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PubMed2006

Analysing the causes of chronic cough: relation to diesel exhaust, ozone, nitrogen oxides, sulphur oxides and other environmental factors.

Air pollution remains a leading cause of many respiratory diseases including chronic cough. Although episodes of incidental, dramatic air pollution are relatively rare, current levels of exposure of pollutants in industrialized and developing countries such as total articles, diesel exhaust particles and common cigarette smoke may be responsible for the development of chronic cough both in children and adults. The present study analyses the effects of common environmental factors as potential causes of chronic cough. Different PubMed-based researches were performed that related the term cough to various environmental factors. There is some evidence that chronic inhalation of diesel can lead to the development of cough. For long-term exposure to nitrogen dioxide (NO2), children were found to exhibit increased incidences of chronic cough and decreased lung function parameters. Although a number of studies did not show that outdoor pollution directly causes the development of asthma, they have demonstrated that high levels pollutants and their interaction with sunlight produce ozone (O3) and that repeated exposure to it can lead to chronic cough. In summary, next to the well-known air pollutants which also include particulate matter and sulphur dioxide, a number of other indoor and outdoor pollutants have been demonstrated to cause chronic cough and therefore, environmental factors have to be taken into account as potential initiators of both adult and pediatric chronic cough.

Journal Article↗

PubMed2006

Acid regurgitation associated with persistent cough after pulmonary resection: an observational study.

BACKGROUND: Following a pulmonary resection, some patients suffer from persistent coughing, which may have a relationship with acid regurgitation. Since few physiological studies have been reported regarding this issue, we conducted the present observational study. METHODS: Persistent cough after pulmonary resection (CAP) was defined as non-productive coughing that occurred after a pulmonary resection in patients with stable chest X-ray results and no postnasal drip syndrome, asthma, or history of angiotensin converting enzyme inhibitor administration. A 24-hour esophageal pH monitor was used with patients with coughing (n = 13) and patients with no coughing (n = 4) after undergoing a lobectomy, and the relationship between acid regurgitation and CAP was assessed using symptom association probability. RESULTS: Based on the results of pH monitoring conducted within 4 weeks of the operation we divided the patients into 3 groups: Type A had frequent gastroesophageal refluxes (>50 occurrences in 24 hours) and frequent coughing (>30 occurrences in 24 hours), Type B had frequent gastroesophageal refluxes and infrequent coughing, and type C had infrequent gastroesophageal refluxes and infrequent coughing. Type A patients (n = 10) were exclusively those with CAP and the symptom association probability was greater than 95%. Five from that group underwent esophageal pH monitoring more than 1 year after surgery and none showed significant improvements in acid regurgitation. CONCLUSION: There was a relationship seen between acid regurgitation and CAP in some patients shortly after surgery, while acid regurgitation remained unimproved after improvement of coughing in most of those 1 year after surgery.

Journal Article↗

PubMed1994

Cough production, leucocytosis and serology of rats infected intrabronchially with Bordetella pertussis.

Adult Sprague-Dawley rats infected intrabronchially with Bordetella pertussis strain 18-323 encased in agarose beads (BP-beads), developed a paroxysmal cough and leucocytosis, both of which peaked at around day 10. When animals were exposed to ether for 2 min after delivery of the beads, there was an enhancement of the number of subsequent coughing episodes. Inclusion of carrageenan in the beads also enhanced coughing. Control rats, given sterile beads or left untreated, showed only a low level of coughing or no coughing, depending upon their source. Rats challenged by the same route with heat-killed B. pertussis in beads, or with live organisms in suspension (without beads) showed no cough induction or leucocytosis. However, intranasal delivery of B. pertussis suspension gave rise to a moderate amount of coughing and leucocytosis. Serum IgG responses to B. pertussis antigens were greatest in rats infected with BP-beads and antibodies against both pertussis toxin and filamentous haemagglutinin were detected. Since the rat is the only conveniently accessible laboratory animal species in which B. pertussis induces an intermittent paroxysmal cough, as in man, it merits further study for determining the mechanisms of pathogenesis and immunity in pertussis.

Animals↗

PubMed1994

Responses to Bordetella pertussis mutant strains and to vaccination in the coughing rat model of pertussis.

Phase I strains 18-323, Tohama and L-84 of Bordetella pertussis produced paroxysmal coughing when encased in agarose beads and administered intrabronchially to adult Sprague-Dawley rats. In contrast, the Phase IV variant of strain L-84 was inactive in cough induction, as was strain BP 357, a transposon-insertion mutant which is deficient only in pertussis toxin (PT). Strain BPM 1809, which lacks only the heat-labile toxin, was similar to the unmodified Phase I strains for cough induction, indicating that this toxin is not needed to induce coughing. B. parapertussis also was inactive as a cough inducer. These results indicate that PT, present in Phase I strains of B. pertussis, and absent from Phase IV strains, strain BP 357 and B. parapertussis, is essential for the induction of paroxysmal coughing in this rat model of whooping cough. Prior injection of DTP (whole-cell) vaccine greatly reduced the incidence of coughing in rats challenged subsequently with Phase I B. pertussis. Serological responses were monitored after intrabronchial infection with the various bacterial strains and after vaccination and challenge. The PT-positive or -negative status of the strains in vivo was confirmed by the appropriate presence or absence of anti-PT IgG in the convalescent sera.

Animals↗

PubMed2005

Methylxanthines for prolonged non-specific cough in children.

BACKGROUND: Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including a variety of asthma medications. Methylxanthines, the main medication used for paediatric asthma for many decades in Western countries, is still widely used in non-Western countries. Also, methylxanthines have other pharmacological properties and their bronchodilator effect is only modest. OBJECTIVES: To evaluate the efficacy of methylxanthines in treating children with non-specific cough. SEARCH STRATEGY: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were performed in Jan 2005. SELECTION CRITERIA: All randomised controlled trials comparing methylxanthines with a placebo medication in treating children with non-specific cough. DATA COLLECTION AND ANALYSIS: Results of searches were reviewed against pre-determined criteria for inclusion. No eligible trials were identified and thus no data were available for analysis. Four small non-randomised controlled trials were reported. MAIN RESULTS: No randomised controlled trials that examined the efficacy of methylxanthines in the management of prolonged non-specific cough in children were found. In the non randomised trials above, a significant effect was seen within 2-14 days of therapy. AUTHORS' CONCLUSIONS: There is currently an absence of reliable evidence to support the routine use of methylxanthines for symptomatic control of non-specific cough in children. If methylxanthines were to be trialled in children with prolonged non-specific cough, cohort data (thus limited) suggest a clinical response (subjective cough severity) would be seen within 2-5 days (and certainly within 14 days) of therapy. However methylxanthine use has to be balanced against the well known risk of toxicity and its low therapeutic range in children. Further research examining the efficacy of this intervention is needed.

Antitussive Agents↗

PubMed1989

Abnormal cough reflex in canine acrylamide neuropathy.

Coughing in response to irritation of the airways is a fundamental protective reflex that is dependent on rapidly adapting bronchopulmonary receptors and their vagal afferent fibers; reflex airway constriction, which is effected by vagomotor efferent fibers, usually accompanies coughing. Although dysfunction of vagally mediated cardiovascular and gastrointestinal reflexes is a well-documented complication of autonomic neuropathy, to date there have been no studies of the effect of peripheral autonomic failure on the cough reflex. In the study reported here, we examined the effect of acrylamide-induced neuropathy, a distal axonopathy, on the ventilatory and tracheomotor components of the cough reflex in conscious dogs. There was a reduction in the cough reflex in response to mechanical irritation of the large airways in the preclinical phase of the neuropathy, and the cough reflex was virtually abolished when the dogs had moderate neuropathy. Following withdrawal of the neurotoxin, there was a substantial recovery of the cough reflex in surviving animals. It is possible that the cough reflex may be reduced in patients with vagal neuropathy and that this might compromise protection of the airway.

Acrylamide↗

PubMed1989

Angiotensin-converting enzyme inhibitor-induced cough.

A 65-year-old woman started taking enalapril 2.5 mg daily for hypertension. Twelve days later she complained of a persistent, dry cough. Due to the coughing and a preexisting cystocele, she developed stress incontinence and a marked decline in her functional status. The coughing and incontinence resolved with the discontinuation of enalapril. During a subsequent hospitalization the patient received captopril 6.25 mg twice daily for congestive heart failure. Within 24 hours the dry cough recurred. It resolved with the discontinuation of the drug. Cough is a symptom that is generally not recognized as a drug side effect. However, increasing numbers of case reports document angiotensin-converting enzyme inhibitor-induced cough. Although the actual frequency and mechanism are currently unknown, the dry cough typically begins early in the course of therapy. It may be specific to this pharmacologic class rather than to one individual agent. Age and sex may be contributing factors. While cough has been considered a minor side effect, unnecessary hospitalizations and inappropriate treatments may easily result. Even minor adverse reactions may have an impact on a patient's quality of life.

Aged↗

PubMed2001

Relationship between bronchial hyperresponsiveness and development of asthma in children with chronic cough.

To evaluate the relationship between bronchial hyperresponsiveness (BHR) and the development of asthma in children with chronic cough, we performed methacholine inhalation challenges and transcutaneous oxygen pressure (tcPO2) measurements in 92 children with chronic cough aged from 1-13 years (55 boys and 37 girls; mean, 5.3 years) and followed them for > or = 10 years. Forty-four age-matched children with asthma (24 males and 20 females; mean, 6.5 years) and 44 age-matched children without cough or asthma served as controls (18 males and 26 females; mean, 4.6 years). Consecutive doubling doses of methacholine were inhaled until a 10% decrease in tcPO2 from baseline was observed. The cumulative dose of methacholine at the inflection point of the tcPO2 record (Dmin-PO2) was considered to represent hyperresponsiveness to inhaled methacholine. After 10 years or more of follow-up, 60 of the 92 subjects with cough answered our questionnaire, and 27/60 had been diagnosed with asthma. There was a statistical difference in Dmin-PO2 between the children who presented with chronic cough originally and who developed asthma (asthma-developed group) and those who did not develop asthma (asthma-free group). There was no difference in the value of Dmin-PO2 between the asthma-developed group and the asthma group, or between the asthma-free group and the age-matched control group. Among the children with chronic cough, there was no difference in Dmin-PO2 between girls and boys, either in the asthma-developed group or in the asthma-group. We conclude that 45% of the children with a chronic cough in early life developed asthma, and that BHR in children with chronic cough during the childhood period is a strong risk factor for the development of asthma.

Administration, Inhalation↗

PubMed1994

A new device for ambulatory cough recording.

Nocturnal cough reporting on diary cards has been shown to be unreliable and inconsistent. Whether subjective reporting of daytime cough is equally unreliable remains unknown. We have, therefore, developed a new and easily portable device (RBC-7) that records electromyographic (EMG) and audio cough signals for at least a 24-hr period, with a capacity of over 48 hr. Additional information is obtained from electrocardiographic (ECG) signals, and from an accelerometer indicating the level of the subject's activity. The RBC-7 can be set up with the aid of a notebook computer at the subjects home, school or workplace. Initial studies utilizing a prototype device were performed to determine the optimal position of the EMG leads and the microphone. The optimal position for the EMG leads was determined as the positive electrode in the sixth intercostal space (ICS) in the midclavicular line on the left, the negative electrode in the same position on the right, and the reference electrode in the midline over the abdomen. This position was shown to give the highest EMG voltages and the greatest difference in voltages between cough and other signals. The optimal microphone position for signal strength and comfort was over the first ICS, either right or left, close to the sternum. Recordings were performed simultaneously in 20 subjects with conventional tape recorders and the multiparametric cough monitoring system (RBC-7). Conventional tape recordings limited the duration of the studies due to the inherent restrictions. No significant difference in the number of single coughs recorded by each system was detected (correlation coefficient = 0.996). The RBC-7 offers a unique opportunity to obtain objective information on cough in ambulatory subjects over at least a 24-hr period, and to relate cough to time, activity and heart rate, while normal activities are pursued.

Adult↗

PubMed1993

The cough response of the anal sphincter.

Rises in intra-abdominal pressure are common and are accompanied by reflex contraction of the external sphincter. Voluntary contraction of the sphincter is an uncommon event but is routinely used as a measure of sphincter strength. Cough pressure and squeeze pressure were compared in 75 patients using a 4 channel perfused catheter (3 anal and 1 rectal side-hole). Maximum anal cough pressure was higher than squeeze pressure (mean 158 vs 133 cm H2O, P = 0.0015). Intra-individual variance was less using cough pressure (mean 20% vs 29%, P = 0.005). There was significant overall correlation between cough pressure and squeeze pressure (P < 0.001) although in some cases there were wide differences, suggesting that use of both cough and squeeze pressure in manometry will assess sphincter strength more reliably. Measurement of the recto-anal pressure gradient during coughing correlated significantly better with degree of incontinence than cough or squeeze pressure (P = 0.005). The presence of a positive gradient was 100% specific for incontinence but the sensitivity was only 43% suggesting that factors other than simple mechanical sphincter weakness are involved in incontinence. Measurement of cough pressure has both clinical and research importance and should be added to standard manometric protocols.

Anal Canal↗

PubMed1996

Sustained cough in methotrexate therapy for rheumatoid arthritis.

Sustained cough is a frequent complaint in methotrexate (MTX) treatment for rheumatoid arthritis and can be a symptom of incipient MTX-induced pneumonitis. This study was performed to characterize MTX-associated cough clinically and to clarify by which means this condition can be distinguished from incipient MTX pneumonitis. Three patients with MTX-induced pneumonitis and 10 patients with sustained cough unassociated with pneumonitis were examined clinically, by pulmonary function testing, and bronchoalveolar lavage (BAL). In MTX pneumonitis, cough was associated with progressive dyspnoea, constitutional symptoms, impaired pulmonary function, and interstitial infiltration of variable degree by chest X-ray. BAL cytology invariably showed lymphocytic alveolitis while transbronchial biopsy revealed active interstitial inflammation in only one patient. Ten patients had sustained, nonprogressive cough in the absence of constitutional symptoms, progressive dyspnoea and impaired pulmonary function. Neither X-ray nor BAL nor transbronchial biopsy revealed any evidence of interstitial lung disease. In the majority of these patients, cough abated with symptomatic treatment with or without temporary discontinuation of MTX. It is concluded that MTX-associated cough can be a reflection of isolated airway disease. Clinically, absence of constitutional symptoms, impaired pulmonary function, and interstitial infiltration on X-ray distinguished this condition from incipient MTX pneumonitis. Cough without pulmonary parenchymal involvement appears to result from an irritant effect of MTX on the airways.

Aged↗

PubMed2003

Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl.

PURPOSE: Fentanyl, a synthetic opioid, is a popular choice amongst anesthesiologists in the operating room. Preinduction iv fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy. METHODS: Two hundred patients aged 18-60 yr, undergoing elective laparoscopic cholecystectomy were randomized into four groups of 50 each. Group I served as control, while Groups II, III and IV received an aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room. Following iv fentanyl (2 micro g x kg(-1)) the incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5) depending on the number of coughs observed. Results were analyzed using 'z' and Fischer's Exact test. A P value of < or = 0.05 was considered significant. RESULTS: The incidence of cough was 28% in the control group, 6%, 0% and 4% in the salbutamol, beclomethasone and sodium chromoglycate groups respectively. Occurrence of cough was significantly low (P < or = 0.05) in the treatment groups, however the difference amongst the groups was not significant (P >/= 0.05). CONCLUSION: The use of salbutamol, beclomethasone or sodium chromoglycate aerosol 15 min prior to iv fentanyl administration minimizes fentanyl-induced coughing.

Adolescent↗

PubMed2002

Chronic cough due to gastroesophageal reflux disease: efficacy of antireflux surgery.

BACKGROUND: Gastroesophageal reflux disease (GERD) can be overlooked as the cause of chronic cough (CC) when typical gastrointestinal symptoms are absent or minimal. We analyzed the outcomes of Nissen fundoplication (NF) for patients who failed medical therapy for CC attributable only to GERD (G-CC). We performed a prospective outcome evaluation of 21 consecutive patients with G-CC undergoing NF from 1997 to 2000 at a tertiary care university hospital. MATERIALS AND METHODS: Twenty-one patients without prior antireflux surgeries had G-CC diagnosed by a clinical profile and 24-h pH monitoring showing a cough-reflux correlation. Respiratory symptoms alone were present in 53% of patients. NF was performed when G-CC persisted despite intensive medical therapy, including an antireflux diet. Preoperatively, all patients underwent 24-h pH monitoring, esophageal manometry, barium swallow, gastric emptying study, bronchoscopy, and upper endoscopy. NF was utilized in all cases, laparoscopically in 18. Before and after surgery, patients graded their cough severity using the Adverse Cough Outcome Survey (ACOS). Quality of life was measured using the Sickness Impact Profile (SIP). RESULTS: Postoperatively, 18 patients (86%) reported an improvement of their cough. G-CC considerably improved in 16/21 patients (76%), with complete resolution in 13 patients (62%). Mild to moderate improvement was found in 2 patients (10%). Patient-reported cough severity (ACOS) and quality of life (SIP) both significantly improved early (6-12 weeks) postoperatively and persisted during the long-term (1 year) follow-up. The average hospital length of stay was 1.78 +/- 0.2 (l-4) days for the laparoscopic (n = 18) and 6.3 +/- 1.2 (4-8) days for the open surgery (n = 3) groups. CONCLUSION: Twenty-four-hour esophageal pH monitoring is a valuable tool for preoperative cough-reflux correlation. Antireflux surgery is effective in carefully selected patients whose refractory CC is attributable only to GERD. NF controls the severity of cough while improving the quality of life. Outcomes are further enhanced using laparoscopic procedures with shorter hospital stays.

Chronic Disease↗

PubMed2004

Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux related cough?

BACKGROUND: Of patients with chronic cough, 21% have GERD. Up to half of these patients may not respond adequately to medical, but the long-term results of antireflux surgery for cough is unknown. METHODS: A total of 905 patients (209 with respiratory symptoms, mainly cough) underwent laparoscopic Nissen fundoplication. Preoperatively patients underwent esophageal motility studies, 24-h pH monitoring, and symptom evaluation using a validated scale. Of eligible patients, 81% were followed at 6 months, 73% at 2 years, and 60% at 5 years. RESULTS: Before surgery, 83% of respiratory patients (RP) and 51% of nonrespiratory patients (NRP) had cough. RP had higher cough scores ( p < 0.0001), but improvement in cough compared to baseline was similar in the RP and NRP ( p = 0.1105 at 6 months, 0.4206 at 2 years, and 0.1348 at 5 years). Cough improved in 83% at 6 months, 74% at 2 years, and 71% at 5 years. CONCLUSIONS: Laparoscopic Nissen fundoplication is successful in the long-term control of GERD-related cough, even in patients who fail medical therapy.

Adult↗

PubMed2006

Biofeedback and cognitive coping in the treatment of pediatric habit cough.

Habit cough is a persistent "barking" cough that does not have a medical basis. The current study evaluated a biofeedback approach using skin temperature feedback with a family focus in the treatment of an 11-year-old girl diagnosed with habit cough. Treatment consisted of six, one hour sessions with the family for part of the session and then individually with the girl. Individual treatment involved skin-temperature biofeedback to teach relaxation during the coughing episodes. The girl was cough free at the end of the sixth session and remained cough free at the end of a one and two year follow-ups. The use of a single case baseline design demonstrated the reduction of coughing and increase in extracurricular activity. It is, noteworthy that the girl demonstrated a significant ability to increase skin temperature during treatment and when asked to try to control her cough.

Adaptation, Psychological↗

PubMed1989

Limitations of cough in maintaining blood flow during asystole: assessment by two-dimensional and Doppler echocardiography.

It has been previously demonstrated that patients can maintain consciousness by vigorously coughing during episodes of prolonged ventricular asystole or ventricular fibrillation. Using two-dimensional Doppler echocardiography and arterial blood pressure recordings, we evaluated the changes that occur during coughing in nine patients who were dependent on pacemakers and in whom periods of asystole could be induced. During asystole in each patient the mitral valve stayed partially open and the left ventricular area comprised 87% and 90% (apical four-chamber view, short-axis view, respectively) of the area during diastole of paced rhythm. Peak arterial pressure during coughing and asystole was 80% of peak systolic pressure of paced rhythm (P = 0.001). Left ventricular area during coughing was 110% (both apical four-chamber view and short-axis views) of the area during asystole when patients were not coughing. Both the mitral and aortic valves showed no appreciable motion during coughing. During coughing the mean flow velocity across the mitral valve was 0.06 +/- 0.03 m/sec and the flow velocity integral was 0.03 +/- 0.02 cm. Thus coughing during asystole produced minimal flow despite a rise in brachial arterial pressure.

Aged↗

PubMed1988

Cough and bronchoconstriction mediated by capsaicin-sensitive sensory neurons in the guinea-pig.

Neural pathways involved in cough and reflex bronchoconstriction and the effects of drugs on these airway reflexes have been studied in unanaesthetised guinea-pigs exposed to aerosols of citric acid (0.13-0.78 M), capsaicin (30 microM), nicotine (9.2 mM) and histamine (0.9 mM). The number of coughs was counted during the first 3 min of exposure and the time to onset of signs of dyspnea, as an indication of bronchoconstriction, was measured. Citric acid produced bronchoconstriction and dose-dependently increased the number of coughs. Capsaicin produced both cough and bronchoconstriction. Nicotine mainly produced cough and histamine bronchoconstriction. Pretreatment of adult guinea-pigs with capsaicin (50 mg kg-1 s.c.) produced a long-lasting (greater than or equal to 10 weeks) depletion of substance P- and calcitonin gene related peptide-like immunoreactivities in the sensory nerves of the larynx, tracheobronchial tree and lung. In capsaicin-treated animals, citric acid (0.39 M) and capsaicin (30 microM) caused neither cough nor bronchoconstriction. Nicotine (9.2 mM) and mechanical stimulation still produced cough, and histamine (0.9 mM) bronchoconstriction. It is concluded that in guinea-pigs both capsaicin-sensitive (probably C-fibre endings) and capsaicin-resistant (probably rapidly adapting stretch receptors) afferent neurons may be involved in cough and reflex bronchoconstriction.

Animals↗

PubMed2006

Sesame oil use in ameliorating cough in children: a randomised controlled trial.

OBJECTIVES: To examine the role of sesame oil (SO) in reducing the frequency and severity of acute cough in children 2-12 years of age. DESIGN: Double blind, placebo controlled randomised trial. SETTING: Seven primary health care centres/clinics in Lebanon. A total of 107 children between the age of 2 and 12 years with cough secondary to common cold were enrolled. INTERVENTION: Five milliliters of SO or placebo by mouth at bed time. OUTCOME MEASURES: Cough strength and frequency as judged by parents on a four points Likert scale after giving three syrup doses over three consecutive nights. Analysis was performed on an intention to treat basis. RESULTS: At day 1, the effect size for cough frequency and cough strength were +0.26 (95%CI -0.64,+0.12) and +0.15 (95%CI -0.53, +0.23), respectively. SO decreased cough symptoms more than placebo but these were not statistically significant. The effect size decreased from days 1 to 3. Cough symptoms improved over the 3 days both in SO and placebo group. No evidence of undesirable effects were noted to SO. CONCLUSION: Like other over the counter antitussives, SO did not result in marked improvement in cough symptoms.

Child↗