In the patients with dry cough, the airway mucosa was atrophic with a conspicuously rich, slender vascular network and without any secretion, ie, quite opposite to the asthmatic airway inflammation which is characterized by a swollen, hyperemic, edematous mucous membrane with plenty of secretion. Another asthma characteristic, increased bronchial responsiveness, was found in only a few patients and was by itself not an indication of asthma. It has been demonstrated that bronchial challenges are of low discriminatory value in patients with chronic cough. Autoimmune diseases viagra online for sale with pulmonary manifestations such as rheumatoid arthritis, connective tissue disorders, and primary biliary cirrhosis were unlikely to be the cause of cough because no clinical or laboratory signs of such diseases were found.
The dry, atrophic airway mucous membrane indicated the possibility of Sjogren syndrome, an autoimmune disease mostly affecting women. In Sjogren syndrome, infiltration of the bronchial mucosa by CD4+ lymphocytes has been observed. However, alveolitis and bronchiolitis dominated by CD8+ lymphocytes, neutrophils, and/or activated macrophages have also been described in Sjogren syndrome. Furthermore, the diagnostic characteristics of Sjogren syndrome, xerostomia and xerophthalmia, were not present in our patients. Other conditions associated with lymphocytic airway inflammation such as sarcoidosis were excluded by normal chest radiographs, normal levels of angiotensin-converting enzyme and calcium in the blood, and normal CT findings in some selective cases.
In the dry coughers, there was a clear connection between the first appearance of cough and an airway infection coinciding with perimenopause in otherwise healthy women. In the women in whom dry cough started at < 40 years of age, one woman underwent an oophorectomy 2 years prior to the study at the age of 36 years, and the other woman < 40 years of age had symptoms indicating early perimenopause. We have described an accumulation of CD4+ lymphocytes and elevated CD4/CD8 ratio in BAL fluid in healthy, postmenopausal women, a finding that was not observed in men.