Chronic cough by definition is a disabling complaint affecting 5–10% of the general population [
1]. It is considered chronic when the duration is longer than 8 weeks in adults and adolescents older than 14 years old [
2], and interferes with normal activity and daily life [
3]. One of the most common causes of chronic cough is cough-variant asthma, a specific and atypical asthma phenotype, which accounts for approximately one-third of cases [
4]. This phenotype of asthma is characterized by airway hyperresponsiveness, eosinophilic inflammation, and bronchodilator responsiveness without clinical manifestations such as wheezing and dyspnea [
5]. Patients often show extreme sensitivity of the neuronal pathways mediating cough to environmental irritants such as perfumes, air pollutants, bleaches, and cold air, which results in throat irritation and the urge to cough [
1]. Diagnostic tests such as spirometry (before and after bronchodilator) and methacholine challenge tests help to assess bronchial hyperreactivity and lung mechanics, although these methods do have imperfections and should be interpreted only in the context of the patient’s clinical presentation [
6]. Early introduction of inhaled corticosteroids may prevent progression of cough-variant asthma to classic asthma [
7]. In intractable cases, treatment of the existing gastroesophageal reflux may prove to be helpful [
7].
This case is an example of cough-variant asthma with atypical clinical manifestation, presenting with chronic severe dry cough leading to red–purple discoloration of both eyelids, which disappeared after an optimal asthma management plan was put in place.