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PubMed1997

[Sensitivity of the cough reflex in awake guinea pigs, rats and rabbits].

BACKGROUND AND AIM: Medical literature provides heterogeneous author's opinions concerning the application of various laboratory animals to cough research. Therefore the cough response to chemical stimuli was compared in awake guinea-pigs, rats and rabbits. METHODS: 15 adult guinea-pigs (TRIK strain) of mean body weight 435 +/- 35 g, 28 adult rats (WISTAR strain) of mean body weight 400 +/- 30 g, and 18 rabbits of mean body weight 3.2 +/- 0.3 kg were used. Awake animals were inhaling the aerosols of both citric acid and capsaicin. Animals were placed in a bodyplethysmographic box and two procedures of chemical stimulation were used: 3-5 minutes lasting inhalation of overthreshold concentration of tussive agents, and the second procedure resided in an exposure to a dose-response study with doubled concentrations of citric acid. The cough was analysed on the basis of air-flow changes measured by pneumotachograph. The effect of mechanical stimulation of airway musosa was studied in 13 rats anaesthetised by urethane (1 g/kg b.w., i.p.). The cough was then analysed on the basis of changes in pleural pressure measured by electromanometer using pleural cannula. RESULTS: All awake guinea-pigs were coughing during the exposure to both citric acid and capsaicin, too. Citric acid was potent to elicit cough in 42.9% of awake rats and capsaicin only in 28.6% of them. 61.1% of rabbits expossed to citric acid were coughing. Capsaicin was ineffective to produce cough in rabbits. The highest intensity of cough was in guinea-pigs. Guinea-pigs were the species reacting most intensively to citric acid dose-response exposure. The intensity of cough was not correlated with the concentration of citric acid in awake rats and rabbits. Mechanically induced cough was present in 53.8% of exposed rats under light urethane anaesthesia. CONCLUSIONS: 1. Guinea-pigs are the most useful laboratory animal for experimental studies of chemically induced cough. 2. The sensitivity of cough reflex in awake guinea-pigs could be characterised by the relationship between the intensity of cough and the concentration of the tussive agent. 3. The mechanically induced cough could be elicited in half of the rats under light urethane anaesthesia. (Fig. 4, Tab. 1, Ref. 21.)

Administration, Inhalation↗
PubMed2002

Voluntary control of cough.

Cough is normally referred to a reflex mediated by control centres in the respiratory areas of the brainstem. However, there is much experimental information that indicates that human cough is under voluntary control and that higher centres such as the cerebral cortex have an important role in both initiating and inhibiting cough. Studies on acute cough associated with common cold, and capsaicin induced cough have demonstrated that human cough can be voluntarily inhibited and often abolished. Further evidence for some role of consciousness in the control of cough comes from studies that show that cough is inhibited or abolished during sleep and with light anaesthesia. This paper discusses the historical development of the brainstem 'cough centre' and discusses the experimental evidence on the voluntary control of cough in man. A cough model demonstrating the voluntary and reflex control of cough in man is proposed. A hypothesis is proposed that cough associated with common cold is a mixture of both reflex and voluntary cough.

Consciousness↗
PubMed1995

Pharmacological studies of allergic cough in the guinea pig.

The pharmacological mechanisms of allergic cough in the guinea pig were studied. Actively sensitized guinea pigs were exposed to aerosols of antigen to elicit coughing. In separate experiments, naive guinea pigs were exposed to aerosols of capsaicin to elicit coughing. Both allergic and capsaicin-induced cough were inhibited by loratadine (0.3-10 mg kg-1 p.o.) and chlorpheniramine (0.1-3.0 mg kg-1 p.o.). Neither cimetidine (10 mg kg-1 s.c.), nor thioperamide (3-10 mg kg-1 s.c.), inhibited allergic or capsaicin-induced cough. Codeine (3-30 mg kg-1 p.o.), salbutamol (0.003-3.0 mg kg-1 s.c.) and ipratropium (0.03-1.0 mg kg-1 s.c.) inhibited both allergic and capsaicin-induced cough. Hexamethonium (10 and 30 mg kg-1 s.c.) inhibited allergic, but not capsaicin-induced cough. Allergic and capsaicin-induced cough were unaffected by phenidone (5.0 and 10.0 mg kg-1 s.c.). Indomethacin (5.0 and 10.0 mg kg-1 s.c.) had no effect on allergic cough but slightly inhibited capsaicin-induced cough. We conclude that allergic and capsaicin-induced cough are modulated by histamine H1 receptor and cholinergic mechanisms. Histamine H2 or histamine H3 receptor mechanisms, and lipoxygenase and cyclooxygenase products of arachidonic acid metabolism do not influence allergic and capsaicin-induced cough. Ganglionic mechanisms play a minor role in the production of allergic cough and no role in capsaicin-induced cough.

Administration, Oral↗
PubMed1993

Voluntary suppression of cough induced by inhalation of capsaicin in healthy volunteers.

The aim of the present study was to investigate the voluntary suppression of cough in response to capsaicin inhalation in healthy volunteers, and to determine if the dose-response curve to capsaicin was significantly altered when volunteers were asked to suppress their cough response. The quantification of the degree of voluntary suppression of induced cough could provide a new methodology for screening antitussive agents as antitussives may act by influencing voluntary control of cough. Cough was induced by inhalation of capsaicin. Two challenges were given 5 min apart, each comprising five ascending concentrations of capsaicin (1 x 10(-5) M-3.33 x 10(-4) M). During one of these challenges the volunteer was allowed to cough when required, and during the other they were asked to suppress cough. These two conditions were given in random order. The cough response was recorded by means of a microphone with the integrated sound trace displayed on a chart recorder. A dose-response relationship was obtained on administration of ascending concentrations of capsaicin. In the non-suppressed challenge 23/24 subjects coughed on inhalation of capsaicin (3.33 x 10(-4) M) with a mean number of coughs of 2.92 +/- 0.34, whereas in the suppressed challenge only 3/24 subjects coughed with a mean number of coughs of 0.29 +/- 0.18 (P < 0.001). These results demonstrate that cough induced by inhalation of capsaicin can be voluntarily suppressed. The mechanism of voluntary suppression of cough is discussed in relation to capsaicin challenge and the screening of antitussive medications.

Administration, Inhalation↗
PubMed2004

[Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold].

BACKGROUND: In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI). METHODS: Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires. RESULTS: The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires. CONCLUSIONS: This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.

Adolescent↗
PubMed1998

The relationship between the treatment of cough during early infancy and maternal education level, age and number of other children in the household. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

The main objective of this study was to investigate how the consultation rate and medication use in the treatment of cough symptoms in infants during their first 6 months of life varied by their mothers' education levels, ages and the presence of other children in the household. A prospective cohort of children were studied from birth. Data were collected by means of self-completion postal questionnaires. All 6682 children born between 1 July 1991 and 30 June 1992, inclusive within the three health districts of former Avon which are within the South-west Regional Health Authority were included in the study. The proportion of children ever having a cough during their first 6 months of life and of those with cough symptoms, the proportion receiving cough medicine and the proportion consulting a doctor was investigated. Some 61% of children were reported as having had a cough during their first 6 months of life and this proportion did not vary significantly across educational levels. The proportion of children with coughs who were taken to a doctor (60%) and the proportion with coughs who were given cough medicine (20%), however, did vary with education. The association between mother's education level and the treatment of her child's cough was much stronger than with either of the mother's age or number of other children. After controlling for confounding factors, the percentage of mothers who consulted a doctor for their children's coughs decreased progressively with increasing maternal education from 70% (95% confidence interval: 66%, 73%) of those with CSE or less to 50% (95% CI: 45%, 55%) of those with a degree. A similar pattern emerged with the use of cough medicine, 22% (95% CI: 19%, 25%) of children whose mothers were in the lowest education group received cough medicine compared with 12% (95% CI: 9%, 15%) in the highest group. A large proportion, 60%, of children under 6 months with coughs are taken to a doctor. Children of more highly educated mothers are less likely to see a doctor or to receive cough medicine.

Adult↗
PubMed2001

Frequency and perception of cough severity.

OBJECTIVE: The frequency of the common symptom of cough in children is unknown. The aim of this study was to compare cough frequency and perception of cough severity in children with and without recurrent cough. METHODOLOGY: Eighty-four children with (C) and without (NC) recurrent cough were recruited in the same season. Cough frequency (measured with cough-meter) and subjective cough severity (measured on parent-completed and child-completed diary cards on two subjective systems), were compared between the two groups. RESULTS: Cough frequency in C (median 65/day) was significantly higher than in NC (10/day). The correlation between daytime and night-time cough was higher in NC (rs = 0.51, P < 0.00001) than in C (rs = 0.3, P = 0.05). The C group had significantly higher coughs per score than NC, for both subjective methods. CONCLUSIONS: Children with recurrent cough have a higher frequency and different pattern of cough than controls enrolled in the same season. Subjective perception of cough severity is dependent on the population studied.

Adolescent↗
PubMed2001

Angiotensin-converting enzyme gene insertion/deletion, not bradykinin B2 receptor -58T/C gene polymorphism, associated with angiotensin-converting enzyme inhibitor-related cough in Chinese female patients with non-insulin-dependent diabetes mellitus.

To investigate the genetic susceptibility associated with cough related to angiotensin-converting enzyme inhibitor (ACEI) therapy in patients with type 2 diabetes, 189 non-insulin-dependent diabetes mellitus (NIDDM) patients with proteinuria or hypertension treated with perindopril were studied. Cough was considered to be present if the patients had been bothered by a cough during treatment and if they had had related symptoms for at least 2 weeks without an identifiable cause. Polymerase chain reaction (PCR) coupled with single-strand conformation polymorphism (SSCP) was used to detect polymorphisms of ACE and bradykinin B2-receptor genes. After 8 weeks of treatment, 49.2% (93 of 189) of our NIDDM patients were found to be suffering from ACEI-related cough. ACEI-related cough was mainly associated with female patients, with 71.7% (76 of 106) of female and only 20.5% (17 of 83) of male patients experiencing cough after ACEI treatment. There was a significant association of ACE II genotype with ACEI-related cough. The genotype frequencies were 58.2% for II, 47.8% for ID, and 16.7% for DD in patients with ACEI-associated cough and 41.8% for II, 52.2% for ID, and 83.3% for DD in subjects without ACEI-associated cough (chi(2) = 10.268; df = 2, P =.006). As female patients made up the majority of the subjects suffering from ACEI-related cough, we further analyzed the association of ACE I/D genotype with ACEI-related cough separately by sex. Male patients with ACEI-related cough were not associated with ACE I/D genotype distribution, while female patients were strongly associated with ACE I/D genotype polymorphism (chi(2) = 16.12; df = 2; P <.001). There was no association between the bradykinin B2 receptor gene -58T/C polymorphism with ACEI-related cough. In conclusion, our results indicate that Chinese diabetic female subjects are susceptible to ACEI-related cough, and this susceptibility may be genetically predetermined.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

[Proposals for a rationale and for rational diagnosis of coughs].

Cough is probably the most frequent symptom in chest diseases. Hence, a rational and economical diagnostic procedure is essential to prevent unnecessary costs to the health services, i.e. acute bronchitis, a self-limiting disease, which is the most frequent cause for cough should not involve extensive per case costs. History, physical examination, chest X-ray and lung function testing--which constitute both the first and second, i.e. the basic level of a stepwise approach--allows to diagnose causes in most patients with cough. Without evidence of the cause after completing this basic diagnostic procedure patients with acute cough may require blood gases analysis, electrocardiography, echocardiography, lung perfusion study, spiral CT angiography, bronchoscopy or laboratory examinations for diagnosis of pulmonary embolism, aspiration or (seldom) pleuritis sicca. Chronic persistent cough (CPC) is diagnosed if the basic standard approach to chronic cough fails to lead to final diagnosis. Patients will then need further subtle diagnostic management, i.e. bronchial provocation testing, 24 hour pH probe, ENT- or neurological examination, high resolution CT of the thorax and bronchoscopy. We present two algorithms for the rational diagnostic approach to acute (figure 1) and chronic (figure 2) cough. Each algorithm considers spectrum and frequency of causes on the one hand, the positive predictive value, costs and patient discomfort due to the examination on the other. Nonetheless, despite extensive examination up to 20% of patients suffering from CPC the cause remains unclear [11]. Frequently, the capsaicin cough challenge test can reveal an idiopathic upregulation of the cough reflex as the hypothesised underlying condition. Psychogenic cough however, a rare condition in adults should not coincide with hypersensitivity of the cough reflex. Inconsistency and low reproducibility of results of the capsaicin challenge in patients with psychogenic cough preclude his routine clinical use. In conclusion, the very common acute bronchitis and the ACE inhibitor-induced cough do not require any other diagnostic procedure except patient history and physical examination. A simple basic diagnostic approach will usually allow to evaluate acute and chronic cough. In the remaining cases the proposed algorithm should be used for best results and to prevent excessive costs.

Acute Disease↗
PubMed1999

Persistent cough in an adolescent.

Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a neutral tone, "I don't know. It's never been like this before." Jessica's pediatrician prescribed an inhaled steroid with the albuterol. When the cough did not respond after 1 week, he ordered a chest radiograph (normal) and a tuberculin skin test (purified protein derivative-negative), and he added montelukast (a leukotriene inhibitor) and monitored airway resistance with a peak flow meter. The cough persisted, and the peak flow recording showed normal airway resistance. At this time, Jessica's pediatrician suspected a conversion reaction and contemplated the next best therapeutic strategy.

Adolescent↗
PubMed2005

Chronic cough in adults with interstitial lung disease.

PURPOSE OF REVIEW: Although dyspnea is the most common and distressing symptom in patients with chronic interstitial lung disease, chronic cough, a potentially debilitating symptom that impairs health-related quality of life, has been described as another common symptom in these patients. RECENT FINDINGS: Many patients with interstitial lung disease have their chronic cough mistakenly attributed to that condition when, in fact, the cough is due to more common disorders such as asthma, upper airway cough syndrome (previously referred to as postnasal drip syndrome), or gastroesophageal reflux disease. This article presents new data on a select group of patients and shows that more than 50% of patients with interstitial lung disease who are referred to a cough clinic for evaluation can have cough caused by these other more common causes of chronic cough. It is also clear, however, that chronic interstitial lung disease, by itself, can cause chronic cough, perhaps related to an increased cough reflex sensitivity. SUMMARY: Clinicians should be cautious when ascribing chronic cough to interstitial lung disease without first completely evaluating for other possible causes of cough. When cough is attributed to interstitial lung disease, therapy, when available, should be directed at the specific underlying diagnosis. Corticosteroids may be helpful in alleviating chronic cough in some cases of interstitial lung disease, but, because of the potential side effects of corticosteroids and lack of proven efficacy for some types of interstitial lung disease (e.g. idiopathic pulmonary fibrosis), treatment should weigh the risks and benefits for each patient individually. Nonspecific antitussive therapies shown to be clinically effective for chronic cough in general are codeine and dextromethorphan, but these have not been studied specifically in interstitial lung disease.

Chronic Disease↗
PubMed2007

Cough and asthma.

PURPOSE OF REVIEW: The intention of this article is to discuss and place into perspective recent articles on cough and asthma. RECENT FINDINGS: Asthma continues to be a major diagnosis in most studies of cough. The first prospective study of sub-acute cough demonstrated an asthma incidence lower than that for chronic cough, a logical finding; upper airway cough syndrome often causes cough in the postinfectious state. The first prospective study of cough in infants suggested asthma to be a minor cause of cough in infants, but methodological flaws make the conclusions uncertain. Efforts to separate cough-variant asthma from classic asthma continue. One group has demonstrated that the maximal bronchoconstrictor response in cough-variant asthma is blunted when compared with classic asthma, a possible explanation for the absence of wheeze and dyspnea in cough-variant asthma. Another look at airway resistance showed a less rapid rate of rise in resistance in cough-variant asthma with increasing methacholine dosing than in classic asthma. On the biochemical front, a group has demonstrated differences in vascular endothelial growth factor, which may be the underpinnings of differences between cough-variant asthma and classic asthma. SUMMARY: Recent data suggest that cough-variant asthma is part of a continuum in the expression of asthma symptoms and in the asthmatic inflammatory response.

Adrenal Cortex Hormones↗
PubMed1989

Change in cough reflex after treatment with enalapril and ramipril.

OBJECTIVE: To find out whether enalapril or ramipril causes the sensitivity of the cough reflex to change or symptomatic cough to develop in patients with hypertension. DESIGN: Prospective, placebo controlled, double blind, randomised crossover study. SETTING: Academic units of clinical pharmacology and medicine. PATIENTS: 20 Patients (nine men and 11 women) who needed to take angiotensin converting enzyme inhibitors to control hypertension. INTERVENTIONS: All patients received enalapril 10 mg daily, ramipril 10 mg daily, or placebo daily for one week in random order, with a washout period of at least one week between treatments. For assessment of sensitivity of the cough reflex the patients inhaled various concentrations of capsaicin solution in random order. MAIN OUTCOME MEASURES: Measurement of the doses of capsaicin required to cause two or more and five or more coughs or the development of a symptomatic cough. RESULTS: Blood pressure, symptoms of cough, and the sensitivity of the cough reflex to inhaled capsaicin were recorded at the start of the study and before and at the end of each treatment period. Plasma urea and creatinine concentrations and angiotensin converting enzyme activity were measured at the start of the study and the end of each treatment period. Data were analysed by two way analysis of variance. Mean blood pressure was 159/97 mm Hg at the start of the study and 152/92, 143/88, and 147/86 mm Hg after treatment with placebo, enalapril, and ramipril respectively. Mean (SE) plasma angiotensin converting enzyme activity was 2.2 (0.2) mmol/l/h after treatment with placebo and fell significantly to 1.3 (0.1) mmol/l/h and to 0.4 (0.1) mmol/l/h after treatment with enalapril and ramipril respectively. No patient complained of cough while taking placebo but three women complained of cough when taking both enalapril and ramipril. The mean (95% confidence interval) lowest dose of capsaicin causing two or more coughs was 2.4 (1.5 to 4.0), 1.8 (1.12 to 2.82), and 2.2 (1.7 to 3.0) nmol after treatment with placebo, enalapril, and ramipril respectively; none of these changes were significant. The lowest dose of capsaicin causing five or more coughs was 18.9 (13.9 to 25.8), 14.4 (8.4 to 24.5), and 15.3 (10.8 to 21.2) nmol respectively; none of these changes were significant. The three patients who complained of cough had normal sensitivity to capsaicin after treatment with placebo but had a considerably increased sensitivity after treatment with enalapril and ramipril. CONCLUSIONS: Both enalapril and ramipril increase the sensitivity of the cough reflex appreciably in patients who complain of cough during treatment, but they do not change the se

Adult↗
PubMed2006

Opiate therapy in chronic cough.

RATIONALE: Cough is the most common complaint for which medical attention is sought, and chronic cough can be both physically and mentally debilitating. There is currently no evidence supporting the use of antitussives in chronic treatment-resistant cough. OBJECTIVES: We tested the hypothesis that morphine sulfate in the dose of 5 mg twice daily would bring about a reduction in cough frequency and severity in patients failing to respond to specific measures. METHODS: Patients recruited from the Hull Cough Clinic were enrolled into a randomized double-blind placebo-controlled study using 4 weeks of slow-release morphine sulfate and a corresponding period of matched placebo. An open-labeled extension of the core study allowed dose escalation to 10 mg twice daily. Cough was assessed using the Leicester Cough Questionnaire, daily symptom diary, and citric acid cough challenge. RESULTS: Twenty-seven patients completed the core study. A significant improvement of 3.2 points over baseline was noted on the Leicester Cough Questionnaire (p < 0.01). A rapid and highly significant reduction by 40% in daily cough scores was noted among patients on slow-release morphine sulfate (p < 0.01). Objective testing of the cough reflex using citric acid cough challenge tests did not show any significant changes. Eighteen patients continued into the extension study. Two-thirds of these patients opted to increase the morphine to 10 mg twice daily. At the end of 3 months, there was a similar improvement in cough between the 5- and 10-mg groups. CONCLUSION: Morphine sulfate is an effective antitussive in intractable chronic cough at the doses of 5 to 10 mg twice daily.

Analgesics, Opioid↗
PubMed1998

Cough and sleep in inner-city children.

This study aimed to determine whether cough at night keeps children awake, to describe the relationship between children's cough and sleep and to report parents' perceptions of their children's cough and sleep. Thirty-nine children with reported persistent cough at night (>3 weeks) were recruited and studied for 6 nights by video-recording. Coughs were counted and sleep state was coded for awake, restless sleep and quiet sleep. The relationships between cough and sleep state between subjects and within subjects were examined by correlation and regression. After night 2 the parents were asked whether their child had coughed or had disturbed sleep and after night 6 they were asked whether there had been any change. There was a weak relationship between log percentage of the night awake and log number of coughs (r=0.13, SE 0.036), and log (percentage of the night awake plus restless sleep) and log number of coughs (r=0.016, SE 0.0071). If the relationship between cough and sleep state is causal, halving the number of coughs will reduce the percentage of the night awake by 9% (95% confidence interval (CI) 4-15%) and percentage awake and restless by 1% (95% CI 0-2%). All but one parent correctly identified coughing and 82% detected change. Most could not comment on their child's sleep. Improvement in cough would result in little reduction in either the percentage of the night awake or awake and restless in the average child in the population studied. Parents could detect whether their children were coughing but not whether their sleep was disturbed.

Asthma↗
PubMed2005

Citric acid cough threshold in patients with gastroesophageal reflux disease rises after laparoscopic fundoplication.

BACKGROUND: It has been reported that antireflux surgery can diminish chronic cough due to gastroesophageal reflux disease (GERD) that is resistant to pharmacologic therapy. The aim of this study was the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to GERD before and 3 months after laparoscopic Toupet fundoplication. METHODS: Thirty subjects (20 women and 10 men; median age, 45.3 years) with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid. Twenty subjects with GERD, a group of 14 women and 6 men (mean age, 45.5 years), underwent the same protocol 3 months after laparoscopic fundoplication. Daytime and nighttime cough score questionnaires (verbal category descriptive score) were completed in all groups. RESULTS: The geometric mean of CACT was significantly lower in GERD patients (9.62 mg/mL) than in healthy volunteers (50.8 mg/mL, p < 0.001). The results of cough score measurement significantly improved within 2 weeks after laparoscopic surgery. In 13 weeks of postoperative follow-up, cough disappeared or was greatly improved in 14 of the 20 patients (70%); in 3 other patients, cough resolved partially. In three patients. there was no improvement in cough. Cough challenge after surgery revealed a significant increase in mean cough threshold, from 8.28 to 19.03 mg/mL (p < 0.05). CONCLUSIONS: The results suggest that GERD influences CACT, which was significantly lower in GERD patients compared to healthy subjects. A significant correlation was found between subjective and objective measurements of cough in GERD patients. We found laparoscopic fundoplication to be objectively beneficial in GERD-induced chronic cough, as it reduced the CACT.

Adult↗
PubMed2006

Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines.

UNLABELLED: GOALS/OBJECTIVES: To review the scientific evidence on cough associated with tumors in the lungs. METHODS: MEDLINE literature review (through March 2004) for all studies published in the English language, including case series and case reports, since 1966 using the medical subject heading terms "cough" and "lung neoplasms." RESULTS: Primary bronchogenic carcinoma is the most common lethal neoplasm in the United States. Malignancies that arise in other organs will often metastasize to the lungs. Any form of cancer involving the lungs may be associated with cough. However, cough is far more likely to indicate involvement of the airways than the lung parenchyma because of the location of cough receptors. Cough is present in >65% of patients at the time lung cancer is diagnosed, and productive cough is present in >25% of patients. While cough as a presenting symptom of lung cancer is common, many studies have shown that lung cancer is the cause of chronic cough in <or=2% of all patients who present with a chronic cough. CONCLUSIONS: Bronchoscopy is usually indicated when there is suspicion of airway involvement by a malignancy. Conversely, bronchoscopy usually should not be performed to assess a cough for the possibility of lung cancer when there is little risk for lung cancer (nonsmokers) and when there are normal findings on a plain chest radiograph. If the lung cancer can be removed surgically, cough will usually abate. Radiation therapy, chemotherapy (especially with gemcitabine), and endobronchial treatment methods likely will improve cough caused by lung cancer. Centrally acting narcotic antitussive agents are usually administered for the control of cough caused by lung cancer when other treatment methods fail.

Bronchoscopy↗
PubMed2006

Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines.

BACKGROUND: A dry, persistent cough is a well-described class effect of the angiotensin-converting enzyme (ACE) inhibitor medications. The mechanism of ACE inhibitor-induced cough remains unresolved, but likely involves the protussive mediators bradykinin and substance P, agents that are degraded by ACE and therefore accumulate in the upper respiratory tract or lung when the enzyme is inhibited, and prostaglandins, the production of which may be stimulated by bradykinin. METHODS: Data for this review were obtained from a National Library of Medicine (PubMed) search, which was performed in May 2004, of the literature published in the English language from 1985 to 2004, using the search terms "angiotensin-converting enzyme," "angiotensin converting enzyme inhibitors," and "cough." RESULTS: The incidence of ACE inhibitor-induced cough has been reported to be in the range of 5 to 35% among patients treated with these agents. However, a much lower incidence has been described in studies of patients presenting for the evaluation of chronic cough. The onset of ACE inhibitor-induced cough ranges from within hours of the first dose to months after the initiation of therapy. Resolution typically occurs within 1 to 4 weeks after the cessation of therapy, but cough may linger for up to 3 months. The only uniformly effective treatment for ACE inhibitor-induced cough is the cessation of treatment with the offending agent. The incidence of cough associated with therapy with angiotensin-receptor blockers appears to be similar to that of the control drug. In a minority of patients, cough will not recur after the reintroduction of ACE inhibitor therapy. CONCLUSIONS: In a patient with chronic cough, ACE inhibitors should be considered as wholly or partially causative, regardless of the temporal relation between the initiation of ACE inhibitor therapy and the onset of cough. Although the cessation of therapy is the only uniformly effective treatment for ACE inhibitor-induced cough, some pharmacologic agents have been shown to attenuate the cough.

Angiotensin-Converting Enzyme Inhibitors↗