Medical expert of the article
New publications
Coughing with asthma
Last reviewed: 05.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Coughing in asthma is accompanied by attacks of suffocation. However, coughing in bronchial asthma may also be without suffocation or with minor episodes of difficulty breathing. In such cases, it is more difficult to assume the presence of asthma, but coughing remains a characteristic symptom. It will most likely be paroxysmal, more often at night, and in "cough" asthma it may only be at night. It may be accompanied by distant "whistles" or "wheezing".
[ What causes cough in asthma?
Provoking factors are identified. Cough in atopic asthma is provoked by contact with allergens:
- contact with pets in case of epidermal allergy:
- cleaning an apartment in case of sensitization to household, epidermal and fungal allergens:
- going out of town, undergoing herbal therapy, eating certain foods for pollen allergies;
- visiting a damp basement, eating fermented products in case of fungal allergy.
Cough can also be provoked by pollutants, strong odors, cold air (or a sharp change in air temperature), loud laughter, forced breathing, physical exertion. In such cases, we can talk not about allergies, but about the manifestation of bronchial hyperreactivity to non-specific irritants.
One of the factors that increases bronchial reactivity is ARVI. In this case, a prolonged dry cough after ARVI may be a manifestation of asthma.
How does cough manifest itself in asthma?
Cough in asthma can be seasonal, that is, it appears annually in certain months. In the case of pollen allergy, it is usually combined with rhinitis, rhinoconjunctivitis. However, not only with pollen, but also with other forms of asthma, cough is often combined with allergic rhinitis.
Coughing with asthma, and at the end of the attack, a small amount of thick, viscous, "glassy" sputum may be released. At the same time, with non-atopic asthma or with the addition of a respiratory infection, sputum may have other characteristics and be released in greater quantities. With the cholinergic variant of asthma, a significant amount of light mucous sputum may be coughed up. In some such patients, clinical manifestations of bronchial obstruction are minimal, and the patient focuses his attention (and the doctor's attention) on a wet cough.
It should be borne in mind that there is a high probability of asthma in blood relatives.
How to recognize cough in asthma?
Eosinophilic leukocytosis is typical for bronchial asthma, especially during exacerbation. In "cough" asthma, the number of eosinophils in the peripheral blood is usually within 5-10%. In some forms of asthma (fungal sensitization, asthmatic triad, combination with parasitic invasion), the number of eosinophils can reach 15% or more.
Eosinophilia of sputum and bronchoalveolar lavage is also considered a characteristic sign of bronchial asthma. It is necessary to take into account that inhaled glucocorticoids can eliminate sputum eosinophilia, and the use of systemic hormones reduces the number of eosinophils in the peripheral blood to 0% (in this case, "steroid leukocytosis" may appear - 10-11x10 9 /l).
In addition, Curschmann spirals are sometimes detected in the sputum of patients (less often they occur in obstructive bronchitis, pneumonia, and lung cancer). Curschmann spirals are mucus strands consisting of a central dense axial thread and a spiral-shaped mantle enveloping it, into which leukocytes (often eosinophilic) and Charcot-Leyden crystals (colorless octadrons of varying sizes, resembling a compass needle in shape) are embedded. Charcot-Leyden crystals consist of protein released during the breakdown of eosinophils, and there are more of them in stale sputum.
Allergological examination identifies allergens that provoke coughing in asthma in a given patient. Skin allergy tests are performed only by an allergist-immunologist. Provocative inhalation tests with allergens, as well as determination of the level of total (usually increased in atopic asthma) and the presence of allergen-specific IgE in the blood serum can be used as additional tests.
A study of FVD allows us to determine the nature of ventilation disorders caused by cough in asthma. In many cases of cough (pharyngitis, tonsillitis, postnasal drip syndrome, acute respiratory viral infection, psychogenic, reflex cough), the spirogram will be normal. In case of lung tissue damage (pneumonia, bronchiectasis, interstitial lung diseases, left ventricular failure), predominantly restrictive ventilation disorders (decreased VC) will be detected. The days of development of bronchial obstruction (BA, obstructive bronchitis) are characterized by pulmonary ventilation disorders of the obstructive type (decreased FEV1, FVC, Tiffeneau index, PSV). The main difference between obstructive bronchitis and BA is the reversibility of bronchial obstruction - in BA it is reversible.
Chest X-rays of cough-variant asthma usually show no changes. If the cough is caused by other conditions, the changes will correspond to the underlying disease. In case of a disease of the nose and paranasal sinuses, the corresponding changes will be detected in the paranasal sinuses on the X-ray.