Cough-Variant Asthma

What is cough-variant asthma?

Cough-variant asthma (CVA) is a type of asthma where cough is your only symptom. It causes a chronic or recurring dry cough that gets better with asthma treatment, like inhalers.

In other forms of asthma, cough can be the main symptom, along with other “traditional” asthma symptoms, like wheezing or difficulty breathing. If you have CVA, cough will be your only symptom.

Is cough-variant asthma serious?

Cough-variant asthma is usually manageable with inhaled medications. But it may eventually progress to additional, more serious symptoms. These symptoms can also be managed, but can cause severe attacks.

What are the symptoms of cough-variant asthma?

Usually, people with asthma have breathing problems, wheezing and other symptoms. But cough is the only symptom of cough-variant asthma. It’s usually a dry cough but some people have a cough with mucus.

What causes cough-variant asthma?

Narrowed, swollen (inflamed) airways cause asthma. In many people, this makes it hard to breathe, but if you have cough-variant asthma, it makes you cough. Symptoms usually happen in episodes or attacks that can last hours or days. Attacks are triggered by things that irritate your lungs.

What triggers cough-variant asthma?

Anything that triggers asthma, like allergies or other things that irritate your lungs, can trigger cough-variant asthma. But the most common triggers for CVA tend to be:

• Cold air.
• Weather changes.
• Exercise.

Who’s at higher risk for cough-variant asthma?

While we don’t know what causes some people to have asthma, you might be at higher risk if you:

• Have a biological parent or a close relative with asthma.
• Smoke.
• Have obesity (a body mass index, or BMI, of 30 or higher).
• Grew up in an area with high levels of air pollution.
• Work around dust, chemicals and vapors.

How is CVA diagnosed?

A healthcare provider will diagnose cough-variant asthma based on your symptoms, health history and lung function tests. They might put you on a trial of asthma medications to see if that relieves your symptoms.

What tests should I expect?

Tests your provider might perform include:

• Pulmonary function tests. These test how well your lungs work. Spirometry is commonly used to evaluate asthma.
• Questionnaires. Your provider might have you fill out a form that asks questions about how often you cough, if anything triggers the cough or makes it better, and how much it disrupts your life. This helps them to get a complete picture of what might be causing the cough and what they can do to diagnose and treat it.
• Chest X-ray. Getting pictures of your lungs can rule out other causes of a cough.
• Bronchoprovocation test. During this test, you’ll inhale a medication that can make your airways narrow. It tests how sensitive (or reactive) your airways are.
• Treatment trials. Your provider might have you use inhaled corticosteroids or leukotriene receptor antagonists for two to four weeks to see if your symptoms improve.

How is cough-variant asthma treated?

The treatments for cough-variant asthma are the same as those for other forms asthma. Specific treatments include:

• Short-acting bronchodilators. These are rescue inhalers that quickly open up your airways during a sudden attack. They include short-acting beta-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs).
• Inhaled corticosteroids (ICS). These reduce inflammation and mucus. They come in a maintenance inhaler that you use every day to keep your cough from flaring up.
• Leukotriene receptor antagonists (like montelukast). This is a pill you take daily that helps prevent asthma symptoms.
• Long-acting bronchodilators. These also come in maintenance inhalers, combined with ICS, that you use every day. They include short-acting beta-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs). You shouldn’t use long-acting bronchodilators without also using an ICS to treat asthma. Long-acting bronchodilators alone can increase your risk of severe complications (including death) from an asthma-related event.

How soon after treatment will I feel better?

It might take a few weeks of maintenance medications to notice an improvement in your cough. Rescue inhalers work quickly, usually within 15 to 20 minutes.

Can CVA be prevented?

Since we don’t always know why some people get asthma while others don’t, there’s no known way to prevent it. You might be able to lower your risk by:

• Not smoking.
• Wearing a mask or other appropriate safety gear if you have to be around dust or chemicals regularly.
• Maintaining a weight that’s healthy for you.

What can I expect if I have cough-variant asthma?

If you have CVA, you should be able to manage your symptoms by avoiding your triggers and taking maintenance medications. About 40% of people with CVA will eventually develop additional asthma symptoms.

How do I take care of myself?

You can manage your symptoms and reduce your risk of a severe attack by:

• Avoiding known triggers.
• Creating and following an asthma action plan with your healthcare provider. This is a set of guidelines to let you know how to treat different stages of symptoms and when to call your provider.
• Following up with your provider frequently. Let them know if you have any new symptoms or if your medications stop working as well.

When should I see my healthcare provider?

Talk to your healthcare provider if you have a chronic, unexplained cough (cough for more than eight weeks). If you’ve been diagnosed with CVA, let your provider know if you start having additional asthma symptoms, like shortness of breath or wheezing.

When should I go to the ER?

Go to the emergency room if you have severe symptoms, including:

• Severe shortness of breath.
• High heart rate (tachycardia).
• Blue skin, lips or nails (cyanosis).
• Confusion or an altered mental state.

What questions should I ask my doctor?

Ask your healthcare provider to give you step-by-step instructions and show you how to use your inhalers. It might also be helpful to ask them:

• What new or worsening symptoms should I look out for?
• How do I take my medications?
• What do I do if I have an attack?
• Can you help me make an action plan?

Does acid reflux cause cough-variant asthma?

There’s no evidence that acid reflux causes CVA. Treating CVA with acid reflux medications usually doesn’t help relieve symptoms.

A note from Cleveland Clinic

Chronic cough can be frustrating, and it’s often hard to find the cause. With cough-variant asthma, your symptoms get better with asthma medication. By avoiding triggers and working closely with your provider to find the right medications, you should be able to manage your cough.