Fig. 1
*moderate dose of ICS according to GINA (pMDI: beclometasone dipropionate HFA, extrafine particle or ciclesonide or budesonide) in combination with formoterol 12-24 mcg daily; &montelukast 10 mg daily; $prednisone 0.5 mg/kg daily. CVA: cough variant asthma; GINA: The Global Initiative for Asthma; HFA: hydrofluoroalkane; ICS: inhaled corticosteroids; LABA: long-acting β2-agonists; ΔLCQ: change in Leicester cough questionnaire from the baseline; LTRA: leukotriene receptor antagonist; pMDI: pressurized metered-dose inhaler; OCS: oral corticosteroids; ΔVAS: change in cough severity from the baseline
Stepwise approach to treatment of patients with chronic cough and bronchial hyperresponsiveness. The protocol of treatment was based on an add-on approach and included three consecutive steps. Therapy was initiated with a combination of a moderate dose of ICS + LABA (formoterol). If the improvement was reported (ΔLCQ + 1.3 points and ΔVAS − 20 mm from the baseline) after 4 weeks of treatment, the patient was diagnosed with CVA. However, if cough persisted, step 2 was initiated with add-on LTRA (montelukast 10 mg), with measurement of LCQ and VAS after the next 4 weeks of treatment. In case of the treatment failure, a short course (10 days) of OCS (0.5 mg/kg of prednisone) was introduced. The diagnosis of CVA was established if the improvement was noted after any of three steps