Quinchy or spasmodic cough

Specialty: Respiratory.

• paroxysmal coughing spells
• coughing in recurrent bursts

Why it occurs

• Infection with Bordetella pertussis or Bordetella parapertussis (paroxysmal phase of whooping cough, characterized by rapid and successive bouts of coughing, grouped in series of five or "fifths", followed by inspiratory stridor)
• Post-infectious airway hyperreactivity syndrome (persistent spasmodic cough that is self-perpetuating for weeks after a respiratory viral infection due to RSV, adenovirus or mycoplasma)
• Acute exposure to chemical irritants or inhalation of toxic vapors (chlorinated gases, industrial fumes that activate fast-conducting bronchial irritation receptors)
• Variant asthma with cough (cough-variant asthma, where bronchospasm manifests clinically exclusively as attacks of spasmodic cough triggered by cold, exercise or allergens)

Initial workup

PCR in nasopharyngeal swab for Bordetella pertussis and respiratory viruses; Forced spirometry with bronchial challenge test with methacholine (if baseline spirometry is normal); Chest x-ray; Ambulatory cough monitoring using audio recording devices if appropriate.

Standard management

• Budesonide — inhaled, 400 micrograms every 12 hours to modulate bronchial inflammation and reduce the cough reflex threshold
• Salbutamol — 100-200 micrograms inhaled as needed before exposure to known triggers
• Azithromycin (500 mg orally per day for 3 days if prescribed in the initial catarrhal phase of whooping cough to attenuate paroxysms).