A common respiratory condition often goes undiagnosed because it shares symptoms with asthma but lacks typical airway obstruction.1


RT’s Three Key Takeaways:

  1. Inflammation Without Obstruction: Nonasthmatic eosinophilic bronchitis (NAEB) presents with eosinophilic airway inflammation but lacks the airway hyperresponsiveness and airflow obstruction characteristic of asthma.
  2. Diagnostic Sputum Testing: The identification of eosinophils in induced sputum is the primary method for diagnosing NAEB in pediatric patients who present with normal spirometry results.
  3. Steroid Responsiveness: Inhaled corticosteroids are the primary treatment for NAEB, and pediatric patients typically show significant improvement in cough symptoms following therapy.


Nonasthmatic eosinophilic bronchitis (NAEB) remains a frequently overlooked cause of chronic cough in pediatric patients, often leading to delayed diagnosis and inappropriate treatment, according to a report published in Cureus.1

The condition is characterized by a persistent, nonproductive cough and eosinophilic inflammation of the airways.1 While NAEB shares the same type of airway inflammation found in asthma, it is distinguished by the absence of airway hyperresponsiveness (AHR) and variable airflow limitation.1 This distinction is critical for healthcare providers, as children with NAEB will have normal results on traditional lung function tests, such as spirometry and bronchodilator reversibility tests.1

Challenges in Diagnosis

Because NAEB does not present with the wheezing or shortness of breath typically associated with asthma, it is often missed during initial clinical evaluations.1 The diagnosis of NAEB in children requires the demonstration of eosinophilic inflammation, typically defined as an eosinophil count of greater than 2.5% or 3% in an induced sputum sample.1

The report notes that NAEB may account for a significant portion of chronic cough cases in children, yet the technical challenges of obtaining induced sputum in younger populations often prevent its routine use in clinical practice.1 Without this specific test, many children may be misdiagnosed with cough-variant asthma or other respiratory conditions.1

Treatment and Management

The primary treatment for NAEB is the administration of inhaled corticosteroids (ICS).1 Unlike other causes of chronic cough that may require antibiotics or antihistamines, NAEB is highly responsive to steroid therapy. Most patients experience a resolution of symptoms within weeks of starting treatment.1

“The recognition of NAEB as a distinct clinical entity is essential for the effective management of chronic cough in children,” the study authors stated.1

For respiratory therapists and specialists, the findings underscore the need to consider NAEB in the differential diagnosis for any child presenting with a chronic cough and normal lung function.1 Early identification and the use of ICS can prevent unnecessary diagnostic testing and provide rapid relief for pediatric patients.1

The study also highlights that while NAEB is a stable condition for many, a small percentage of patients may eventually develop fixed airflow obstruction or transition to typical asthma, necessitating long-term monitoring by healthcare professionals.1


Reference

  1. Al Dhouyani B, et al. Nonasthmatic Eosinophilic Bronchitis: An Overlooked Cause of Chronic Cough in Children. Cureus. 2026 Apr. 18(4): e107552. doi:10.7759/cureus.107552