[Effect of Bakumondo-to on increased sensitivity of the cough reflex in a Sjögren syndrome patient with interstitial lung disease].

A 63-year-old woman had complained of a persistent dry cough. Comparison of chest roentgenograms obtained 3 months earlier and at hospital admission, revealed progressive infiltrative shadows in bilateral middle and lower lung fields and mild volume loss. Hematologic study showed polyclonal hyper-gamma-globulinemia, positive anti-nuclear antibodies, and positive antibodies to Ro (SS-A) antigens. Ophthalmologic study demonstrated keratoconjunctivitis sicca. Parotid sialography showed an apple tree sign. Histopathologic features of labial salivary gland biopsy revealed agglomeration of at least 50 mononuclear cells. Chest CT showed non-segmental dense opacity in outer zones of middle and lower lung fields. Lung function test revealed a restrictive pattern with low diffusion capacity. Blood gas analysis showed hypoxemia (PaO2: 74 Torr, PaCO2: 32 Torr). Bronchoalveolar lavage fluid disclosed increased lymphocytes, and histologic features of a transbronchial lung biopsy included thickening of alveolar walls, infiltration of lymphocytes in the interstitium, and foamy cells in alveolar spaces. Therefore, the patient was diagnosed with primary Sjögren syndrome with interstitial lung disease. Bakumondo-to (Mai men dong tang) was started for the troublesome dry cough. The cough was subjectively relieved, cough scores were decreased, QOL scores improved, and sensitivity of the cough reflex measured by inhalation of capsaicin improved, but the chest roentgenogram was unchanged. Steroid hormone therapy was added, and radiographic abnormalities improved subsequently. Bakumondo-to, a traditional Chinese blended medicine, has notable antitussive activity in bronchitic guinea-pigs and in patients with postinfectious cough. It was concluded that Bakunondo-to may provide effective antitussive activity in some cases of interstitial lung disease with increased sensitivity of the cough reflex.