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PubMed1994

The opioid agonist codeine and antagonist naltrexone do not affect voluntary suppression of capsaicin induced cough in healthy subjects.

Opioids exert an analgesic action by mimicking the effects of endogenous neurotransmitter substances in the central nervous system. Opioids are widely used as antitussives, and it is reasonable to assume that endogenous opioids are involved in the control of cough. In order to investigate this hypothesis, a parallel design study was carried out to examine the effects of 50 mg codeine (opioid agonist), 50 mg naltrexone (opioid antagonist) and placebo on capsaicin-induced cough in 80 healthy volunteers (mean age 25 yrs). Volunteers received two capsaicin challenge units (each consisting of five inhalations of different concentrations of capsaicin, 0.00-3.33 x 10(-4) M). On one challenge unit subjects were instructed to suppress cough, and on the other challenge unit subjects coughed freely. Coughs were recorded on a tape cassette player and later played back into a pen recorder to produce integrated sound traces. The number of coughs in the suppression challenge unit was significantly reduced in all three treatment groups compared to that recorded in the non-suppression challenge unit. Comparisons between the three treatment groups showed that there was no statistical difference between the three groups both before and 90 min after treatment for the total coughs in the suppression challenge unit and for the total coughs in the non-suppression challenge unit. These results demonstrate that capsaicin-induced cough can be voluntarily suppressed, but that both suppressed and non-suppressed cough were unaffected by treatment with codeine, naltrexone or placebo. These results do not provide any support for the hypothesis that capsaicin-induced cough is influenced by endogenous opioid substances.

Adolescent↗
PubMed1997

A new use for an old Holter monitor: an ambulatory cough meter.

Cough is commonly used as an outcome measure in clinical studies, although the subjective reporting of cough is unreliable when compared to objective measures. We describe an inexpensive new ambulatory cough meter that is based on a disused Holter monitor. The cough meter consists of a Holter monitor and a cough processor, designed on a computer to select the most appropriate filters. The cough meter was then validated against the overnight tape recorder on 21 occasions in 18 children (aged 6-15 yrs). The agreement between the cough meter and the tape recorder was good (mean difference of -0.3 coughs x h(-1); limits of agreement -2.2 to 1.7 coughs x h(-1)). We conclude that our newly described ambulatory cough meter provides a valid and inexpensive method of objectively monitoring cough for up to 24 h.

Adolescent↗
PubMed2002

[Coughing model by microinjection of citric acid into the larynx in guinea pig].

Many studies of cough were performed under the restrained or anesthetized condition, and coughs were evoked by inhalation of capsaicin or citric acid. Inhalation of irritants induced by "diving response" with apnea and coughs, and these responses induced a change of tidal volume. As a result, respiratory responses are dependent on the inhalation volume. Therefore we developed a new coughing model, and coughs were evoked by microinjection of citric acid into the larynx in the unanesthetized unrestrained guinea pig. Microinjection of 7.5% citric acid (2 microliters/30 s, 5 min) induced coughs (27.03 +/- 4.03 coughs/10 min), and citric acid-induced responses were stable independent of the inhalation volume. In the inhalation studies, animals were exposed to citric acid only once because induced-responses were remarkably decreased by repeated administration at an interval of 24 h. However in our coughing model it was possible to repeatedly challenge the animals by microinjection of citric acid at intervals of 24 h. Microinjection of citric acid into the larynx induced coughs in Sprague-Dawley rats, but inhalation of citric acid did not induce cough. These results indicate that this coughing model is highly sensitive and correctly assessed cough responses.

Animals↗
PubMed1992

Ineffectiveness of cough for enhancing mucus clearance in asymptomatic smokers.

Using monodisperse aerosols radiolabeled with 99mTc, we studied the effectiveness of cough and rapid inhalations for clearing mucus in ten asymptomatic smokers. On three separate study days, each subject breathed 5 microns (MMAD) 99mTc-iron oxide particles under controlled breathing conditions. While seated in front of a gamma camera, retention (R) of lung activity (measured as a percent of initial activity) was measured over the initial 2 h and again at 24 h following particle inhalation. On the control day the subject sat quietly in front of the camera, while on the cough day each subject performed 60 controlled coughs during the first hour of retention measurements, and on the rapid inhalation study day each subject performed 90 rapid inhalations during the first hour of retention measurements. Because breathing patterns were controlled during particle inhalation, initial lung deposition patterns were matched on control, cough, and rapid inhalation study days. By paired analysis, retentions at both 1 and 2 h (R1 and R2) for the cough and rapid inhalation measurements were not significantly different from control (mean control R1 = 69 percent; mean cough R1 = 66 percent; mean rapid inhalation R1 = 66 percent, NS; and mean control R2 = 59 percent, mean cough R2 = 55 percent; mean rapid inhalation R2 = 54 percent, NS). Retention at 24 h (R24) was not significantly different between cough, rapid inhalation, and control measurements (mean cough R24 = 15 percent, mean rapid inhalation R24 = 14 percent, mean control R24 = 17 percent). In other words, these young smokers with normal pulmonary function were unable to enhance their rate of mucus clearance by coughing. The inability of these young smokers to enhance their mucus clearance by cough suggests a change in the mucociliary apparatus from normal.

Aerosols↗
PubMed1996

Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux.

STUDY OBJECTIVE: Coughing was studied in relation to different disorders and objective variables indicative of airway inflammation. SETTING: A random sample of 800 persons, aged 20 to 44 years, was chosen from a larger cohort of participants in the European Community Respiratory Health Survey in Uppsala Sweden; of these, 623 participated. This sample was enriched with 201 individuals who reported asthma-related symptoms or the use of asthma medication. METHODS: The study comprised a structured interview, including questions about habitual (productive and nonproductive) and nocturnal coughing and spirometry, methacholine challenge, peak flow diary, skin prick tests, and measurements of blood eosinophil count and serum eosinophil cationic protein (S-ECP). RESULTS: A significant positive correlation was found between productive coughing and asthma (adjusted odds ratios [OR] = 2.0), allergic rhinitis (OR = 1.9), gastroesophageal reflux (OR = 4.4), smoking (OR = 1.9), and anxiety (OR = 1.8), while nonproductive coughing was related to female gender (OR = 1.8) and anxiety (OR = 1.7). Nocturnal coughing was positively correlated to female gender (OR = 1.8), smoking (OR = 1.9), and asthma (OR = 2.2). Bronchial hyperresponsiveness was positively related to productive coughing (p < 0.001), nonproductive coughing, and nocturnal coughing (p < 0.05). S-ECP was significantly higher in individuals with nonproductive coughing compared with subjects without habitual coughing (p < 0.01). CONCLUSIONS: We conclude that habitual coughing has a significant association with different disease categories.

Adult↗
PubMed2002

Chronic cough due to gastroesophageal reflux disease: failure to resolve despite total/near-total elimination of esophageal acid.

BACKGROUND: While medical therapy may fail to improve cough due to gastroesophageal reflux disease (GERD), it is not known if inadequate esophageal acid suppression is responsible. METHODS: In a prospective, before-and-after interventional trial, we assessed the effects of antireflux surgery in eight patients whose chronic coughs were due to GERD resistant to intensive medical therapy. All patients met a profile predicting that cough was likely due to GERD and had an initial positive 24-h esophageal pH monitoring study, and then underwent serial 24-h esophageal pH monitoring on gradually intensified medical therapy until the percentage of time that esophageal pH was < 4 was zero and there were no acid reflux events > 4 min. The effects of medical and surgical therapy on cough were assessed clinically by a visual analog scale (VAS) and the Adverse Cough Outcome Survey (ACOS). RESULTS: Before surgery (median, 23.7 days), patients still complained of cough, VAS score was 73.1 +/- 6.1, and ACOS score was 15.0 +/- 1.1. After surgery (median, 41.2 days and 1 year), cough improved in all, VAS score decreased to 19.1 +/- 8.3 and 22.6 +/- 8.1 (p = 0.001), respectively, and ACOS score decreased to 2.0 +/- 1.3 and 3.6 +/- 2.3, respectively (p = 0.002). CONCLUSIONS: Antireflux surgery can improve chronic cough due to GERD resistant to intensive medical therapy. There is a clinical profile that can predict when GERD is the likely cause of cough. GERD cannot be excluded on clinical grounds as the potential cause of cough. The term acid reflux disease, when applied to chronic cough due to GERD, can be a misnomer.

Adult↗
PubMed2003

Impaired efficacy of cough in patients with Parkinson disease.

STUDY OBJECTIVES: Aspiration pneumonia, a leading cause of death in patients with Parkinson disease (PD), usually occurs at the advanced stages of the disease. We investigated both motor and sensory components of cough and induced-sputum substance P (SP) concentrations in patients with early and advanced stages of PD to assess whether cough efficacy is impaired in PD. SUBJECTS: Fifteen female patients with early stages of PD (Hoehn and Yahr stage II-III), 10 patients with advanced stages of PD (Hoehn and Yahr stage IV), and 15 age-matched female control subjects were investigated. MEASUREMENTS: The motor component of cough efficacy was assessed by monitoring voluntary maximal cough peak flow. The sensory component of cough efficacy was assessed by measuring cough reflex sensitivity to citric acid inhalation. Sputum SP concentrations were measured in sputum induced by hypertonic saline solution inhalation. RESULTS: The mean (+/- SD) cough peak flow rates in patients with both early PD (230 +/- 74 L/min; p < 0.005) and advanced PD (186 +/- 60 L/min; p < 0.0001) were significantly weaker than that in control subjects (316 +/- 70 L/min). Cough reflex sensitivity in patients with advanced PD (46.7 +/- 49.3 g/L) was significantly lower compared to control subjects (14.5 +/- 16.6 g/L; p < 0.01) and patients with early PD (11.2 +/- 14.8 g/L; p < 0.005). The sputum SP concentration was significantly lower in patients with advanced PD (11.2 +/- 8.4 pg/mL) compared to that in control subjects (35.6 +/- 15.4 pg/mL) and patients with early PD (28.5 +/- 16.4 pg/mL). CONCLUSION: In the early stages of the disease, mainly the motor component of cough was impaired. In advanced stages of the disease, both the motor and sensory components of cough were impaired. Sputum SP concentration significantly declined in patients with advanced PD. The results suggest that the combination of impaired motor and sensory components of cough may play an important role in the development of aspiration pneumonia in PD.

Aged↗
PubMed2004

Gender differences in health-related quality of life in patients complaining of chronic cough.

STUDY OBJECTIVES: To confirm that more women than men who complain of chronic cough seek medical attention, to determine whether the health-related quality of life (HRQOL) of these women is more adversely affected than men, and to determine whether there are gender differences in the ways that chronic cough adversely affects HRQOL. DESIGN: Analysis of previously, prospectively collected data, but not previously analyzed or reported data, plus additional prospectively collected data to enrich the database to make meaningful gender comparisons. SETTING: Cough clinic in an academic, tertiary care medical center. PARTICIPANTS: Subjects seeking medical attention complaining of cough of at least 8 weeks duration and a control group of smokers not complaining of cough. MEASUREMENTS: Assessment of chronic cough on HRQOL utilizing a valid and reliable cough-specific HRQOL instrument, the cough-specific quality-of-life questionnaire (CQLQ). INTERVENTIONS: All subjects completed the CQLQ prior to any contact with the cough specialist and medical intervention. RESULTS: In the original cohort of subjects, women (116 subjects) outnumbered the men (38 subject) by 3:1 (p < 0.0001). In the current study, total CQLQ scores for women were higher than for men (67.1 vs 59.7, respectively; p = 0.002). Women had higher scores than men in three of six subscales, as follows: physical complaints (21.6 vs 19.0, respectively; p = 0.004); psychosocial issues (14.7 vs 12.9, respectively; p = 0.002); and extreme physical complaints (8.9 vs 6.6, respectively; p < 0.001). Men and women had similar scores on the remaining subscales. Women scored significantly higher on 10 of the 28 items that make up the six subscales. The item that showed the greatest disparity and the most significant difference between women and men was wetting the pants (p < 0.001) as a result of chronic coughing. CONCLUSIONS: Women with chronic cough were probably more inclined to seek medical attention than men because their HRQOL was more adversely affected and because they were more apt to suffer from physical complaints such as stress incontinence, which provoked psychosocial issues such as becoming embarrassed.

Adult↗
PubMed2006

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

BACKGROUND: Asthma is among the most common causes of chronic cough in adult nonsmokers. Although cough usually accompanies dyspnea and wheezing, it may present in isolation as a precursor of typical asthmatic symptoms, or it may remain the predominant or sole symptom of asthma. The latter condition is known as cough-variant asthma (CVA). METHODS: Data for this review were obtained from a National Library of Medicine (PubMed) search, performed in April 2004, of the English language literature from 1975 to 2004, limited to human studies, using the search terms "cough" and "asthma." RESULTS: The diagnosis of cough not associated with typical asthmatic symptoms (ie, CVA) presents a challenge, because physical examination and spirometry findings may be entirely normal. Methacholine inhalation challenge testing can demonstrate the presence of bronchial hyperresponsiveness; however, the diagnosis of cough due to asthma is only confirmed after the resolution of cough with antiasthmatic therapy. In general, the therapeutic approach to asthmatic cough is similar to that of the typical form of asthma. Most patients will respond to inhaled bronchodilators and inhaled corticosteroids. A subgroup of patients will require the addition of leukotriene receptor antagonists and/or a short course of oral corticosteroids. CONCLUSIONS: Asthma should be considered as a potential etiology in any patient with chronic cough, because asthma is a common condition that is commonly associated with cough. Because the subgroup of asthmatic patients with CVA presents with no other symptoms of asthma, clinical suspicion must remain high. Cough due to asthma responds to standard antiasthmatic therapy.

Asthma↗
PubMed2006

Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.

BACKGROUND: The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to acute bronchitis and make recommendations that will be useful for clinical practice. Acute bronchitis is one of the most common diagnoses made by primary care clinicians and emergency department physicians. It is an acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks. Respiratory viruses appear to be the most common cause of acute bronchitis; however, the organism responsible is rarely identified in clinical practice because viral cultures and serologic assays are not routinely performed. Fewer than 10% of patients will have a bacterial infection diagnosed as the cause of bronchitis. The diagnosis of acute bronchitis should be made only when there is no clinical or radiographic evidence of pneumonia, and the common cold, acute asthma, or an exacerbation of COPD have been ruled out as the cause of cough. Acute bronchitis is a self-limited respiratory disorder, and when the cough persists for >3 weeks, other diagnoses must be considered. METHODS: Recommendations for this review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, which was performed in August 2004. The search was limited to literature published in the English language and human studies, using search terms such as "cough," "acute bronchitis," and "acute viral respiratory infection." RESULTS: Unfortunately, most previous controlled trials guiding the treatment of acute bronchitis have not vigorously differentiated acute bronchitis and the common cold, and also have not distinguished between an acute exacerbation of chronic bronchitis and acute asthma as a cause of acute cough. For patients with the putative diagnosis of acute bronchitis, routine treatment with antibiotics is not justified and should not be offered. Antitussive agents are occasionally useful and can be offered as therapy for short-term symptomatic relief of coughing, but there is no role for inhaled bronchodilator or expectorant therapy. Children and adult patients with confirmed and probable whooping cough should receive a macrolide antibiotic and should be isolated for 5 days from the start of treatment; early treatment within the first few weeks will diminish the coughing paroxysms and prevent spread of the disease; the patient is unlikely to respond to treatment beyond this period. CONCLUSION: Acute bronchitis is an acute respiratory infection that is manifested by cough and, at times, sputum production that lasts for no more than 3 weeks. This syndrome should be distinguished from the common cold, an acute exacerbation of chronic bronchitis, and acute asthma as the cause of acute cough. The widespread use of antibiotics for the treatment of acute bronchitis is not justified, and vigorous efforts to curtail their use should be encouraged.

Acute Disease↗
PubMed2003

Coughing, mucus accumulation, airway obstruction, and airway inflammation in control horses and horses affected with recurrent airway obstruction.

OBJECTIVE: To investigate relationships between cough frequency and mucus accumulation, airway obstruction, and airway inflammation and to determine effects of dexamethasone on coughing and mucus score. ANIMALS: 13 horses with recurrent airway obstruction (RAO) and 6 control horses. PROCEDURE: 6 RAO-affected and 6 control horses were stabled for 3 days. Coughing was counted for 4 hours before and on each day horses were stabled. Before and on day 3 of stabling, tracheal mucus accumulation was scored, airway obstruction was assessed via maximal change in pleural pressure (deltaPpl(max)), and airway inflammation was evaluated by use of cytologic examination of bronchoalveolar lavage fluid (BALF). Effects of dexamethasone (0.1 mg/kg, IV, q 24 h for 7 days) were determined in 12 RAO-affected horses. RESULTS: To assess frequency, coughing had to be counted for 1 hour. In RAO-affected horses, stabling was associated with increases in cough frequency, mucus score, and deltaPpl(max). Control horses coughed transiently when first stabled. In RAO-affected horses, coughing was correlated with deltaPpl(max), mucus score, and airway inflammation and was a sensitive and specific indicator of deltaPpl(max) > 6 cm H2O, mucus score > 1.0, and > 100 neutrophils/microL and > 20% neutrophils in BALF Dexamethasone reduced cough frequency, mucus score, and deltaPpl(max), but BALF neutrophil count remained increased. CONCLUSIONS AND CLINICAL RELEVANCE: Because of its sporadic nature, coughing cannot be assessed accurately by counting during brief periods. In RAO-affected horses, coughing is an indicator of airway inflammation and obstruction. Corticosteroid treatment reduces cough frequency concurrently with reductions in deltaPpl(max) and mucus accumulation in RAO-affected horses.

Airway Obstruction↗
PubMed2003

Pathophysiology of headache associated with cough in patients with Chiari I malformation.

OBJECT: The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. In addition, the authors evaluated the use of intrathecal pressure during cough as a means of assessing obstruction to the free flow of cerebrospinal fluid (CSF) at the craniocervical junction. METHODS: Twenty-six adult patients with Chiari I malformation and syringomyelia, four adult patients with Chiari I malformation without syringomyelia, and 15 healthy volunteers were prospectively studied. Testing before surgery included the following: 1) clinical evaluation for the presence of headache associated with cough; and 2) evaluation of lumbar subarachnoid pressure at rest, during three to five coughs, while performing the Valsalva maneuver, during jugular compression, and after removal of CSF. Patients underwent suboccipital craniectomy, C-1 laminectomy, and duraplasty. Testing was repeated 6 months after surgery. CONCLUSIONS: Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.

Adult↗
PubMed1998

Angiotensin converting enzyme inhibitors and cough--a north Indian study.

Cough is an important side effect of Angiotensin Converting Enzyme Inhibitor (ACEI) therapy. The incidence of cough was investigated in a prospective 8 week study in 250 hypertensive patients receiving ACEI alone or in combination with other agents. Enalapril (5-20 mg/day), Lisinopril (5-20 mg/day), Captopril (25-75 mg/day) or Ramipril (5-15 mg/day) was prescribed to patients, who were followed up at weekly visits. Cough developed in 73 of the 250 patients i.e. an incidence of 29.2%. Females had a higher incidence of cough as compared to males--37.9% versus 15.5% (p < 0.001) and there was no significant difference in the cough incidence in the various age groups. A dry, non-productive cough developed in all patients within 4 weeks of ACEI initiation. Increased nocturnal intensity of cough was reported by 79.4% patients. Cough incidence was 34.4%, 24.3% and 18.1% in patients on Enalapril, Ramipril and Lisinopril, respectively. Cough was not dose related and was not related to smoking. There was no statistically significant difference among patients on ACEI alone or in combination with beta blockers, calcium channel blockers or diuretics. Of the 18 patients with ACEI induced cough who received Indomethacin, 50 mg bid, 8 reported complete cure and cough was reduced in intensity in the remaining ten.

Adult↗
PubMed2001

Cough and asthma.

Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them. Cough, wheeze and breathlessness are classical features of asthma syndrome. Many diseases may lead to this syndrome. Asthmatic children present with cough of variable intensities and patterns. At times, wheeze and breathlessness may not be clinically apparent. It was well known that all that wheezes is not asthma but now it is well understood that every asthmatic child does not wheeze. In an acute attack of asthma, cough often starts at the end of wheezing episode. It leads to expulsion of thick, stringy mucus often in the form of casts. Though cough is a minor symptom during acute attack, it ensures removal of secretions and avoid complications. Cough is a prominent symptom in persistent asthma especially between acute exacerbations. Episodic nocturnal cough may be the only symptom of chronic asthma. Children with cough variant asthma do not wheeze. It is postulated that they have milder degree of airway hyperresponsiveness and higher wheezing threshold. However, they show all the characteristics of asthma on laboratory tests. Cough represents bronchial hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many diverse etiologies such as gastroesophageal reflux, enlarged adenoids, sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and relevant tests may be necessary for proper diagnosis.

Asthma↗
PubMedDate not supplied

Psychogenic cough in adults: a report of two cases and review of the literature.

Psychogenic cough, also known as "habit cough," is a well-documented condition in the pediatric and adolescent population, with numerous cases reported in the medical literature. Many of these patients are strikingly similar in their clinical characteristics and, although the data are limited, a variety of treatment options may be successful in terminating this form of cough. However, psychogenic cough in adults has been reported infrequently and is less well defined. We report two cases of psychogenic cough in adult patients referred to our service for an evaluation of refractory, chronic cough and review the relevant medical literature. Our patients seemingly represent the first cases of psychogenic cough reported in the geriatric population and share clinical features with children, adolescents, and young adults. One case is unique in the sense that the cough responded to a distracter in the form of a throat lozenge, and this patient consumed > or = 20 lozenges/day for approximately 13 years. Psychogenic cough should be considered in adult patients who present with a chronic cough of no obvious organic basis that has failed therapy directed at postnasal drip, asthma, and gastroesophageal reflux. We propose criteria to assist in making a diagnosis of psychogenic cough in adult patients and review the limited information that exists concerning treatment modalities.

Aged↗
PubMed2004

[The effects of bakumondo-to (mai-men-dong-tang) on asthmatic and non-asthmatic patients with increased cough sensitivity].

UNLABELLED: Some patients with bronchial asthma (BA) have increased throat sensitivity. In some instances, it is envisaged that this may result in increased coughing or wheezing. Bakumondo-to is a traditional herbal medicine that is well known to reduce coughing in patients with BA and chronic bronchitis. AIM: The present study was conducted to investigate the effect of Bakumondo-to on cough sensitivity in patients with BA and non-asthmatic (non-BA) conditions. The effect on respiratory tract inflammation was also examined. METHODS: We examined 21 BA and 22 non-BA subjects whose cough threshold for capsaicin was less than 3.9 microM. We prepared 1000, 500, 250, 125, 62.5, 31.2, 15.6, 7.80, 3.90, 1.95, 0.98, and 0.49 microM solutions. Cough thresholds to a concentration of inhaled capsaicin solution causing 5 or more coughs was measured before treatment and after 2 months or more of treatment with Bakumondo-to (9 g/day, TJ-29). The number of eosinophils in the peripheral blood, the sputum eosinophil ratio, and the ECP level in the serum were also measured before and after treatment. RESULTS: 1. Bakumondo-to significantly improved the cough threshold value in 76% of patients with BA and in 82% with non-BA conditions. 2. Bakumondo-to was more effective in reducing cough sensitivity to capsaicin in BA than in non-BA conditions. 3. While Bakumondo-to did not significantly reduce the sputum eosinophil count, its effectiveness in suppressing cough was greatest in patients whose sputum eosinophil count was > or = 2%. It remains to be established whether Bakumondo-to inhibits eosinophil activation. Our results suggest that Bakumondo-to is an effective therapeutic preparation for cough hypersensitivity accompanying chronic cough disease, especially in cases of severe allergic inflammation.

Adult↗
PubMed2004

Effects of intranasal capsaicin challenge on cough reflex in healthy human volunteers.

Rhinosinusitis is the most common cause of chronic cough. There is clinical experience that cough can be elicited from lower airways including the larynx. However, there is no experimental evidence, that afferent nerve endings localized in the nose or sinuses can directly mediate the cough reflex. Stimulation of nasal afferents affects breathing pattern (apnea) and bronchial smooth muscles (nasobronchial reflex). The question arises of whether stimulation of nasal afferents could also interfere with the cough reflex. Intranasal capsaicin enhances the cough response in cats and guinea pigs. In the present study we address the problem of modulation of the cough response by intranasal capsaicin challenge in humans. Twelve healthy volunteers were recruited for the study. The effect of intranasal capsaicin (25 microl, 750 microM) and the airway cough threshold were determined at the start of the experiment. After that, cough response was provoked by inhalation of a tussigen during stimulation of nasal afferents with capsaicin and in control conditions in a randomized order. The cough response provoked during intranasal capsaicin was significantly enhanced compared with that during control conditions. Thus, the result was similar to that obtained in previous animal studies. The enhancement of the cough response could be explained by a facilitating interaction between the afferent information of nasal origin and the central neuronal network responsible for creation of cough pattern.

Administration, Inhalation↗
PubMed2005

Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.

SETTING: Governmental health facilities in six districts of India. OBJECTIVE: To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks. DESIGN: Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy. RESULTS: Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks. CONCLUSION: The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.

Adolescent↗