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Glenfield Hospital, Leicester, UK
Correspondence to: Surinder S. Birring, MD, Institute for Lung Health, Respiratory Medicine, Glenfield Hospital, Groby Rd, Leicester, LE3 3NS, UK; e-mail: sb134{at}le.ac.uk
To the Editor:
In a recent article in CHEST (May 2005), Mund et al1 described 11 female patients with idiopathic chronic dry-cough, with onset occurring around the menopause, that was associated with an increase in absolute lymphocyte count in BAL fluid. We have also previously described2 a lymphocytic bronchoalveolitis in patients with idiopathic chronic dry-cough and have noted the onset of cough around the age of menopause. In our experience, these patients have an increased prevalence of organ-specific autoimmune disease, particularly hypothyroidism.23 We have suggested that the cough may be the result of the aberrant homing of activated lymphocytes to the airways in a manner analogous to the airway diseases seen with inflammatory bowel disease.2 Support for this view is provided by our findings that patients with treated hypothyroidism have an increased prevalence of cough, a heightened cough reflex sensitivity, and evidence of low-grade airway inflammation.45 It is not clear from the study presented by Mund et al whether their patients with idiopathic cough were asked specifically about the presence of organ-specific autoimmune disease and whether autoantibodies were measured. Further immunopathologic studies are required to identify novel therapeutic targets for this troublesome condition.
References
National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Correspondence to: Ester Mund, MD, Unit of Lung and Allergy Research, Karolinska Institutet, Sweden SE 171 77; e-mail: em.mund{at}stockholm.mail.telia.com
To the Editor:
We appreciate very much the comments by Birring and Pavord on our article in CHEST (May 2005).1 In our study, we described a condition characterized by dry cough and a lymphocytic bronchitis dominated by activated CD4+ cells. Apart from dry cough, all patients were, according to the inclusion criteria, otherwise asymptomatic and were not receiving regular treatment with drugs. This condition, which was characterized by dry cough as the only symptom, was found only in women, and it seemed to have commenced in connection with an airway infection that coincided with the menopause. Although we did not take specific diagnostic measures in order to prove the existence of hypothyreosis, diabetes mellitus, pernicious anemia, inflammatory bowel disease, Sjögren syndrome, or other autoimmune conditions, no patients had symptoms that led us into the suspicion of organ-specific autoimmune diseases. We agree that further immunopathologic studies are required for a more detailed identification of the condition. It is an intriguing thought that the described "dry cough condition" is mediated by autoimmune mechanisms and that infections during menopause may increase the inclination toward development of autoimmune disorders. In healthy menopausal women, there are indications on an increase in airway T-helper lymphocytes and a shift in the relation between T-helper and T-cytotoxic cells.2 It could be speculated that such changes in T-cell function by menopause may constitute the basis for an altered immune response to a common infection.
References
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