither blood eosinophils nor FeNO are useful in NAEB diagnosis. Efficacy of treatment NAEB with ICS is limited