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Case Report Open Access

Cough variant asthma with coexisting gastroesophageal reflux disease: A case report

  • Authors:
    • Fengjuan Yan
    • Weiliang Gao
    • Xiaoqing Quan
    • Xiehui Chen
    • Lvwen Ning
  • View Affiliations / Copyright

    Affiliations: Department of Geriatrics, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong 518110, P.R. China, Department of General Practice, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong 518110, P.R. China
    Copyright: © Yan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 189
    |
    Published online on: August 6, 2025
       https://doi.org/10.3892/etm.2025.12939
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Abstract

Chronic cough is a common clinical challenge and a leading cause of outpatient visits to respiratory clinics. In primary care settings, limited diagnostic resources and the absence of standardized evaluation protocols often result in misdiagnosis and suboptimal management. The present report presents the case of a 30‑year‑old woman with a >1‑year history of persistent, non‑productive cough unresponsive to initial anti‑inflammatory and antitussive therapies. Comprehensive evaluations revealed coexisting cough‑variant asthma and gastroesophageal reflux disease, supported by a positive bronchial provocation test, elevated fractional exhaled nitric oxide and laryngoscopic evidence of reflux laryngitis. Early treatment with a combination of inhaled corticosteroid, leukotriene receptor antagonist, acid suppressant and prokinetic agents produced only a limited response. However, a pathophysiology‑guided dual therapy approach ultimately resulted in the full resolution of symptoms, as reported by the patient during structured telehealth follow‑up over 6 months. The present case underscores the multifactorial nature of chronic cough and highlights the value of systematic evaluation, personalized treatment strategies and multidisciplinary collaboration. It also emphasizes the importance of improving diagnostic capacities in primary care to prevent the mismanagement of chronic cough.
View Figures

Figure 1

High-resolution chest CT scans of the
patient. No evidence of pulmonary inflammation, infiltrates,
nodular lesions, bronchial wall thickening or interstitial
abnormalities was observed. The lung parenchyma appears clear and
symmetrical, with no signs of infection, bronchiectasis or
mass-like lesions. (A) Axial CT image at the upper lung level
showing the apices and upper lobe structures. (B) Axial CT image at
the mid-lung level demonstrating the hilar vessels and airway
structures. (C) Axial CT image at the lower lung level showing the
bilateral lower lobes. (D) Additional axial CT slice at a slightly
different lower lung level illustrating the lower lobe structures.
CT, computed tomography.

Figure 2

Pulmonary function test with
acetylmethacholine bronchial provocation. Baseline spirometry
demonstrated normal ventilatory function with a normal
FEV1. However, during the acetylmethacholine challenge,
progressive airway hyperresponsiveness was observed. A ≥20% decline
in FEV1 occurred at a cumulative acetylmethacholine dose
of 2.504 mg, confirming a positive bronchial provocation result
consistent with cough-variant asthma. The provocative dose causing
a 20% reduction in FEV1 is indicative of heightened
bronchial sensitivity. (A) Table summarizing spirometric
measurements across multiple test repetitions. (B) Flow-volume loop
graph; curves labeled 1-6 correspond to repeated test attempts. (C)
Volume-time curve; curves labeled 1-6 correspond to repeated test
attempts. FEV1, forced expiratory volume in 1 sec; FVC,
forced vital capacity; FEV1%F, FEV1/FVC ratio, the
percentage of the forced vital capacity that is exhaled in the
first second; PEF, peak expiratory flow; MMEF, maximal
mid-expiratory flow; MEF 75/50/25, maximum expiratory flow at
75/50/25% of FVC; FET, forced expiratory time; PIF, peak
inspiratory flow; MVV, maximum voluntary ventilation; Cumul.,
cumulative; F/V ex, flow/volume during exhalation; F/V in,
flow/volume during inhalation; Vol, volume; VCmax, maximum vital
capacity; Vol%VCmax, volume as a percentage of VCmax. Pred,
predicted value; A1, measured value at baseline; A1/Pred, measured
value as a percentage of predicted; P1-P5, values obtained during
different test phases, including post-bronchial provocation and
post-bronchodilator administration; Chg%1-5, percentage change in
measured values compared to baseline, reflecting response over
successive test repetitions.

Figure 3

Fiberoptic bronchoscopy. Schematic
diagram of airway anatomy and corresponding images. Fiberoptic
bronchoscopy revealed normal upper airway anatomy, with a normal
epiglottis and mild lymphoid follicular hyperplasia on the
posterior pharyngeal wall. The vocal cords were mobile with good
closure. The trachea was patent with a sharp carinal ridge and
normal mobility. The mucosa of the right and left main bronchi and
their branches appeared hyperemic and edematous as indicated by the
red arrows, but the lumens were unobstructed. A small amount of
secretion was observed, but no evidence of structural obstruction,
foreign bodies, neoplasia or bronchial tuberculosis was
observed.

Figure 4

Fiberoptic laryngoscopy. Laryngoscopic
images demonstrating chronic erythema and edema of the
interarytenoid area and vocal folds, indicative of
laryngopharyngeal reflux consistent with reflux laryngitis. (A)
Posterior view of the vocal cords, showing the posterior glottis,
posterior laryngeal wall and part of the epiglottis. (B)
Mid-glottic level, visualizing the vocal folds, glottic cleft and
the epiglottis. (C) Anterior view of the vocal cords, including the
anterior glottis, anterior laryngeal wall, epiglottis and the
anterior aspects of the arytenoid cartilages.
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Copy and paste a formatted citation
Spandidos Publications style
Yan F, Gao W, Quan X, Chen X and Ning L: Cough variant asthma with coexisting gastroesophageal reflux disease: A case report. Exp Ther Med 30: 189, 2025.
APA
Yan, F., Gao, W., Quan, X., Chen, X., & Ning, L. (2025). Cough variant asthma with coexisting gastroesophageal reflux disease: A case report. Experimental and Therapeutic Medicine, 30, 189. https://doi.org/10.3892/etm.2025.12939
MLA
Yan, F., Gao, W., Quan, X., Chen, X., Ning, L."Cough variant asthma with coexisting gastroesophageal reflux disease: A case report". Experimental and Therapeutic Medicine 30.4 (2025): 189.
Chicago
Yan, F., Gao, W., Quan, X., Chen, X., Ning, L."Cough variant asthma with coexisting gastroesophageal reflux disease: A case report". Experimental and Therapeutic Medicine 30, no. 4 (2025): 189. https://doi.org/10.3892/etm.2025.12939
Copy and paste a formatted citation
x
Spandidos Publications style
Yan F, Gao W, Quan X, Chen X and Ning L: Cough variant asthma with coexisting gastroesophageal reflux disease: A case report. Exp Ther Med 30: 189, 2025.
APA
Yan, F., Gao, W., Quan, X., Chen, X., & Ning, L. (2025). Cough variant asthma with coexisting gastroesophageal reflux disease: A case report. Experimental and Therapeutic Medicine, 30, 189. https://doi.org/10.3892/etm.2025.12939
MLA
Yan, F., Gao, W., Quan, X., Chen, X., Ning, L."Cough variant asthma with coexisting gastroesophageal reflux disease: A case report". Experimental and Therapeutic Medicine 30.4 (2025): 189.
Chicago
Yan, F., Gao, W., Quan, X., Chen, X., Ning, L."Cough variant asthma with coexisting gastroesophageal reflux disease: A case report". Experimental and Therapeutic Medicine 30, no. 4 (2025): 189. https://doi.org/10.3892/etm.2025.12939
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