TOPLINE:

Cough imposed a substantial symptom burden in patients with hypersensitivity pneumonitis (HP). Corticosteroid therapy over 3 months was tied to reduced patient-reported cough severity and improved cough-related quality of life, but it did not significantly reduce cough frequency.

METHODOLOGY:

• Researchers conducted a prospective cohort study to assess cough characteristics in patients with HP and to evaluate changes in cough frequency and patient-reported outcomes after starting corticosteroid therapy.
• They recruited 101 patients (mean age, 65.5 years; 60% women), including those newly diagnosed within the previous 3 months who had not yet received any treatment, as well as those with prior or ongoing steroids or immunosuppressive therapy.
• Patients completed subjective assessments, including the cough visual analog scale (VAS) and the Leicester Cough Questionnaire (LCQ). For the VAS, patients rated cough severity from 0 to 100 mm, with higher scores indicating more severe cough, while for the LCQ, higher scores indicated better cough-related quality of life.
• Objective 24-hour cough frequency was measured using a cough monitor, with recordings processed to exclude silence and noncough sounds.
• Changes in cough outcomes over 3 months after initiating corticosteroid or immunosuppressive therapy were assessed in a subset of newly diagnosed patients.

TAKEAWAY:

• Cough affected the majority of patients in the cohort (89 out of 101). The median cough VAS was 35 mm, and the median LCQ was 15.2; the median 24‑hour cough frequency was 8.7 coughs per hour.
• Among 44 patients treated with corticosteroids, patient-reported cough improved, with a 13.7-mm decrease in cough VAS (P = .002) and a 1.89-point increase in LCQ score (P < .001). However, in a subset of 16 patients, objective cough frequency did not change significantly.
• Female sex (P = .004), lower forced vital capacity (P < .001), and higher bronchoalveolar lavage lymphocyte fractions (P = .002) independently predicted worse cough severity on the VAS.
• Patient-reported subjective cough measures showed moderate-to-strong correlations with objective 24-hour cough frequency (cough VAS, P < .001; LCQ, P = .002).

IN PRACTICE:

“These findings underscore an urgent need for further research to delineate the pathophysiological mechanisms of HP-related cough and to develop more effective therapeutic strategies,” the authors wrote.

SOURCE:

The study was led by Z. Wu, National Heart and Lung Institute, Imperial College London, London, England. It was published online on April 8, 2026, in Chest.

LIMITATIONS:

The sample size was relatively small, and only a subset of patients underwent objective cough monitoring. The analyses did not adjust for multiple comparisons. As an observational study, corticosteroid dosages were not standardized, and the long-term effects of steroid therapy beyond 3 months were not examined.

DISCLOSURES:

The study was supported by the National Institute for Health and Care Research through the Imperial Biomedical Research Centre, Manchester Biomedical Research Centre, and Clinical Research Facility at Guy’s and St Thomas’ National Health Service Foundation Trust. One author received support from the Asthma + Lung UK Chair award, and another disclosed serving as a member of the Chest Diffuse Lung Disease editorial board.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.