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PubMed2004

[Eosinophilic airway disorders: important causes of prolonged cough in Japan].

We studied 223 outpatients who presented between October 2001 and June 2003 with persistent cough of more than 3 weeks' duration. Eosinophilic airway disorders (EAD), including atopic cough and cough variant asthma, were clinically diagnosed in 119 patients, on the basis of the following factors: history of atopic disease, duration of cough, history of previous prolonged cough, or presence of forced expiration wheeze. Since eosinophils are frequently found in the sputum of patients with EAD, a positive test strongly suggests the presence of EAD. In this study, the test was positive in 86% of the patients with EAD. The patients with clinically diagnosed EAD, including those with no eosinophils in the sputum, were treated with inhaled fluticasone 400 or 800 microg/day. Fluticasone was effective in 97% of the patients with EAD and was more effective than bronchodilators or antiallergic drugs. When we compared the results of fluticasone 400 microg/day with those of 800 microg/day doses, the cough disappeared within 1 week in 28% of the patients who received 400 microg/day, whereas in 76% with 800 microg/day. Among the patients with diagnosed EAD, bronchial asthma developed in 6 patients during the observation period. Most of these patients had forced expiration wheeze and lower FEV 1 at the initial visit. This study showed that EAD could be diagnosed in the early stage on the basis of thorough history-taking, the presence of forced expiration wheeze and detection of eosinophils in the sputum. It is important to diagnose and treat EAD as early as possible since inhaled steroid is highly effective.

Administration, Inhalation↗
PubMed2004

[Mechanisms responsible for coughing in patients with rhinitis].

Mechanisms responsible for coughing in patients with rhinitis are not completely elucidated, because afferent innervation of nasal mucosa is not able to mediate cough reflex. There are several mechanisms that can participate in this pathogenetic process. The group of these mechanisms include: postnasal dripping of nasal mucus into the larynx, complete obstruction of the nasal cavity with inappropriate air conditioning, incomplete obstruction of nasal cavity with a possibility of microaspiration of nasal exudate, nasobronchial reflex, facilitating interaction between afferent inputs from nasal mucosa and central neuronal network responsible for coughing or propagation of the inflammatory process from the nose via airways or via systemic circulation into the lower airways mucosa. The most important mechanism that should be taken into consideration is hightened cough sensitivity (decreased threshold of afferent nerve endings in the larynx, trachea and more peripheral airways mediating cough) due to different effects of mechanisms mentioned above on the structure and/or function of afferent nerve endings in the lower airways responsible for inception and modulation of the cough reflex.

Cough↗
PubMed2004

Gastroesophageal reflux and chronic cough.

Gastroesophageal reflux (GOR) disease is one of the 3 commonest causes of chronic cough. It can be difficult to diagnose as the traditionally recognised symptoms of GOR, such as heartburn and acid regurgitation, are often absent. More subtle indicators of a link between the cough and the oesophagus should therefore be sought. These include cough which occurs in relation to eating or phonation, cough which settles at night and does not tend to wake the patient from sleep and symptoms suggestive of laryngopharyngeal reflux. Investigations such as oesophageal manometry and 24 hour pH monitoring can be useful in characterising any underlying oesophageal abnormality, but may underestimate the problem since non-acid reflux can precipitate cough. Empirical trials of treatment are therefore often employed, but should be continued for at least 2 months, as symptoms can be slow to improve due to plasticity of the cough reflex. Pharmacologic treatment options include proton pump inhibitors, H2 receptor antagonists, pro-motility agents and liquid alginate preparations. Surgical fundoplication can also be effective when performed in appropriately selected individuals.

Algorithms↗
PubMed1992

[A case of chronic persistent cough (CPC) caused by gastroesophageal reflux (GER) (including a study of CPC caused by suspected GER)].

A patient, an 80-year-old female, had complained of a cough for 20 weeks, and was not cured by cough medicine. Gastroesophageal reflux was considered as the cause of the cough because of her symptoms and gastrointestinal fiberscopy (GIF) and barium meal studies. She made favorable progress on a histamine H2 blocker and cysapurid for 4 weeks. Therefore we diagnosed her cough as caused by gastroesophageal reflux. We also studied the incidence of chronic persistent cough in patients suspected of gastroesophageal reflux because of symptoms and GIF results. Among 676 cases examined by GIF at Niigata-kenritsu Myoko Hospital, we detected 7 cases who complained of heartburn and in whom we observed hiatal hernia and reflux esophagitis by GIF. Only one of them, the present case, complained of a cough. CPC caused by gastroesophageal reflux is not seen frequently, but the possibility of GER as the cause of CPC should be considered.

Aged↗
PubMed2006

Changes of cough reflex sensitivity induced by cancer radiotherapy of chest and neck regions.

It is reasonable to suppose that airway mucosa can be damaged by irradiation applied to chest and neck regions. The inflammatory process is a consequence of an injury. Airway inflammation is one mechanism responsible for cough induction. So, one can suppose that radiotherapy (RT) focused on the patients' chest or neck may injure airway mucosa, which might change sensitivity of the nerve-endings mediating the cough reflex. The purpose of this study was to examine cough reflex sensitivity (CRS) in patients who underwent RT in the chest and neck regions. CRS test using capsaicin was performed in patients with breast cancer (Group A, n=19), and with lung or neck cancer in (Group B, n=14) who underwent RT. Capsaicin aerosol in doubled concentrations (0.49-1000 microM) was inhaled by a single breath. CRS was defined as the lowest capsaicin concentration that evoked 2 or more coughs (C2). Radiation doses ranged from 40 to 70 Gy. Capsaicin cough challenge was performed before and then in the 2(nd) and 5(th) week of RT. We observed a significantly reduced value of C2, i.e., increased cough reflex sensitivity, in Group B in the 2(nd) week of RT (P= 0.04). We conclude that CRS in the lung or neck cancer patients undergoing RT is significantly enhanced, which could result from injury to the nerve endings in airway mucosa.

Adult↗
PubMed1991

Role of simulated repetitive coughing in mucus clearance.

The role of repetitive simulated coughing on the clearance of gel mucus simulant was investigated in vitro, by using a simulated cough machine. The repetition of cough induced a significant increase (p less than 0.01) in mucus simulant clearance (139.3 +/- 78.7 mm) in comparison to a single cough (24.9 +/- 27.5 mm). Moreover, the increase in frequency of the repetitive coughing induced a marked and significant increase in mucus simulant clearance (75.4 +/- 51.1 mm and 139.3 +/- 78.7 mm at 0.1 Hz and 1.6 Hz frequency, respectively). A significant (p less than 0.05) correlation was observed between the percentage increase of clearance and both shear-thinning index (r = 0.62) and the thixotropic index (r = 0.63). These results suggest that the shear-dependent properties of mucus, associated with a repetitive coughing, may increase the efficiency of mucus clearance by air flow mechanisms.

Cough↗
PubMed1990

Persistent dry cough with enalapril: incidence depends on method used.

In a cohort of 136 hypertensive patients started consecutively on enalapril the incidence of persistent dry cough by life-table analysis was 14.6% (95% CI 10.2-19.0%). The incidence in women (19.2%; 95% CI 11.3-27.1%) was twice that in men (9.7%; 95% CI 6.6-12.8%). Dry cough was unrelated to age, smoking habit, renal function, or the dose and duration of enalapril treatment. In one half of patients who developed cough enalapril had to be stopped. The incidence of withdrawal due to cough was 6.0% (95% CI 4.5-7.5%), and cough was by far the most common reason for discontinuing enalapril treatment. Reviewing previous studies of enalapril-induced cough, it is evident that postmarketing surveillance studies have grossly underestimated the incidence and importance of this side-effect. Surveys in hospital clinics have slightly underestimated the true incidence through failure to use life-table methods of analysis.

Adult↗
PubMed1990

Spectra of the voluntary first cough sounds.

The voluntary cough sounds recorded according to Korpas and Sadlonova-Korpasova were sampled at a frequency of 20.000Hz and spectra of six consecutive windows of 50ms were estimated. To digitize signals an autotrigger mode was used. The subjects were healthy volunteers as well as patients with chronic bronchitis, asthma, bronchial carcinoma (growing intraluminarly in the 1st or in the 2nd or in the 3rd order bronchi), emphysema, laryngeal nerve paralyzis or laryngotomy. The duration of averaged cough sounds of patients was longer than that of healthy volunteers. The mean power of the spectra in the successive windows showed different patterns in the same group. In the third window of healthy volunteers (0.10 s-0.15 s) a high modulus broad bandwidth (between 1-2 kHz) spectrum was found which was considered as a bronchial "flute", and was probably related to the lowest resistance as well as to the velocity of airflow of cough manoeuvre. This pattern appeared with a delay and/or it was changed in the diseased groups compared to the healthy volunteers. Due to this delay, the spectra of the fifth window (0.20 s-0.25 s) showed somewhat higher harmonics (400-800 Hz) in the patients with chronic obstructive pulmonary diseases (COPD), carcinoma and laryngeal nerve paralyzis than in healthy volunteers. In emphysematous patients in the first (0.00-0.05 s), in the third (0.10-0.15 s) and in the fifth (0.20-0.25 s) windows the fundamental frequency was low (156-176 Hz) compared to that of the other groups. The paralyzed vocal cords functioning as an added resistance to the expiratory effort caused a phase-shift in the cough patterns, similarly to that seen in COPD patients. Due to the cannula, the spectra of patients having laryngotomy had a lot of high harmonics. They also had peaks nearly identical to that of bronchitic patients because they suffered from serious chronic bronchitis. It was found that by examination the cough spectra of series of voluntary cough sound signals it was possible to distinguish healthy volunteers from patients. This examination would therefore be useful for screening of bronchial diseases.

Adult↗
PubMed1990

Separation of cough and reflex bronchoconstriction by inhaled local anaesthetics.

Cough and airway constriction are common features of respiratory diseases. Both can be caused by stimulation of airway nerves. We have studied the effects of airway anaesthesia on these reflexes, stimulated by inhaled capsaicin, in order to determine whether they are controlled by the same sensory nerves. Ten volunteers had capsaicin cough dose responses performed before and at 10 min after inhaling placebo (ascorbic acid in saline), and the topical anaesthetics lignocaine 40 mg, and dyclonine 8 and 4 mg. The effect of the drugs on respiratory resistance (Rrs), measured using a forced oscillation technique, was measured both before and after the inhalation of a dose of capsaicin which caused less than two coughs. Lignocaine (40 mg) and dyclonine (8 mg) caused significant reports of oral anaesthesia but only lignocaine reduced the cough response to inhaled capsaicin, increasing the log dose of capsaicin causing three or more coughs by 162%. None of the treatments altered basal Rrs or its increase after inhaled capsaicin. Thus, the cough and reflex bronchoconstriction caused by inhaled capsaicin have different sensitivities to inhaled local anaesthesia, suggesting that the effect may be mediated by different sensory pathways.

Administration, Inhalation↗
PubMed1989

[Pulmonary complication after resection of lung cancer--difficulty in expectoration and cough dynamics].

From January 1975 to December 1986, 415 patients were operated for primary lung cancer. Postoperative pulmonary complications were observed in 83 patients and among them 48 patients (57.8%) suffered from difficulty in expectoration. Postoperative expectoration mostly depends on the ability of coughing. To evaluate cough dynamics, expiratory flow-rate and volume at voluntary maximal cough were measured. The more expiratory flow rate and volume a cough has, the more effective it is for expectoration. In those patients with decreased FEV1.0, or respiratory muscle weakness because of emaciation and aging, or severe pain in the wound, the cough dynamics was decreased. By cleaning retained secretions in the respiratory tract, postoperative pulmonary complications would be prevented. However in cases where the decrease in postoperative cough dynamics is predictable, application of limited resection should be considered as well.

Aged↗
PubMed1989

Cough associated with angiotensin-converting enzyme inhibitors.

Cough is reported by between 0.7% and 14% of patients taking angiotensin-converting enzyme (ACE) inhibitors. There are more reports from women and non-smokers. The development of cough during ACE inhibitor therapy is associated with a reversible increase in the response of the cough reflex. The response remains normal in those who do not develop cough while on ACE inhibitor therapy. Both hypersensitivity of the cough reflex and the symptom of cough are reversed by sulindac which suggests that the abnormal reflex is dependent on cyclo-oxygenase products.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1987

Angiotensin converting enzyme inhibitors and cough.

The relationship between angiotensin converting enzyme inhibitors (ACE inhibitors) and the development of cough was studied in 80 patients. Cough developed in 25 (31%). Seventeen patients had detailed respiratory investigations of whom 12 developed a new cough. Five of the 12 patients had a remission on placebo and recurrence on rechallenge. Cough does occur with ACE inhibitors but there are other possible causes of cough such as asthma, bronchitis, smoking and heart failure. The true incidence of new cough with ACE inhibitors is uncertain at present.

Adult↗
PubMed1987

Graphometric analysis of cough tachogram.

The tachogram shows that the flow of cough is neither continuous nor steady. Within a cough, 5 different phases can be differentiated: 1) acceleration, 2) initial fast decleration, 3) intermediary decleration, 4) terminal fast decleration, and 5) the flow-pause. Only in the course of phases 1) and 3) is the air flowing out from the lungs. In cough series the peak-flows of subsequent coughs are growing smaller and smaller. This decrease follows the form of an isosceles hyperbola. A cough can be short or elongated. From the flow-phases the 1-st, 2-nd and 4-th ones are of fairly stable duration. The wide deviation of the intermediary deceleration shows that this phase makes it possible to elongate voluntarily the cough.

Cough↗
PubMed1987

Spectral analysis of cough sounds recorded with and without a nose clip.

The voluntary cough sounds of healthy volunteers, patients with chronic rhinitis, chronic rhinitis with bronchial asthma and asthma were recorded with and without a nose clip. A gated series of signals of the first cough sound lasting 200 ms was analysed by a system with a 20 ms delay of the first signal. In the case of filtered cough sounds, low-cut digitally, the mean values of averaged spectra of the healthy volunteers showed a first peak around 350 Hz, similar to the expiratory spectra of respiratory sounds. Second and third harmonics were also identified. The mean values of averaged spectra from the patients with airway disease differed significantly in the range of low frequency components. The upper airways work as narrow-band acoustic filters determining the harmonic contents of speech as well as those of cough sounds. To minimize these effects for acoustic analytical purposes, the application of a nose clip is suggested to find the cough harmonics related to those of pulmonary sounds. The voluntary cough sounds contain diagnostic information, but to build up a quantitative, diagnostic, decision-making system, further investigations as well as standardization of recording and analysis are necessary.

Adolescent↗
PubMed1985

Whooping cough and pertussis vaccine: a comparison of risks and benefits in Britain during the period 1968-83.

Since 1975, acceptance of pertussis vaccine has fallen from over 70% to 50% or less in most parts of Britain. This permits evaluation of a continuing natural experiment in which the frequency and severity of whooping cough can be compared those of adverse events following injections of pertussis vaccine. National data show an increase in notifications of whooping cough in most parts of Britain since 1975. Hospital admissions show considerable variation between areas with relatively high rates in some areas of deprivation but very low rates in more affluent areas even where vaccine-acceptance is around 50%. Deaths of infants with whooping cough have decreased steadily since 1900, the rate since 1975 being the lowest ever. Active epidemiological surveillance in Glasgow, with a population of 216,000 children and 13,000 births annually, shows that outbreaks and severe cases requiring admission to hospital were concentrated consistently in a few areas of deprivation. There is a significant correlation between vaccine-acceptance and hospital admission by district of residence but analysis of variance shows this effect to be less than that of overcrowding in households and other deprivation variables. In each of three outbreaks studied prospectively (1974-5, 78-78 and 82) about 30% of cases occurred in children who had received three doses of pertussis vaccine. Such vaccination had a significant protective effect in children aged 1-4 years but not in older children. There was no evidence of a herd immunity sufficient to protect infants below age for vaccination. Admissions to hospital decreased during the period 1970-83. There were no deaths attributable to proven or suspected infections with Bordetella pertussis during the period 1972-1983. No cases of encephalopathy, permanent brain damage or lung damage were detected in a follow up of all cases notified, surveyed or admitted to hospital between 1975 and 1982. Collectively, these national and local data provided estimates of the frequency of infection, complications of infection, admission to hospital and death in children with whooping cough for comparison with local, national and published estimates of the frequency and severity of adverse reactions, encephalopathy, permanent brain damage and death after injections of pertussis vaccine. It is concluded that, in children living in non-deprived circumstances in Britain, the risk of pertussis vaccine during the period 1970-83 exceeded those of whooping cough. In some deprived sectors, the risks from whooping cough might have been marginally higher but there was no evidence that this was associated with any increase in deaths or permanent disabilities.

Adolescent↗
PubMed1979

Effect of experimental hydrothorax on the cough reflex in conscious cats.

The authors induced experimental hydrothorax in cats by injecting dextran into the pleural cavity under brief N2O anaesthesia. They examined the parameters of cough -- elicited by mechanical stimulation of the airway mucosa -- and blood gas and pH values under normal conditions and after the injection of 50, 100, 200 and 250 ml dextran. The tests were always performed 30 min after terminating anaesthesia, i.e. in conscious animals. The free fluid in the thorax was found, in conscious cats, to reduce the inspiratory values of cough, but to have no effect on cough expiration. This is in agreement with previous findings showing that the intensity of a cough expiration does not always depend on the intensity of the preceding cough inspiration. According to this finding, the decrease in the expiratory values of cough observed during experimental pleurisy cannot be due to the actual exudate. In cats, experimental hydrothorax in doses of 200 and 250 ml leads to respiratory insufficiency. The authors further found that, for the study of interoception in the airways of conscious cats, which requires experimental induction of pathological conditions under brief anaesthesia, nitrous oxide is a convenient anesthetic.

Animals↗
PubMed1979

Prevalence and etiology of chronic cough without sputum production in coal miners.

Chronic cough in the sense of the international definition was found in 50.5% of a group of 970 coal-miners at work without pneumoconiosis. In 14.7% of these subjects the cough was without phlegm production. Non productive cough is therefore not a rare event and this symptom may not be neglected in the natural history of chronic bronchitis in coal-miners. The changes in lung function are similar whether the cough is productive or not. In both cases endoscopic and histological features are suggestive of an established chronic inflammatory process. Allergy is not more frequent in subjects with dry cough than in those with productive cough.

Bronchi↗
PubMed1983

[Difference in the effects of antitussive drugs on respiration and cough reflex].

In order to understand the relationship between the cough and respiratory centers in the brain stem, we investigated the effects of antitussive drugs such as codeine, dextromethorphan, eptazocine and fominoben on respiratory movement and the cough reflex. Coughs were induced using electrical stimulation of the central cut end of the right superior laryngeal nerve in lightly anesthetized dogs. The drugs were administered intraarterially into the vertebral artery. Rate (RR), amplitude (RA) and volume (RV) of the respiration and number (NC) and amplitude (AC) of the cough reflex evoked were measured as indices. Codeine produced a decrease in RR, RV and NC at 0.3 mg and, additionally, AC at 1 mg. Dextromethorphan increased RR and RV and rather enhanced NC and AC at 0.3 mg, but the agent reduced NC and AC at 3 mg even if it increased RR and RV. Eptazocine produced decreases in RA, NC and AC at 1 mg, and, additionally, RV at 10 mg. Fominoben increased RR, RA and RV dose-dependently at 0.3-3 mg, although it depressed NC and AC at 3 mg. These findings suggest that the thresholds for the cough responses and respiratory responses to antitussive drugs are different from drug to drug and that the respiratory centers and cough center in the brain stem are affected in a different manner even qualitatively.

Analgesics↗