Management of Exercise-Induced Cough in Asthma

Initial Treatment Approach

• The American College of Chest Physicians recommends initiating treatment with inhaled bronchodilators and inhaled corticosteroids for patients with asthmatic cough, reserving systemic corticosteroids for severe or refractory cases 1, 2, 3
• First-line treatment consists of inhaled bronchodilators plus inhaled corticosteroids, which should be initiated immediately for any patient with asthmatic cough 1, 2, 3

Systemic Corticosteroid Use

• Systemic corticosteroids should be reserved for severe and/or refractory asthmatic cough that persists despite treatment with inhaled corticosteroids and bronchodilators 1, 2, 3
• When systemic steroids are indicated, a short course of 1-2 weeks of oral corticosteroids followed by transition back to inhaled corticosteroids is recommended 1, 2, 3

Evidence-Based Guidelines

• The American College of Chest Physicians guidelines provide clear hierarchical recommendations, prioritizing high-dose inhaled corticosteroids plus long-acting beta-agonists, followed by leukotriene receptor antagonists, and only then systemic corticosteroids if needed 4, 1, 3
• Asthma should always be considered as a potential cause of chronic cough, as it is commonly associated with this symptom 4, 1, 3

Treatment Pitfalls to Avoid

• The American College of Chest Physicians advises against jumping directly to systemic steroids without trying inhaled therapy first, as this exposes patients to unnecessary systemic side effects when inhaled medications are highly effective 1, 2, 3
• Newer non-sedating antihistamines are ineffective for cough management and should not be used 4