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Temperature (Austin, Tex.) 2015Temperatures above and below what is generally regarded as "comfortable" for the human being have long been known to induce various airway symptoms, especially in... (Review)
Review
Temperatures above and below what is generally regarded as "comfortable" for the human being have long been known to induce various airway symptoms, especially in combination with exercise in cold climate with temperatures below 0°C, which is naturally since exercise is followed by enhanced ventilation and thus greater amounts of inhaled cold air. The aim was to highlight the knowledge we have today on symptoms from the airways (here also including the eyes) arisen from various temperatures; the mechanisms, the pathophysiology and their clinical significance. The most common eye and airway conditions related to temperature changes are dry eye disease, rhinitis, laryngeal dysfunction, asthma, chronic obstructive pulmonary disease and chronic cough. Transient receptor potential (TRP) ion channels are probably involved in all temperature induced airway symptoms but via different pathways, which are now beginning to be mapped out. In asthma, the most persuasive hypothesis today is that cold-induced asthmatic bronchoconstriction is induced by dehydration of the airway mucosa, from which it follows that provocations with osmotic stimuli like hypertonic saline and mannitol can be used as a surrogate for exercise provocation as well as dry air inhalation. In chronic unexplained cough there seems to be a direct influence of cold air on the TRP ion channels followed by coughing and increased cough sensitivity to inhaled capsaicin. Revelations in the last decades of the ability of several airway TRP ion channels to sense and react to ambient air temperature have opened new windows for the understanding of the pathogenesis in a diversity of airway reactions appearing in many common respiratory diseases.
PubMed: 27227021
DOI: 10.1080/23328940.2015.1012979 -
Respiratory Medicine Jul 2020Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations. (Review)
Review
BACKGROUND
Cough is a common yet distressing symptom that results in significant health care costs from outpatient visits and related consultations.
OBJECTIVE
The understanding of the pathobiology of cough in recent times has undergone an evolution with Cough hypersensitivity syndrome (CHS) being suggested in most cases of dry cough. However, in the case of productive cough, ancillary mechanisms including impaired Mucociliary clearance, in addition to hypermucosecretory bronchospastic conditions of Smoker's cough, asthma-COPD overlap, bronchiectasis, and allergic bronchopulmonary aspergillosis, need to be critically addressed while optimizing patient care with symptomatic therapy in outpatient settings of India.
METHODS
In this review, evidence-based graded recommendations on use of antitussives - & protussives as a Position Paper were developed based on the Level and Quality of Scientific evidence as per Agency for Health Care and Quality (AHRQ) criteria listing and Expert opinions offered by a multidisciplinary EMA panel in India.
RESULTS
Management of acute or chronic cough involves addressing common issues of environmental exposures and patient concerns before instituting supportive therapy with antitussives or bronchodilatory cough formulations containing mucoactives, anti-inflammatory, or short-acting beta-2 agonist agents.
CONCLUSION
The analyses provides a real world approach to the management of acute or chronic cough in various clinical conditions with pro- or antitussive agents while avoiding their misuse in empirical settings.
Topics: Antitussive Agents; Aspergillosis, Allergic Bronchopulmonary; Asthma; Bronchiectasis; Bronchodilator Agents; Cough; Evidence-Based Medicine; Expectorants; Health Planning Guidelines; Humans; India; Medication Errors; Mucociliary Clearance; Pulmonary Disease, Chronic Obstructive; Smoking
PubMed: 32469706
DOI: 10.1016/j.rmed.2020.105949 -
Current Medical Research and Opinion Oct 2023EA 575 (Prospan) is a herbal medicine containing a dried extract of ivy leaves (drug extract ratio 5-7.5:1; extraction solvent, 30% ethanol). Although widely used for... (Review)
Review
OBJECTIVES
EA 575 (Prospan) is a herbal medicine containing a dried extract of ivy leaves (drug extract ratio 5-7.5:1; extraction solvent, 30% ethanol). Although widely used for the treatment of cough, there remains a lack of clarity on the effects of EA 575 in children. This study aimed to evaluate the efficacy and tolerability of EA 575 in pediatric patients with cough, a literature review and expert survey.
METHODS
A MEDLINE/PubMed database search was performed to identify articles evaluating the efficacy and tolerability of EA 575 in pediatric patients with cough. An online survey of international pediatric cough experts was conducted to gather expert opinion regarding the use of EA 575 for pediatric cough.
RESULTS
Ten controlled clinical trials and nine observational studies were identified. Controlled trials reported improvements in lung function and subjective cough symptoms with EA 575, while observational studies indicated overall favorable efficacy. EA 575 was generally well tolerated, with a low incidence of adverse events in children of all ages, including those aged <1 year. Survey responses from ten experts aligned with findings from the reviewed studies. Most experts agreed that EA 575 may improve quality of life, and highlighted its potential benefits on sleep.
CONCLUSIONS
EA 575 has minimal side effects in pediatric patients with cough, as demonstrated by large, real-world studies. EA 575 may provide clinical benefits in pediatric patients; however, more robust clinical trials are needed to confirm its efficacy.
PubMed: 37731370
DOI: 10.1080/03007995.2023.2258777 -
The Annals of Thoracic Surgery Jun 2023Persistent cough after pulmonary resection may reduce quality of life for patients. However, there remains a lack of description of clinical characteristics and the risk...
BACKGROUND
Persistent cough after pulmonary resection may reduce quality of life for patients. However, there remains a lack of description of clinical characteristics and the risk factors for persistent cough after pulmonary resection. This study aimed to describe the characteristics of persistent cough after pulmonary resection and investigate independent risk factors for it.
METHODS
This single-institution study retrospectively included 901 consecutive patients who had undergone thoracoscopic pulmonary resection between June 2019 and December 2020. The characteristics of persistent cough after pulmonary resection are described, and univariable and multivariable regression analyses were performed to identify the independent risk factors for persistent cough after pulmonary resection.
RESULTS
Persistent cough after pulmonary resection occurred in 190 (21.1%) of the patients. It was usually an irritating dry cough (75.3%) that appeared on postoperative day 7 (interquartile range [IQR], 6-9) and lasted for approximately 5 (IQR, 2-6) months. It was often induced by a pungent smell, cold air, deep inhalation, speaking, postural changes, pungent food, or emotional excitement. Multivariable analyses showed that resection of the right upper lobe (odds ratio [OR] 2.311, 95% CI 1.246-4.285) and mediastinal lymph node removal (OR 3.686, 95% CI 2.140-6.346) were independently associated with the risk of persistent cough after pulmonary resection.
CONCLUSIONS
Persistent cough after pulmonary resection is a common complication that should receive more attention. Mediastinal lymph node removal and resection of the right upper lobe may be independent risk factors for persistent cough after pulmonary resection.
Topics: Humans; Cough; Retrospective Studies; Quality of Life; Lung Neoplasms; Risk Factors; Pneumonectomy
PubMed: 35779598
DOI: 10.1016/j.athoracsur.2022.05.054 -
PloS One 2022Inhaled antimicrobials enable high local concentrations where needed and, compared to orally administration, greatly reduce the potential for systemic side effects. In...
RATIONALE
Inhaled antimicrobials enable high local concentrations where needed and, compared to orally administration, greatly reduce the potential for systemic side effects. In SARS-CoV-2 infections, hydroxychloroquine sulphate (HCQ) administered as dry powder via inhalation could be safer than oral HCQ allowing higher and therefore more effective pulmonary concentrations without dose limiting toxic effects.
OBJECTIVES
To assess the local tolerability, safety and pharmacokinetic parameters of HCQ inhalations in single ascending doses of 5, 10 and 20 mg using the Cyclops dry powder inhaler.
METHODS
Twelve healthy volunteers were included in the study. Local tolerability and safety were assessed by pulmonary function tests, electrocardiogram and recording adverse events. To estimate systemic exposure, serum samples were collected before and 0.5, 2 and 3.5 h after inhalation.
RESULTS AND DISCUSSION
Dry powder HCQ inhalations were well tolerated by the participants, except for transient bitter taste in all participants and minor coughing irritation. There was no significant change in QTc-interval or drop in FEV1 post inhalation. The serum HCQ concentration remained below 10 μg/L in all samples.
CONCLUSION
Single doses of inhaled dry powder HCQ up to 20 mg are safe and well tolerated. Our data support that further studies with inhaled HCQ dry powder to evaluate pulmonary pharmacokinetics and efficacy are warranted.
Topics: Administration, Inhalation; Dry Powder Inhalers; Healthy Volunteers; Humans; Hydroxychloroquine; Powders; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 35930536
DOI: 10.1371/journal.pone.0272034 -
Internal and Emergency Medicine Jan 2019Idiopathic pulmonary fibrosis is a peripheral subpleural interstitial lung disorder limited to the lung not involving the airways. It has a poor prognosis (survival less... (Review)
Review
Idiopathic pulmonary fibrosis is a peripheral subpleural interstitial lung disorder limited to the lung not involving the airways. It has a poor prognosis (survival less than 5 years) and commonly an interstitial pneumonia radiological pattern. Patients complain of a chronic dry cough in 80% of cases. A cough is often the first symptom of this rare disease, preceding dyspnea by years, and is associated with a poor prognosis, high dyspnea scores and low FVC percentages. The pathogenetic mechanisms leading to coughing in IPF are unclear. This review focuses on recent evidence of cough pathophysiology in this disease. Gastroesophageal reflux may promote coughing in IPF patients; bile salts and pepsin may be abundant in BAL of these patients, inducing overproduction of TGF-β by airway epithelial cells and mesenchymal transition with fibroblast recruitment/activation and extracellular matrix deposition. Patients have an enhanced cough reflex to capsaicin and substance P with respect to control subjects. Moreover, patients with the MUC5B polymorphism show more severe coughing as MUC5B encodes for the dominant mucin in the honeycomb cysts of IPF patients. Comorbidities, including asthma, gastroesophageal reflux, hypersensitivity pneumonitis, bronchiectasis, chronic obstructive pulmonary disease and emphysema, can induce coughing in IPF patients. There is no clear explanation of the causes of coughing in IPF. Further research into the pathophysiology of IPF and the pathogenetic mechanisms of coughing is necessary to improve survival and quality of life.
Topics: Comorbidity; Cough; Humans; Idiopathic Pulmonary Fibrosis; Prognosis; Risk Factors
PubMed: 30269188
DOI: 10.1007/s11739-018-1960-5 -
BMJ (Clinical Research Ed.) Jun 2024
Topics: Humans; Cough; Female; Dyspnea; Tomography, X-Ray Computed; Diagnosis, Differential; Middle Aged
PubMed: 38843893
DOI: 10.1136/bmj-2023-078329 -
Medical Archives (Sarajevo, Bosnia and... Feb 2017Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often... (Review)
Review
Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often conclude localization, and sometimes even the nature of the disease that causes it. Cough is not only the physiological defense reaction, but a symptom of a disease. According to duration it can be acute, chronic and recidivist, recurrent and persistent, strong or discreet, caused by changes in body position and changes in outside temperature. Pathoanatomically it is divided into lobar, lobular, alveolar and interstitial, pathogenetically to bronchogenic and hematogenous, as well as in immuno competent and immunocompromised, and clinically on the local and inpatient (72 hours after hospital admission). Considering the contents, cough can be productive-with secretion from the respiratory tract, and unproductive-dry, without secretion. By auscultation bronchial breathing, rattle and crepitus can be heard. The primary diagnostics is radiological, posterior to anterior (P-A) and lateral footage of the chest. Laboratory findings in typical pneumonia, are characterized by leukocytosis, neutrophilia and shift of blood image to the left. Sedimentation is accelerated and C-reactive protein is elevated. The basic bacteriological diagnosis is sputum Gram's stain and culture of sputum. In atypical pneumonia, leukocytes are usually in the normal range, and it is necessary to do serological tests (IgM and IgG antibodies). The role of doctors in primary health care is auscultation differentiation of murmurs with confirmation of doubt if there is pathological findings by laboratory tests and treatment, depending on the type of cough. Treatment is essentially pharmacological, with irrefutable importance of non-pharmacological measures.
Topics: Adolescent; Child; Chronic Disease; Cough; Guidelines as Topic; Humans; Predictive Value of Tests; Primary Health Care; Respiratory Function Tests; Sputum
PubMed: 28428678
DOI: 10.5455/medarh.2017.71.66-68 -
Lung Feb 2024Chronic cough is characterized by a state of cough hypersensitivity. We analyze the process of transpiration, by which water appears to evaporate from laryngeal and... (Review)
Review
Chronic cough is characterized by a state of cough hypersensitivity. We analyze the process of transpiration, by which water appears to evaporate from laryngeal and tracheal mucus as from the surface of a leaf, as a potential cause of cough hypersensitivity. In this process, osmotic pressure differences form across mucus, pulling water toward the air, and preventing mucus dehydration. Recent research suggests that these osmotic differences grow on encounter with dry and dirty air, amplifying pressure on upper airway epithelia and initiating a cascade of biophysical events that potentially elevate levels of ATP, promote inflammation and acidity, threaten water condensation, and diminish mucus water permeability. Among consequences of this inflammatory cascade is tendency to cough. Studies of isotonic, hypotonic, and hypertonic aerosols targeted to the upper airways give insights to the nature of mucus transpiration and its relationship to a water layer that forms by condensation in the upper airways on exhalation. They also suggest that, while hypertonic NaCl and mannitol may provoke cough and bronchoconstriction, hypertonic salts with permeating anions and non-permeating cations may relieve these same upper respiratory dysfunctions. Understanding of mucus transpiration and its role in cough hypersensitivity can lead to new treatment modalities for chronic cough and other airway dysfunctions promoted by the breathing of dry and dirty air.
Topics: Humans; Chronic Cough; Respiratory Aerosols and Droplets; Cough; Mucus; Hypersensitivity; Water
PubMed: 38135857
DOI: 10.1007/s00408-023-00664-0 -
The Journal of the Association of... May 2018To evaluate effectiveness and safety of Levocloperastine in the treatment of dry cough in adult Indian patients. (Observational Study)
Observational Study
PURPOSE/AIM
To evaluate effectiveness and safety of Levocloperastine in the treatment of dry cough in adult Indian patients.
METHODS
In this prospective, observational study, patients aged 18-60 years, presenting with dry cough and prescribed with Levocloperastine at baseline or a day prior to enrolment, as per standard clinical practice, were recruited from 3 centers in India. The scores of cough severity (100 mm VAS), cough frequency since last 24 h (7-point Likert scale), sleep disruption due to night-time awakenings (10 cm VAS), quality of life (QoL) (Leicester Cough Questionnaire [LCQ]), and number of days for achieving minimal important difference (MID) in cough severity (17 mm improvement on VAS) were assessed from baseline to Day 14. In addition, physicians' assessment of effectiveness of Levocloperastine at Day 14, adverse drug reactions (ADRs) and proportion of patients reporting sedation and other central nervous system side effects were also reported during the study. Descriptive statistics was used to summarize the data.
RESULTS
A total of 100 patients were enrolled in the study. The mean scores of cough severity, cough frequency and sleep disruption due to night-time awakening were significantly reduced from baseline to Day 14 (p<0.0001). A significant improvement in QoL scores (total and by domain) was noted from baseline to Day 14 (p<0.0001). Post treatment with Levocloperastine, the mean time for achieving MID was 5.3±0.26 days. Disappearance of cough was reported in 44% of patients; 54% patients reported improvement of cough by Day 14. No ADRs, cases of sedation or other side-effects were reported in the study.
CONCLUSION
Levocloperastine was found to be effective and safe in the management of dry cough. A significant reduction in severity scores, frequency of cough and sleep disruption was reported, with an overall improvement in patient's QoL.
Topics: Adolescent; Adult; Cough; Humans; India; Middle Aged; Prospective Studies; Quality of Life; Surveys and Questionnaires; Young Adult
PubMed: 30477064
DOI: No ID Found