Eosinophil-Associated Cough

Asthma is characterized by variable symptoms such as wheeze, shortness of breath and coughing and is usually associated with airway inflammation, with variably reduced spirometric indices [4, 5], with increased non-specific airway responsiveness (AR) to spasmogens [6, 7] and increased levels of semm immunoglobulin E (IgE) and eosinophils [8-10]. The symptoms of asthma are primarily due to excessive airway narrowing, which leads to an increased resistance to airflow, especially during forced expiration, and produces characteristic spirometric findings. A cardinal feature of asthma is that airway narrowing is reversible either spontaneously or as the result of therapy. 

Asthma (as defined by the Global Initiative for Asthma). Asthma is a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells, eosinophils and T lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough particularly at night and/or in the early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. This inflammation also causes an associated increase in airway responsiveness to a variety of stimuli. 

Pulmonary infiltrates with eosinophilia (Loeffler s syndrome) have been associated with nitrofurantoin,para-aminosalicytic acid, methotrexate, sulfonamides, tetracycline, chlorpropamide, phenytoin, NSAIDs, and imipramine (Table 29-5). The disorder is characterized by fever, nonproductive cough, dyspnea, cyanosis, bilateral pulmonary infiltrates, and eosinophilia in the blood. Lung biopsy has revealed perivasculitis with infiltration of eosinophils, macrophages, and proteinaceous edema fluid in the alveoli. The symptoms and eosinophilia generally respond rapidly to withdrawal of the offending drug. 

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