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PubMed1982

[A quantitative analysis of the phrenic nerve activities during the cough reflex].

The phrenic nerve activity is an appropriate indicator for the output of the respiratory center as a whole, although a quantitative analysis of each of the frequency band components that constitute the neural activities during the respiratory reflex has not yet been made by other investigators. In the present study, we have made a quantitative analysis of each of the frequency band components of phrenic nerve activity during the cough reflex in anesthetized dogs. The efferent activities of the phrenic nerve were recorded from the central cut end of the phrenic nerve. Each fraction of phrenic nerve activity was separated into bands spanning a range of 100 Hz each by a variable filter and analyzed using a program for the power spectrum. The cough reflex was induced by mechanical stimulation of the tracheal mucosa. In the power spectrum analysis of each frequency band, increase in the power of each of the frequency band components was observed during the cough reflex. Particularly, the power of the 2 approximately 100 Hz band components increased significant as compared with the other frequency band components. Such as increase in the power of the 2 approximately 100 Hz band components toward the other frequency band components during the cough reflex was not observed after an i.v. administration of DMPP and lobeline, but the power increased extended over every frequency band. These findings suggest that the process for integrating the cough reflex was different from that of the other respiratory reflexes and that the present method is useful for investigating the central mechanisms of the cough reflex.

Action Potentials↗
PubMed1981

Chronic cough in children: a manifestation of airway hyperreactivity.

Fifteen children who presented with chronic cough as an isolated manifestation of respiratory disease were evaluated for the presence of exercise-induced airway hyperreactivity. Pulmonary function tests using air and a helium/oxygen gas mixture were performed before exercise. Eight subjects were also evaluated by spirometry and maximum expiratory flow volume curves before and after isoproterenol inhalation on a separate day. Ten subjects had normal pulmonary function tests at rest and five had isolated minor abnormalities. No significant changes in pulmonary function tests were recorded after inhalation of isoproterenol in the eight subjects studied. Following exercise, all 15 subjects demonstrated changes in pulmonary function tests which were similar to those seen in children with mild exercise-induced bronchospasm. After institution of theophylline, exercise-induced decreases in flow rates low in the vital capacity were blocked in all subjects; however, several subjects had persistent mild decreases in peak flow. Within six months of discontinuing the theophylline, cough recurred in 11 of the 15 subjects. Nine subjects were restudied after return of their cough. Exercise again resulted in decreased lung function. Reinstitution of theophylline eliminated the cough in these nine subjects. This study demonstrates that chronic cough in some children may be a manifestation of airway hyperreactivity. Both the cough and the reactivity can be blocked with theophylline.

Adolescent↗
PubMed1995

[Neural control of tracheal smooth muscle during cough].

Contraction of tracheal smooth muscle during mechanically induced coughing was studied in dogs. Recordings of smooth muscle tension were obtained from the cervical trachea, which is not influenced by intrathoracic pressure. We observed that during breathing at rest, tracheal smooth muscle contracts and relaxes in synchrony with phrenic nerve activity. When cough occurs, the tracheal smooth muscle contracts continuously and tonically with no rhythmic correlation to phrenic nerve activity. Sometimes the contraction starts before the phrenic nerve activity increases. A neuromuscular blocking agent caused a significant decrease in phrenic nerve activity in response to mechanical stimulation. The correlation between phrenic nerve activity and tracheal smooth muscle tension during normal breathing was also observed after afferent inputs from pulmonary mechanoreceptors were interrupted. During coughing, however, this correlation was lost. From these results we conclude that the neural control of tracheal smooth muscle is at least partially independent of phrenic nerve activity during coughing. Because coughing was attenuated by neuromuscular blocking agents, we speculate that there is a positive feedback mechanism from receptors in the chest wall or airway, which increases the magnitude of coughing.

Animals↗
PubMed1993

Clinical trial of the efficacy and safety of moguisteine in patients with cough associated with chronic respiratory diseases.

This completely randomised, double-blind, placebo-controlled, multicentre trial was carried out to evaluate the antitussive activity and safety of a 200 mg t.i.d. regimen of moguisteine (20 mg/ml ready-to-use suspension) during four days in patients with cough associated to chronic respiratory disorders. A total of 87 patients were enrolled, 42 on moguisteine and 45 on placebo. All had persistent dry or slightly productive coughs associated with chronic respiratory disorders. Seventy three were submitted to per protocol efficacy analyses, and eighty-three to intention-to-treat efficacy analyses. All the patients who were administered the study drug were analysed for safety. The underlying disorders reported as being associated with the target symptom were chronic obstructive pulmonary disease, cough of unknown aetiology, respiratory tract malignant neoplasms and pulmonary fibrosis. The treatment groups appeared to have been homogeneous on admission. The number of coughs in the interval 8-10 a.m. on day four vs day one was reduced by 42% on moguisteine against 14% on placebo; the difference between treatments was statistically significant (p = 0.028). The mean percent reduction of ladder scale scores of cough frequency vs baseline was greater on moguisteine than on placebo both in the day-time (especially on days one and two), and at night. The antitussive activity of moguisteine did not show remarkable variations either by diagnosis or by type of cough (dry/slightly productive). No serious adverse events were reported. No changes/trends were identified in laboratory tests that might indicate functional or toxic effects of moguisteine on specific organs.

Adult↗
PubMed1993

Effects of bronchoconstriction on the cough reflex in the cat.

The present study was aimed to analyse the influence of bronchoconstriction (Carbachol, 10 micrograms/kg, i.v.) on the cough response to mechanical stimulation of the tracheal mucosa. Experiments were performed in anaesthetised and spontaneously breathing cats, using the isolated glottis technique. Airflow, pleural pressure, subglottic pressure, blood pressure and total lung resistance were recorded. During bronchoconstriction, the cough response was inhibited significantly as shown by the decrease in the number of cough efforts (p < 0.001), in maximum flow during inspiratory (p < 0.001) and expiratory (p < 0.001) movements and in the change of the expiratory (p < 0.01) and inspiratory (p < 0.01) pleural pressures. The mechanical stimulation of the tracheal mucosa evoked always a prolonged decrease of the larynx resistance, including those cases with inhibition of the cough. This study shows that the activation of some type of receptors during bronchoconstriction can modify the cough response to mechanical stimulation of the tracheal mucosa. On the other hand, the widening of the glottis, an associated component of the cough response, can be obtained separately, suggesting that the laryngeal response is centrally integrated via different mechanisms.

Airway Resistance↗
PubMed1995

Enzootic pneumonia: comparison of cough and lung lesions as predictors of weight gain in swine.

A prospective cohort study was undertaken in a commercial swine herd to determine the relationship between weight gain and the occurrence of enzootic pneumonia (EP). Estimates of the association between EP and weight gain were obtained from multiple linear regression models, using coughing episodes or slaughter checks as indicators of EP status. Models were estimated for pigs in 2 different age groups: roasters (n = 1084, sold at 32 to 50 kg) and market hogs (n = 1162, sold at 100 to 110 kg). The relationship between presence of lung lesions at slaughter and previous coughing episodes was also investigated. Throughout the study period, clinical evaluations were performed weekly, and coughing episodes recorded for each pig. Lungs were inspected at slaughter, and scores were expressed as the percentage of the lung with gross pneumonic lesions. Coughing and lung scores were significantly correlated, after adjusting for other covariates (R = 0.32 and 0.59, respectively, for market hogs and roasters). However, the agreement beyond chance between coughing history and lung lesions at slaughter was poor among both roasters and market hogs (kappa = 0.17 and 0.07, respectively). Although very specific, weekly assessment of coughing was not a sensitive indicator of lung lesions at slaughter. In multiple regression, lung score was a highly significant predictor of lower final weight in pigs of both age groups (P < 0.001 in the selected regression models).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1996

[Chronic persistent cough in general practice: diagnosis and therapy in 329 patients over the course of 2 years].

Chronic Cough: Chronic persistent cough (CPC) lasting from several months to years - without radiographic or spirometric evidence of its cause - was a surprisingly frequent reason (5,7% of all new referrals) to consult our practice. Sophisticated diagnostic evaluation and therapeutic regimen are necessary. We performed a prospective study on 329 consecutive patients (106 male, 223 female) over a two-year period. 65% of the patients had cough as a consequence of bronchial hyperresponsiveness; 27% due to upper airways disease, i.e. often very common rhinitis or pharyngitis; 14% chronic bronchitis; 5% gastrooesophageal reflux (GER); 3% drug induced cough; 4% other causes. 10% of the patients discontinued the diagnostic evaluation prematurely. In 14% the cause for CPC remained unclear and no relief could be achieved. Furthermore, there is a need for consecutive studies to address the following questions: 1. The cause of the striking difference in gender (male : female = 1 : 2) remains unclear. 2. Wether a cough recorder - as occasionally reported in the literature - is needed for an objective evaluation of cough [9]. 3. A standardised methodology of 24 h pH monitoring for the diagnosis of CPC as a consequence of GER has yet to be established.

Adolescent↗
PubMed1996

[Iatrogenic drug-induced bronchospasm, cough, and bronchiolitis. Etiologic and physiopathologic aspects].

Iatrogenic respiratory disorders include bronchic manifestations (asthma, bronchospasm, cough) and bronchiolar manifestations (constrictive or proliferative bronchiolitis). Many pharmacologic agents can induce a bronchospasm. The bronchospasm induced by acetylsalicylic acid and nonsteroidal anti-inflammatory agents, often severe, is mediated by the inhibition of the cyclooxygenase enzyme; it can be prevented by eviction of the drug or desensitization. Leukotriene receptor antagonists and 5-lipoxygenase inhibitors may also be useful. Beta-blockers including cardioselective beta-blockers, cholinergic agonists, inhaled agents, angiotensin-converting enzyme inhibitors (ACE), vindesine, histamine liberators, etc..., can also induce a bronchospasm. Most of the same agents can also induce an isolated cough, particularly beta-blockers, inhaled agents, and ACE, which cause 75% of the reported cases of iatrogenic cough. ACE-induced cough usually disappears within 1 to 4 days after withdrawal of the treatment, confirming the diagnosis; ACE-induced cough may be prevented by sodium cromoglycate. The risk of obliterans bronchiolitis with expiratory airflow impairment during rheumatoid arthritis is increased by D-penicillamine. Many drugs can be involved in the pathogenesis of bronchiolitis obliterans organizing pneumonia, which presents with various clinical and radiological aspects. The physician has to keep in mind that bronchospasm, cough, or bronchiolitis of unknown origin, may have a iatrogenic cause.

Bronchial Spasm↗
PubMed1996

Sensory neurophysiology of the cough reflex.

The epithelium of the larynx, trachea, and larger bronchi contains sensory nerves that are responsible for cough. Their two main categories are rapidly adapting receptors (RARs) and C fiber receptors. Both types respond to a wide variety of mechanical and chemical irritants. The RARs are the main sensory complex responsible for cough. C fiber receptors cause neurogenic inflammation by the release of tachykinins such as substance P. The reflex action of C fiber receptors seems to be inhibition of cough. However, the released tachykinins can stimulate RARs and promote or enhance the cough response. The strength and pattern of cough depends on the sites of the airway that are stimulated and the local and central reflex interactions of the RARs and C fiber receptors. Tachykinins seem to be involved in cough, but their role needs further study.

Afferent Pathways↗
PubMed1996

Ability of caregivers to recognise signs of pneumonia in coughing children aged below five years.

OBJECTIVES: This survey was carried out to determine: 1. The ability of caregivers to recognise signs of pneumonia in children aged below five years who are coughing. 2. The proportion of caregivers who possess a watch and are able to use that watch to count respiratory rates in children. 3. The home remedies used for cough. DESIGN: A cross sectional study. SETTING: Three Primary Health Care Clinics and a tertiary level hospital in Harare. MATERIALS AND METHODS: 413 children aged less than five years attending a health care centre for cough were studied. Socio-demographic and personal characteristics of both mother and child were documented. An inventory of home remedies that were being used since onset of cough was taken. The child was also examined for signs of pneumonia by both caregiver and research nurse. The sensitivity and specificity of the caregiver's ability to recognise signs of pneumonia compared to the research nurse was calculated. RESULTS: The ability of caregivers to recognise signs of pneumonia was high (sensitivity 95pc for hospitalized cases and 85pc for the clinic cases). Sensitivity tended to drop with increase in child's age. The caregiver's ability to recognise signs of pneumonia was not significantly related to the number of children she had or her level of education. Only 19.5pc of caregivers owned a watch and could use a watch to count respiratory rates correctly. Those who owned a watch were more likely to count respiratory rates correctly. Those who claimed ability to use a watch actually counted respiratory rates correctly. Sixty six pc had used some remedy to treat the cough at home. CONCLUSIONS: Caregivers were able to recognise signs of pneumonia without a watch. Only a small proportion of caregivers own watches and are able to use them correctly to count respiratory rates. National ARI control programmes should emphasize caregivers observing breathing when a child has a cough and encourage seeking early and appropriate health care when pneumonia is detected. Watches or timers should be made available and be recommended for use by trained health workers in health centres only. Use of potentially harmful remedies should be discouraged.

Adult↗
PubMed1997

Cromolyn sodium for ACE inhibitor-induced cough.

There are several theories on the cause of ACE inhibitor-induced cough, but the exact mechanism is not known. In many patients, if cough develops, the ACE inhibitor can be discontinued and a drug in another therapeutic class used in its place. However, in patients with CHF, diabetic nephropathy, and patients who have experienced a myocardial infarction, discontinuing the ACE inhibitor may not be in the best interest of the patient. In this patient population it would be reasonable to try cromolyn sodium to treat cough, while continuing the ACE inhibitor. Data are not available to support the efficacy of cromolyn sodium to treat cough in patients with diabetic nephropathy, but these patients clearly benefit from the use of an ACE inhibitor. Other factors not addressed in the case reports and the clinical trial such as patient adherence, cost, and quality of life should also play a role in the decision to use cromolyn sodium. Cromolyn sodium has been effective for the treatment of ACE inhibitor-induced cough in many case reports and has had mild success in one small clinical trial. Although none of the reports adequately assessed adverse effects, studies examining cromolyn for other indications have demonstrated a relatively benign adverse effect profile. It is difficult to recommend an exact dose to use because of the dosing variability in the case reports. The majority of the case reports and the one clinical trial used dosages similar to recommendations for bronchial asthma (i.e., 2 puffs [1.6 mg] 4 times daily via MDI or 20-mg capsules 4 times daily via breath-activated inhalation). At this time, the use of cromolyn sodium is a viable option, but more controlled studies are needed to fully elucidate its role in the treatment of ACE inhibitor-induced cough.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

[Herbal polysaccharides in the treatment of coughs].

BACKGROUND: Because of serious adverse effects of centrally acting antitussive agents, is necessary to find new drugs with cough-suppressing activity. Medicinal herbs are a potential source of polysaccharides with high antitussive efficiency and on the other with minimal side effects. AIM: The study was to assess the antitussive action of mixture of a polysaccharides (RL) and polysaccharide-xylan (XY), both isolated from above-ground parts of Rudbeckie fulgida var. sullivantii. The observed activity was compared to those of narcotic and nonnarcotic antitussive substances used in clinical practice. METHODS: Cough was evoked by mechanical irritation of the airways in nonanaesthetized cats with chronic tracheal cannuly. The plant substances were administered perorally in the dose of 50 mg per kg body weight. RESULTS: Results indicate, that administration of RL induced a suppression of the followed cough parameters from both areas of airways (total fall in cough parameters by 46.6%). Administration of xylan induced the fall in the followed cough parameters with more significant influence on the laryngopharyngeal area of the airways (total fall in cough parameters 48.2%). CONCLUSION: Administration of RL and xylan did not achieve the effect of codeine, but had a more intensive antitussive effect than the peripherally acting droprozine and prenoxdiazine. (Fig. 3, Ref. 11.)

Animals↗
PubMed1997

[Respiratory symptoms and cough reflex in populations exposed to different degrees of environmental pollution].

BACKGROUND: Santiago is a city with a high degree of environmental pollution caused by particulate matter and ozone, producing adverse effects in the respiratory system. AIM: To compare respiratory symptoms and cough reflex in adults from Santiago and from a rural area with low levels of environmental pollution. SUBJECTS AND METHODS: One hundred twenty six non-smoker adults from Santiago and 116 from a rural area with low levels of pollution answered a respiratory symptom questionnaire. Of these 101 subjects from Santiago and 116 from the rural area inhaled doubling concentrations of capsaicin from 0.5 to 500 microM or until five coughs were elicited. The lowest concentration eliciting 2 or more coughs (CD2) or 5 or more coughs (CD5) was recorded. Levels of environmental particulate matter were also recorded in both locations. RESULTS: Levels of particulate matter were 102 +/- 41 and 64 +/- 24 micrograms/m3 in Santiago and the rural area respectively. People from Santiago had higher rates of throat clearing, cough and phlegm. CD2 geometric mean and confidence limits in Santiago and the rural area were 6.9 (5.2-7.4) and 2.8 (2.7-2.9) respectively (p < 0.001). No differences in CD5 were observed between both locations. Multivariate analysis disclosed the variable location (city) as the only independent predictor of respiratory symptoms. CONCLUSIONS: The increased CD2 found in Santiago suggests that the higher rates of respiratory symptoms related to air pollution can be associated to a decreased sensitivity of the cough reflex.

Adolescent↗
PubMed1998

Which cough mixture?

BACKGROUND: Coughing is a defence mechanism to clear the airways but if it becomes ineffective, excessive or persistent it may cause fatigue and impair body function as well as create social problems for the patient. OBJECTIVE: Numerous preparations are available for the alleviation of cough, many containing multiple ingredients including antitussives, expectorants, mucolytics and decongestants. Their modes of action are examined and evidence for their usefulness in treating various types of cough evaluated. DISCUSSION: The use of various preparations in non-productive cough, drug induced cough and productive cough are discussed.

Antitussive Agents↗
PubMed1998

Cough-induced leak-point pressure--a valid measure for assessing treatment in women with stress incontinence.

BACKGROUND: Presently available urodynamic methods are of little use for assessing the severity of urinary stress incontinence or for evaluating of treatment, Cough-induced leak-point pressure may prove to be a more useful urodynamic method in these respects. A vaginal anti-incontinence device was used to validate this new urodynamic method. AIM: The primary aim was to determine the extent to which cough-induced leak-point pressure was affected by the vaginal device. Secondary aims were to study the short-term effects of the vaginal device on leakage and urinary flow, and to relate the change in cough-induced leak-point pressure to the change in leakage as expressed by a short-term pad test. METHODS: In a prospective study of 22 women with a history of stress incontinence, the effect of a new vaginal anti-incontinence device (Conveen Continence Guard) on cough-induced leak-point pressure, a short-term pad test and urinary flow was studied. RESULTS: Cough-induced leak-point pressure increased from 99.9 to 138.9 cm H2O, while leakage, measured by a short-term pad test, decreased from 22.7 to 3.3 g when using the device. Urinary flow was not significantly reduced by the device. CONCLUSIONS: Cough-induced leak-point pressure is a valid, quantitative, dynamic measure of urethral closure function which can be used to study the effects of treatment in patients with stress incontinence. The vaginal device is effective for treatment of stress incontinence in the short-term, without reducing urinary flow.

Adult↗
PubMed1998

Responses to acellular pertussis vaccines and component antigens in a coughing-rat model of pertussis.

Two acellular pertussis vaccines (SmithKline Beecham 3-component and Connaught 5-component), and a whole-cell pertussis vaccine (Evans), were similarly protective against paroxysmal coughing and leukocytosis in a coughing-rat model of pertussis. A two-dose immunization schedule was followed by sublethal intrabronchial challenge with Bordetella pertussis strain 18-323, encased in fine agarose beads, and the coughing monitored by sound-activated tape recorders. Pertussis toxoid by itself gave some protection against coughing, but lower than that afforded by the vaccines, despite inducing a higher serum anti-PT titre. The other component antigens, given individually, failed to protect against coughing although inducing antibodies. Immunization with the whole-cell and acellular vaccines and with their component antigens, as well as challenge with B. pertussis, caused significant elevation of total serum IgE antibodies. Antigen-specific IgG and IgA were detected in tracheobronchial washings from rats recovering from B. pertussis challenge, but vaccination prior to challenge had little influence on these antibody levels. The coughing-rat model of pertussis may be useful for the comparative testing of different formulations of pertussis vaccines before trials in human infants.

Animals↗
PubMed2006

Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients.

STUDY DESIGN: Prospective single centre study. OBJECTIVES: Pulmonary rehabilitation focuses on improving the expiratory muscle function in order to increase the reduced cough capacity in patients with cervical spinal cord injuries (SCI). However, an improvement in the inspiratory function is also important for coughing effectively. Therefore, this study was to examine the significance of the inspiratory muscle strength on the cough capacity in the patients with a cervical SCI. SETTING: SCI unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: The vital capacity (VC), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured. Moreover, the unassisted peak cough flow (PCF) and assisted PCF under three conditions were evaluated. RESULTS: All three assisted cough methods showed a significantly higher value than the unassisted method (P < 0.001). The VC correlated with the voluntary cough capacity and the MIP (R = 0.749) correlated more significantly with the VC than the MEP (R = 0.438) (P < 0.01). The MIP showed a higher correlation with both the unassisted PCF and all three assisted PCFs than the MEP (P < 0.001). CONCLUSIONS: The management of the inspiratory muscle strength should be considered in the pulmonary rehabilitation at cervical SCI patients.

Adult↗
PubMed2005

Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme.

BACKGROUND AND OBJECTIVES: Changes in the symptoms of cough after treatment with a combined herbal preparation containing dry ivy leaf extract as main active ingredient, decoction of thyme and aniseed, and mucilage of marshmallow root (Weleda Hustenelixier, new formulation) and its tolerability were investigated in an open clinical trial ('Anwendungsbeleg'). PATIENTS AND METHODS: Between January and March 2004, 13 general practitioners recruited and treated 62 patients with a mean age of 50 years (range 16-89). The patients had irritating cough in consequence of common cold (n = 29), bronchitis (n = 20) or respiratory tract diseases with formation of viscous mucus (n = 15). The mean daily intake was 10 ml (range 7.5-15) of syrup, and the mean duration of treatment was 12 days (range 3-23 days). Treatment results were assessed on the basis of changes in the symptom scores for cough and expectoration. Safety was evaluated by means of an analysis of adverse events. In addition, efficacy and tolerability were analyzed from the judgments of the doctors and patients. RESULTS: At the final visit, all symptom scores showed an improvement as compared to baseline. Doctors and patients assessed efficacy as good or very good in 86% and 90% of the cases, respectively. Tolerability was assessed as good or very good by 97% of the doctors and patients. Only one adverse event was reported. However, a relation to the medication was classified to be unlikely. CONCLUSION: Considering the traditional use of ivy leaves, thyme herb, aniseed and marshmallow root in preparations for cough, the reduction in the symptom score as well as the good tolerability the investigated combined herbal cough syrup seems to alleviate cough in consequence of common cold, bronchitis or respiratory tract diseases with formation of mucus.

Adolescent↗