Dupilumab reduces patient-reported cough and improves quality of life in patients with severe eosinophilic asthma with or without chronic rhinosinusitis with nasal polyps: a real-life prospective study

Background: Cough is a major symptom of asthma and is associated with poor clinical outcomes. However, current guidelines place little emphasis on the crucial relevance of the cough symptom and its treatment. The objective of this study was to assess the impact of dupilumab on chronic cough (CC) in patients with severe eosinophilic asthma (SEA) and chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: Patients with CC and SEA, CRSwNP, or SEA plus CRSwNP treated with dupilumab were prospectively included. Patients were evaluated before and after 6 months of treatment by collecting Severe Cough Visual Analogue Scale (SC-VAS) scores and the Leicester Cough Questionnaire (LCQ). A total of 67 patients with CC were included. Results: Both SC-VAS and LCQ significantly improved after 6 months in the whole group (paired t-test SC-VAS, mean (SD), from 83.13 (11.54) to 38.21; and LCQ, from 1.98 (0.78) to 4.54 (1.35), both p<0.001), and in each disease subset (paired t-test, p<0.001 in all groups). After treatment, 73% and 82% of patients had a clinically meaningful improvement of SC-VAS and LCQ, respectively. Conclusion: Dupilumab was found to be associated with significant improvement in CC in 50% (n=10) of patients with SEA, in 73% (n=19) of patients with CRSwNP, and in 62% (n=13) of patients with SEA plus CRSwNP, respectively. In this real-life study, dupilumab significantly reduced CC whilst improving quality of life in patients with SEA with or without CRSwNP. These results support the potential role of dupilumab in the treatment of cough as a treatable trait.