Inhaled vs Intranasal Corticosteroids for Chronic Cough in Upper Airway Cough Syndrome

Comparison of the Efficacy of Two Therapeutic Regimens in Patients With Chronic Cough With Signs of Rhinitis or Paranasal Sinusitis

Chronic cough - a cough lasting eight weeks or longer - is one of the most common reasons people see a lung specialist. It can disturb sleep, make conversation difficult, and reduce quality of life.

In many people, chronic cough occurs together with nose and sinus symptoms such as a blocked or runny nose, mucus dripping down the back of the throat, facial pain, or a reduced sense of smell. This combination is often called upper airway cough syndrome. Doctors commonly treat it with a steroid medicine given either as an inhaler breathed into the lungs or as a spray into the nose. Both are approved, widely used medicines, and treatment guidelines mention both. However, no study has directly compared the two to see whether one relieves cough better than the other, so doctors have little evidence to guide the choice.

This study compares the two treatments directly in adults who have chronic cough together with nose or sinus symptoms. Participants are assigned by chance, like flipping a coin, to one of two groups:

an inhaled steroid (budesonide), breathed in twice a day, or a steroid nasal spray (mometasone furoate), sprayed into each nostril twice a day.

Participants use their assigned treatment for 4 weeks and then return to the clinic. At each visit they rate how severe their cough is by marking a line on a 100-millimetre scale, and they fill in a questionnaire about how the cough affects their daily life.

Participants whose cough has cleared up after 4 weeks finish the study at that point. Those whose cough has not cleared up continue for another 4 weeks: people in the inhaler group carry on with the same inhaler, while people in the nasal spray group continue the spray and also start the inhaler. Everyone who continues returns for a final visit at 8 weeks.

The main question is whether the inhaled steroid reduces cough severity more than the nasal spray after 4 weeks of treatment. The study also looks at cough-related quality of life, and at what happens after treatment is adjusted at 4 weeks.

The study takes place at a single outpatient lung clinic in Katowice, Poland. Both medicines are given at their usual approved doses, and participants are otherwise cared for as in routine practice.

Inclusion Criteria:

• Patients with chronic cough and signs of chronic upper airway disease

Exclusion Criteria:

• Symptoms of an acute respiratory tract infection within 4 weeks prior to enrolment.
• Diagnosis of any active chronic respiratory disease.
• Diagnosis of other cause of chronic cough.
• Use of corticosteroids (oral, intranasal, inhaled, intravenous) within 3 months prior to enrolment.
• Chronic use of angiotensin-converting enzyme (ACE) inhibitors within 1 month prior to enrolment.
• Smoking of tobacco products within 6 months prior to enrolment
• Pregnancy.