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At least 1,099 records · Page 61Linked to original sources
PubMed2001

Capsaicin cough sensitivity is decreased in smokers.

Although capsaicin provocation has been used to evaluate treatment against cough, which is one of the most common respiratory symptoms, there are still methodological considerations that are not fully known. Capsaicin stimulates the unmyelinated slow C-fibres of the sensory nervous system, which leads to coughing. Smoking often leads to respiratory symptoms with cough and phlegm. The aim of this study was to examine the effect of smoking on capsaicin provocation. Subjectively healthy smokers and non-smokers were challenged with capsaicin in increasing doses. The coughs were counted and irritation of the lower airways was graded on a symptom score. Smokers reacted to provocation with significantly fewer coughs, but there was no difference regarding other symptoms. These results are in agreement with the hypothesis that nicotine inhibits or blocks C-fibres of the sensory nervous system of the lower respiratory tract. Clinically, this may serve to explain increasing airway symptoms that are often seen after cessation of smoking.

Adolescent↗
PubMed1998

Cough induced stress fracture and arthropathy of the ribs at extreme altitude.

Cough and chest wall pain at high altitude have only received passing mention in the medical literature. Increased minute ventilation of cold dry air at very high altitude is likely to cause airway irritation. This in turn may result in airway drying, mucus production, postnasal drip from vasomotor rhinitis, and bronchospasm acting individually or in combination to stimulate the vagal cough reflex. The cough is exacerbated further at extreme altitudes above 5500 m, and may result in intercostal muscle strain and single or multiple rib fractures. We present a case of multiple cough induced stress fractures and arthropathy documented by technetium-99 bone scan in a high altitude climber and suggest the addition of the term High Altitude Cough Syndrome (HACS) to the medical syntax to identify this discrete medical problem of exposure to very high altitude.

Adult↗
PubMed2002

Cough and paradoxical vocal fold motion.

OBJECTIVES: The differential diagnosis and treatment of patients with chronic cough, paradoxical vocal fold motion, and disordered breathing can be a challenge to most practicing otolaryngologists. Tracheobronchial (ie, asthma, bronchitis, and tracheal stenosis), laryngeal (ie, vocal fold paralysis and neoplasms), and rhinologic (ie, allergies and rhinosinusitis) etiologies are commonly diagnosed and treated effectively. However, occasionally one is faced with patients who are refractory to medical treatment and have no obvious rhinologic, laryngeal or pulmonary cause. STUDY DESIGN AND SETTING: We conducted a review of the literature. METHODS: We present a thorough review of the current medical literature exploring the complex neurologic mechanisms involved in the production of cough and the relationship between gastroesophageal reflux disease, vagal neurapathy, and paradoxical vocal fold motion. RESULTS: The diagnosis and successful treatment of chronic cough can be complex. It requires a thorough understanding of the neurologic mechanisms behind cough excitation and suppression. Successful treatment strategies include aggressive management of the patient's reactive airway disease, gastroesophageal reflux disease, and, in select cases, paradoxical vocal fold motion. This may involve a well-coordinated effort among pulmonologists, otolaryngologists, gastroenterologists, and speech pathologists. CONCLUSION: Gastroesophageal reflux disease, vagal neuropathy, and paradoxical vocal fold motion are additional causes of chronic cough and disordered breathing that need to be considered, in the absence of obvious laryngotracheal and/or rhinologic pathology. A high index of suspicion is essential in making the diagnosis and formulating an effective multidisciplinary treatment plan for these patients.

Chronic Disease↗
PubMed2006

Sinus CT scan findings in patients with chronic cough following sulfur mustard inhalation: a case-control study.

Sinusitis is one of the most common causes of chronic cough, which is the most common manifestation among patients exposed to sulfur mustard (SM). We conducted our study on exposed victims to SM with chronic cough for evaluation of probable sinus abnormality. In a case-control study, among referred patients for evaluation of persistent chronic cough, 39 patients with previous and 35 patients without previous history of exposure to SM underwent paranasal sinus computed tomography (CT) scans (Somatom CR CT scanner) in coronal planes. A well-designed standard pro forma was used for reporting sinus CT abnormalities. Data was analyzed with chi-square and Fisher exact test. Except one, all obtained CT scans findings showed some abnormalities. Mucosal abnormality was detected in 30 chemical-exposed cases (CEs) (76.9%), and 8 cases were categorized as severe types. In general, mucosal thickening in right (left) frontal, sphenoid, and maxillary sinus were observed in 12.8% (7.7), 5.1% (7.7), and 25.6% (30.8) of CEs, respectively; these proportions were 11.4% (11.4), 2.9% (2.9), and 45.6% (60) in non-chemical-exposed cases (NEs), respectively. Air fluid level in the right (left) frontal sinus was 10.3% (7.7) and in the right (left) maxillary sinus was 10.3% (15.4) in CEs; it was 2.9%(0) and 20%(20) in NEs for these locations, respectively. There were no statistically significant differences between findings of two groups (p > .05). Also, comparison of related data to osteomeatal complex obstruction, bulla ethmoidalis, haller cell, agger nasi, and pneumatized crista galli were not significant (p > .05). Thus; various types of sinus abnormalities were highly prevalent in both CEs and NEs with chronic cough and there was no specific pattern. Consequently, current approaches to chronic cough just based on conventional etiologies in this setting can lead to delay in diagnosis and mismanagement.

Adolescent↗
PubMed2003

Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks.

AIMS: Good general lay knowledge of tuberculosis (TB), its cause and treatment is considered important for both prompt healthcare seeking and adherence to treatment. The main aim of this study was to describe the knowledge of TB among med and women with a cough for more than three weeks and to see how their health seeking related to TB knowledge. METHODS: A population-based survey was carried out within a demographic surveillance site in Vietnam. The study population included 35,832 adults aged 15 years or over. Cough cases were identified at household level and structures interviews were carried out with all cases of cough in person. RESULTS: A total of 559 people (1.6%) reported coughing with a duration of three weeks or longer (259 men and 300 women). A large proportion of individuals with a cough for more than three weeks had limited knowledge of the causes, transmission modes, symptoms, and curability of TB. Men had a significantly higher knowledge score than women (3.04 vs 2.55). Better knowledge was significantly related to seeking healthcare and seeking hospital care. More men than women did not take any health care action at all. DISCUSSION: Health education for TB thus seems to be useful, but efforts must be made to ensure that both men and women in different socioeconomic contexts can access the information.

Adolescent↗
PubMed1999

Bordetella pertussis and chronic cough in adults.

To evaluate Bordetella pertussis as a cause of persistent cough in adults, we examined 201 patients who had a cough for 2-12 weeks and no pulmonary disease. We obtained the following at presentation: medical history, chest radiograph, respiratory function measurement, nasopharyngeal aspirate for polymerase chain reaction (PCR), nasopharyngeal swab specimen for culture, and a blood sample (acute serum). Four weeks later a second blood sample (convalescent serum) was obtained. Control sera were obtained from 164 age-matched healthy blood donors with no history of cough during the previous 12 weeks. Four patients were B. pertussis culture-positive; 11 (including the culture-positive patients) were B. pertussis PCR-positive; and 33, including 10 of the 11 PCR-positive patients, had serological evidence of recent B. pertussis infection. Pertussis-positive and -negative patients could not be discriminated by a history of cough. We conclude that B. pertussis infection is a common cause of persistent cough in adults. This is of concern, because these patients may be B. pertussis reservoirs from which transmission may occur to infants, in whom the disease can be devastating.

Adolescent↗
PubMed2005

A comparison of risk factors for wheeze and recurrent cough in preschool children.

In a study of 2,978 Danish children aged 5 years from two suburban counties of Copenhagen, carried out in 1998, the authors compared risk factor profiles for wheeze and recurrent cough without wheeze by using polytomous logistic regression to clarify whether the two conditions are likely to have the same etiology. Data were obtained 1) by a mailed parental questionnaire (International Study of Asthma and Allergies in Childhood questions and supplementary questions on cough, sociodemography, perinatal factors, and environmental exposure); 2) through general practitioners (familial allergic disease); and 3) from the National Medical Birth Register (birth weight). Wheeze (WH) was defined as more than one episode of wheeze within the last 12 months (irrespective of cough status) and recurrent cough without WH (RC) as cough occurring outside colds and usually lasting for periods of more than 1 week in children with no more than one attack of wheeze within the last 12 months. Risk factors for comparison were selected as those that, after repeated stepwise logistic regression, remained significant for children with WH or RC. Significant differences were found for gender (p = 0.003), gestational age (p = 0.0002), maternal history of asthma (p = 0.0008), and standard of housing condition (p = 0.04)-all risk factors for WH but not RC. Results may suggest that the two conditions have different etiologies.

Child, Preschool↗
PubMed1989

Cough associated with angiotensin converting enzyme inhibition.

The therapeutic inhibition of angiotensin converting enzyme (ACE) is associated with the production of a dry cough, which occurs more commonly in women than men and appears to be unrelated to concurrent illness. At present the exact incidence of ACE inhibitor cough and the substrate of ACE responsible for this effect is unknown. Cough challenge by inhalation of aerosols of tussive agents such as citric acid and capsaicin may be used to study the effect of drug administration on the cough reflex. In normal subjects, an oral dose of captopril (25 mg) causes a significant shift in the dose-response curve to capsaicin inhalation, but not that to distilled water or citric acid. The exacerbation of artificially induced cough by ACE inhibition may be the result of a local increase in perineuronal substance P or bradykinin concentrations within the lung.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2003

Electrophysiologic latency to the external obliques of the laryngeal cough expiration reflex in humans.

OBJECTIVE: The purpose of this study was to trigger the laryngeal cough expiration reflex using inhaled tartaric acid aerosol and to record the latency between the time of initiation of the laryngeal cough expiration reflex component of the laryngeal cough reflex and the onset of electromyographically recorded responses in the external abdominal oblique in humans. DESIGN: Five male subjects were tested in the seated position, and four latencies were recorded for each subject. The latencies were recorded from laryngeal stimulation to an electromyogram in the muscle belly of the left external abdominal oblique. The time line was activated by a microswitch attached to a breath-activated nebulizer. Data were analyzed using SPSS for mean latency and standard deviation. RESULTS: The mean (standard deviation) latency to the external abdominal oblique muscle was 17.6 +/- 10.6 msec. No adverse events to inhalation were reported. CONCLUSION: SIn humans, nebulized tartaric acid stimulates primarily rapid adapting receptors in the supraglottic larynx rather than C-fiber receptors. This receptor location in humans evolved neurologically to protect the airway during speech and swallowing, making the laryngeal cough expiration reflex an inseparable component of the laryngeal cough reflex, thus making it clinically significant when assessing airway protection.

Abdominal Muscles↗
PubMed2003

Chlamydia pneumoniae infection in adult patients with persistent cough.

Chlamydia pneumoniae is a frequent causative agent of acute respiratory disease. To assess whether C. pneumoniae plays a role in persistent cough, the prevalence of C. pneumoniae infection in adult patients with persistent cough was investigated. Nasopharyngeal swabs and serology samples from 366 adult patients with a persistent cough lasting in excess of 2 weeks and 106 control subjects were analysed for bacterial isolation and by PCR. C. pneumoniae was isolated from two patients and from none of the controls and was detected by PCR in 20 patients and one control. Serological evidence of acute C. pneumoniae infection was present in 24 patients but in none of the controls. Of these 20 patients who were positive by culture and/or PCR, three were still positive by PCR after 2 weeks of treatment with clarithromycin and symptoms either continued or relapsed. However, when patients were treated with clarithromycin for 5-6 weeks, their symptoms disappeared completely and the results of their cultures and/or PCR for C. pneumoniae became negative. These data suggest that C. pneumoniae infection may cause persistent cough in adults. Furthermore, these data also indicate that it may be necessary to eradicate the organism when C. pneumoniae is detected by culture and/or PCR in patients with persistent cough.

Adolescent↗
PubMed1995

Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study.

1. We report a controlled retrospective cohort study of respiratory adverse reactions to ACE inhibitors. Bronchospasm and cough occurred at a higher rate in patients treated with ACE inhibitors, no links with sex, past history of bronchospasm, drug type or dose were found. 2. Cohorts of 1013 patients on angiotensin converting enzyme (ACE) inhibitors and 1017 patients on lipid lowering drugs (LLDs) were compared for the occurrence of new bronchospasm, relapse of previous bronchospasm, increase of current bronchospasm, and cough. 3. The prevalence of bronchospasm was 5.5% for patients on ACE inhibitors and 2.3% for patients on LLDs, P < 0.001. The relative risk of a bronchospasm adverse reaction for a patient on an ACE inhibitor compared with a patient on a LLD was 2.39, 95% confidence interval 1.47 to 3.90. 4. No ACE inhibitor specificity, or significant sex differences were found in the prevalence of bronchospasm or cough after correcting for bias implicit in the original cohorts. The bronchospastic reactions were not dose dependent. 5. The prevalence of a past history of bronchospasm in patients reporting ACE inhibitor-induced bronchospasm (16%) was not significantly different from the prevalence in patients on ACE inhibitors without an adverse reaction (13%), P = 0.447. 6. The prevalence of ACE inhibitor cohort cough was 12.3% and 2.7% in the patients on LLDs, P < 0.0001. Cough did not occur more commonly in patients on ACE inhibitors who had experienced any bronchospasm (28%) than in patients on LLDs with bronchospasm (27%).

Aged↗
PubMed2000

Functional connectivity among ventrolateral medullary respiratory neurones and responses during fictive cough in the cat.

This study tested predictions from a network model of ventrolateral medullary respiratory neurone interactions for the generation of the cough motor pattern observed in inspiratory and expiratory pump muscles. Data were from 34 mid-collicularly decerebrated, paralysed, artificially ventilated cats. Cough-like patterns (fictive cough) in efferent phrenic and lumbar nerve activities were elicited by mechanical stimulation of the intrathoracic trachea. Neurones in the ventral respiratory group, including the Botzinger and pre-Botzinger complexes, were monitored simultaneously with microelectrode arrays. Spike trains were analysed for evidence of functional connectivity and responses during fictive cough with cycle-triggered histograms, autocorrelograms, cross-correlograms, and spike-triggered averages of phrenic and recurrent laryngeal nerve activities. Significant cross-correlogram features were detected in 151 of 1988 pairs of respiratory modulated neurones. There were 59 central peaks, 5 central troughs, 11 offset peaks and 2 offset troughs among inspiratory neurone pairs. Among expiratory neurones there were 23 central peaks, 8 offset peaks and 4 offset troughs. Correlations between inspiratory and expiratory neurones included 20 central peaks, 10 central troughs and 9 offset troughs. Spike-triggered averages of phrenic motoneurone activity had 51 offset peaks and 5 offset troughs. The concurrent responses and multiple short time scale correlations support parallel and serial network interactions proposed in our model for the generation of the cough motor pattern in the respiratory pump muscles. Inferred associations included the following. (a) Excitation of augmenting inspiratory (I-Aug) neurones and phrenic motoneurones by I-Aug neurones. (b) Inhibition of augmenting expiratory (E-Aug) neurones by decrementing inspiratory (I-Dec) neurones. (c) Inhibition of I-Aug, I-Dec and E-Aug neurones by E-Dec neurones. (d) Inhibition of I-Aug and I-Dec neurones and phrenic motoneurones by E-Aug neurones. The data also confirm previous results and support hypotheses in current network models for the generation of the eupnoeic pattern.

Action Potentials↗
PubMed1989

Cough syncope caused by sinus arrest in a patient with sick sinus syndrome.

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. This paper presents a case of 63-year-old man with recurrent dizziness and syncope. The 24-hour ambulatory electrocardiogram and intracardiac electrogram showed sinus node dysfunction with sinus arrest, both spontaneous and inducible by voluntary cough. Sinus arrest was sometimes associated with dizziness. A permanent VVI pacemaker was implanted and no further cough syncope has occurred. We suggest that sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome.

Cough↗
PubMedDate not supplied

Respiratory illness in children: do deprived children have worse coughs?

Parents of a stratified random sample of 234 children from 21 general practices in North East England were interviewed at home. All these children had been reported in a postal questionnaire as having had a cough between six and ten weeks before the interview. Interviews covered social characteristics of the family, the severity of the child's cough and the reactions of the parents to hypothetical sets of symptoms. The parents of children in materially deprived circumstances appeared to report worse coughs than other parents. We confirmed this finding by constructing a scale of perceived cough severity. However, we found no evidence that the inequality was due to exaggeration of the severity of the cough by materially deprived parents. Our conclusion that materially deprived children suffer worse respiratory illness is the more important because previous evidence suggests that the after-effects persist into adulthood.

Child↗
PubMed1991

Effect of controlled release salbutamol on nocturnal cough in asthma.

Sixteen asthmatic children completed a double blind placebo controlled crossover study of controlled release salbutamol (CRS) to assess its efficacy in controlling night time cough. Children with asthma were enrolled into the study on the basis of a history of persistent cough confirmed by two overnight tape recordings at home. Outcome was measured by two overnight tapes on each medication. Other treatment was unaffected. There was no significant fall in cough counts on CRS. Median scores were 14.5 and 12.0 coughing episodes per night for CRS and placebo respectively. Mean overnight oxygen saturation was identical in both treatment periods but morning peak flow showed a trend towards improvement on CRS. Treatment with CRS does not have a significant effect in control of night cough although it may improve objective measurements of lung function.

Adolescent↗
PubMed1998

Persistent cough: is it asthma?

The aim of this study was to determine if children in the community with persistent cough can be considered to have asthma. A validated questionnaire was given to the parents of 1245 randomly selected children aged 6-12 years. Atopy was measured with skin prick tests. Children with persistent cough had less morbidity and less atopy compared with children with wheeze. Although the syndrome commonly referred to as "cough variant asthma" could not be shown in this study, a significant number of children with persistent cough had been diagnosed as having asthma and were treated with asthma medications including inhaled corticosteroids. Studies are urgently needed to determine the appropriate treatment for children with persistent cough.

Anti-Asthmatic Agents↗
PubMed1986

Cough response to citric acid aerosol in occasional smokers.

Twenty two normal women volunteers underwent a standard cough provocation test by inhaling solutions of citric acid of progressively increasing concentration. Eight were non-smokers, eight moderate smokers, and six occasional smokers. All the non-smokers and moderate smokers coughed. Moderate smokers tended to cough more than non-smokers, but not significantly so. None of the occasional smokers coughed at all (p less than 0.001). Possibly the ability to smoke occasionally with enjoyment is a marker for a diminished cough reflex.

Adult↗
PubMed1988

Asthma as a link between chest illness in childhood and chronic cough and phlegm in young adults.

The link between chest illnesses in childhood to age 7 and the prevalence of cough and phlegm in the winter reported at age 23 was investigated in a cohort of 10,557 British children born in one week in 1958 (national child development study). Both pneumonia and asthma or wheezy bronchitis to age 7 were associated with a significant excess in the prevalence of chronic cough and phlegm at age 23 after controlling for current smoking. This excess was largely attributable to the association of cough and phlegm at age 23 with a history of asthma or wheezy bronchitis from age 16. When adjustment was made for recent wheezing, current cigarette consumption, previous smoking habit, and passive exposure to smoke the relative odds of cough or phlegm, or both, in subjects with a history of childhood chest illness was 1.11 (95% confidence interval 0.97 to 1.27). When analysed separately asthma, wheezy bronchitis, and pneumonia up to age 7 did not significantly increase the prevalence of either cough or phlegm. The explanation for the observed continuity between chest illness in childhood and respiratory symptoms in later life may lie more in the time course of functional disturbances related to asthma than in the persistence of structural lung damage.

Asthma↗