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Respiratory Medicine Oct 2023Refractory/unexplained cough (RUCC) is typically associated with throat symptoms and a dry cough. Some patients attending specialist cough clinics however, report sputum...
INTRODUCTION
Refractory/unexplained cough (RUCC) is typically associated with throat symptoms and a dry cough. Some patients attending specialist cough clinics however, report sputum production (>1 tablespoon daily) and atypical sensations (urge-to-cough in chest). Bronchoscopy findings in this specific cohort have rarely been described.
AIMS
We aimed to evaluate bronchoscopy, bronchoalveolar lavage (BAL) cell differential and microbiology findings in RUCC with mucus production.
METHODS
We retrospectively reviewed case notes, procedure results and treatment of patients undergoing bronchoscopy for RUCC with more than a tablespoon of sputum daily.
RESULTS
Data were included from 54 patients with RUCC, normal or trivial findings on CT (Computerised Tomography) imaging and no response to guideline-directed treatment of their cough. Most (84%) patients had BAL neutrophilia and excessive dynamic airway collapse (EDAC) was seen in 31%. Treatment strategies in these patients differed to those adopted in typical RUCC associated with a dry cough. Management was influenced or changed in 48/54 (89%) of the patients undergoing bronchoscopy.
CONCLUSIONS
Bronchoscopy provides high diagnostic value in RUCC with mucus production (>1 tbsp daily), identifying specific treatable traits including neutrophilic airway inflammation and EDAC.
Topics: Humans; Cough; Bronchoscopy; Retrospective Studies; Bronchoalveolar Lavage; Mucus; Bronchoalveolar Lavage Fluid
PubMed: 37468018
DOI: 10.1016/j.rmed.2023.107335 -
International Journal of Chronic... 2018Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough... (Observational Study)
Observational Study
PURPOSE
Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD.
MATERIALS AND METHODS
Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II-IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive).
RESULTS
Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%).
CONCLUSION
We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.
Topics: Acoustics; Aged; Circadian Rhythm; Cough; Female; Germany; Humans; Lung; Male; Middle Aged; Monitoring, Ambulatory; Prevalence; Pulmonary Disease, Chronic Obstructive; Respiratory Sounds; Risk Factors; Severity of Illness Index; Smoking; Time Factors
PubMed: 29662309
DOI: 10.2147/COPD.S154539 -
Terapevticheskii Arkhiv 2012The review presents an update on the determination of the causes and mechanisms of acute and chronic cough. It assesses the concept of productive and non-productive... (Comparative Study)
Comparative Study Review
The review presents an update on the determination of the causes and mechanisms of acute and chronic cough. It assesses the concept of productive and non-productive cough (acute cough, chronic cough), its duration in different diseases of the lung, upper and lower respiratory tract, pulmonary embolism, gastroesophageal reflux disease, pharyngolaryngeal reflux, and during treatment with angiotensin-converting enzyme inhibitors. Information is given on treatment policy for cough in different diseases.
Topics: Cough; Humans
PubMed: 22994100
DOI: No ID Found -
Pulmonary Pharmacology & Therapeutics 2004Patients with chronic obstructive pulmonary disease (COPD) most commonly complain of cough, production of phlegm and breathlessness. The cough reflex sensitivity is... (Review)
Review
Patients with chronic obstructive pulmonary disease (COPD) most commonly complain of cough, production of phlegm and breathlessness. The cough reflex sensitivity is heightened compared with that in healthy volunteers and is similar to that in subjects with asthma. The degree of airflow obstruction does not predict cough reflex sensitivity or objective cough counts, implying an independent process. Objective cough rates seem to be relatively low in COPD, despite frequent reporting of the symptom by patients. The relative contribution of cough to disability in COPD seems to be small, if assessed by subjective reporting. Effective treatments for cough in COPD have not yet been identified. Improved outcome measures of cough, a better understanding of the mechanisms underlying cough, and the importance of cough to patients is required to progress in this field.
Topics: Clinical Trials as Topic; Cough; Disabled Persons; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Reflex
PubMed: 15564082
DOI: 10.1016/j.pupt.2004.09.006 -
The Cochrane Database of Systematic... Mar 2014The benefits and risks of antibiotics for acute bronchitis remain unclear despite it being one of the most common illnesses seen in primary care. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The benefits and risks of antibiotics for acute bronchitis remain unclear despite it being one of the most common illnesses seen in primary care.
OBJECTIVES
To assess the effects of antibiotics in improving outcomes and assess adverse effects of antibiotic therapy for patients with a clinical diagnosis of acute bronchitis.
SEARCH METHODS
We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January week 1, 2014), EMBASE (1974 to January 2014) and LILACS (1982 to January 2014).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in patients without underlying pulmonary disease.
DATA COLLECTION AND ANALYSIS
At least two review authors extracted data and assessed trial quality.
MAIN RESULTS
Seventeen trials with 3936 participants were included in the primary analysis. The quality of trials was generally good. There was limited evidence to support the use of antibiotics in acute bronchitis. At follow-up, there was no difference in participants described as being clinically improved between antibiotic and placebo groups (11 studies with 3841 participants, risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.15; number needed to treat for an additional beneficial outcome (NNTB) 22. Participants given antibiotics were less likely to have a cough (four studies with 275 participants, RR 0.64, 95% CI 0.49 to 0.85; NNTB 6); have a night cough (four studies with 538 participants, RR 0.67, 95% CI 0.54 to 0.83; NNTB 7) and a shorter mean cough duration (seven studies with 2776 participants, mean difference (MD) -0.46 days, 95% CI -0.87 to -0.04). The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.Antibiotic-treated patients were more likely to be unimproved according to clinician's global assessment (six studies with 891 participants, RR 0.61, 95% CI 0.48 to 0.79; NNTB 25); have an abnormal lung exam (five studies with 613 participants, RR 0.54, 95% CI 0.41 to 0.70; NNTB 6); have a reduction in days feeling ill (five studies with 809 participants, MD -0.64 days, 95% CI -1.16 to -0.13) and a reduction in days with limited activity (six studies with 767 participants MD -0.49 days, 95% CI -0.94 to -0.04). The differences in proportions with activity limitations at follow-up did not reach statistical significance. There was a significant trend towards an increase in adverse effects in the antibiotic group (12 studies with 3496 participants) (RR 1.20, 95% CI 1.05 to 1.36; NNT for an additional adverse effect 5).
AUTHORS' CONCLUSIONS
There is limited evidence to support the use of antibiotics in acute bronchitis. Antibiotics may have a modest beneficial effect in some patients such as frail, elderly people with multimorbidity who may not have been included in trials to date. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalisation for a self-limiting condition, increased resistance to respiratory pathogens and cost of antibiotic treatment.
Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Cough; Humans; Randomized Controlled Trials as Topic
PubMed: 24585130
DOI: 10.1002/14651858.CD000245.pub3 -
Thorax Nov 2003Chronic cough is a common problem in childhood. Viral infections are the most prevalent cause, but other rarer disorders should be excluded whenever cough appears... (Review)
Review
Chronic cough is a common problem in childhood. Viral infections are the most prevalent cause, but other rarer disorders should be excluded whenever cough appears unusually severe and/or frequent, and when there is evidence of failure to thrive and growth retardation. The younger the child, the more the need to exclude underlying disease at an early stage. Passive smoking is an important contributor to chronic cough in children. Chronic productive cough with purulent sputum is always reason for concern in children and is not common as a symptom of asthma. More or less specific diagnoses in children include cystic fibrosis, aspirated foreign body, congenital anatomic abnormalities and primary ciliary dyskinesia.
Topics: Algorithms; Asthma; Child; Chronic Disease; Cough; Diagnosis, Differential; Humans; Lung Diseases; Respiratory Sounds
PubMed: 14586058
DOI: 10.1136/thorax.58.11.998 -
Pulmonary Pharmacology & Therapeutics Dec 2017This review reflects upon the management of cough in primary, secondary and tertiary care settings. It reviews the burden of cough, the diagnostic tools employed to... (Review)
Review
This review reflects upon the management of cough in primary, secondary and tertiary care settings. It reviews the burden of cough, the diagnostic tools employed to investigate the cause of cough and pragmatic treatment strategies. A clinical case vignette presenting in primary care highlights the challenges of managing cough by family practitioners. An approach to establishing a persistent cough clinic service in secondary care is described. Finally, the entity of idiopathic cough in tertiary care and the specialist approaches to treating recalcitrant cough are addressed.
Topics: Animals; Cost of Illness; Cough; Humans; Primary Health Care; Secondary Care; Tertiary Healthcare
PubMed: 28476638
DOI: 10.1016/j.pupt.2017.05.001 -
Lung 2008The Urge-to-Cough is a component of the brain motivation system that mediates cognitive responses to cough stimuli. There are six stages to the cough... (Review)
Review
The Urge-to-Cough is a component of the brain motivation system that mediates cognitive responses to cough stimuli. There are six stages to the cough motivation-to-action system: (1) stimulus, the trigger for the neural event; (2) urge, the physical need to respond to the stimulus; (3) desire, translation of urge into a central neural targeted goal; (4) action, physical response that satisfies the urge-desire; (5) evidence, feedback to the neural system on the action; (6) reward, sensory system that determines if the urge was satisfied. Urge-to-Cough is related to three fundamental types of cough: (1) reflex cough, (2) voluntary cough, and (3) behavioral cough. Urge-to-Cough with reflex cough can be studied by measuring the sensations elicited by a cough stimulus. Neural processes with voluntary cough can be studied using magnitude production cognitive psychometric methods. Results of these studies have shown if the subjects can reliably estimate their Urge-to-Cough, the urge increases with increasing cough stimulus, there is a correlation between the Urge-to-Cough and cough intensity, there is a threshold for eliciting the sensation of the urge that precedes the motor cough behavior, subjects can voluntarily produce coughs of varying magnitudes, the motor cough pattern is directly related to the perceived magnitude of a cough, volitional triggers of a cough are directly related to the reflex cough pattern, and neural triggers of cough initiate a stereotypic motor output. Understanding the Urge-to-Cough motivation-to-action system opens new strategies for research on central neural cough mechanisms.
Topics: Awareness; Behavior; Cerebral Cortex; Cough; Humans; Motivation; Patient Education as Topic; Psychometrics; Reflex
PubMed: 17952695
DOI: 10.1007/s00408-007-9045-7 -
Annals of Allergy, Asthma & Immunology... Aug 2023Capsaicin cough sensitivity (C-CS) reflects airway neuronal dysfunction and may be a significant biomarker of asthma. Although mepolizumab reduces cough in patients with...
BACKGROUND
Capsaicin cough sensitivity (C-CS) reflects airway neuronal dysfunction and may be a significant biomarker of asthma. Although mepolizumab reduces cough in patients with severe uncontrolled asthma, it is unclear whether the cough reduction is associated with improved C-CS.
OBJECTIVE
To clarify the effect of biologics on C-CS and cough-specific quality of life (QoL) in patients with severe uncontrolled asthma using our previous study cohort.
METHODS
Overall, 52 consecutive patients who visited our hospital for severe uncontrolled asthma were included in the original study cohort, and 30 patients were eligible for this study. Changes in C-CS and cough-specific QoL were compared between patients treated with the anti-interleukin-5 (IL-5) pathway (n = 16) and those treated with other biologics (n = 14). The C-CS was measured as the concentration of capsaicin required to induce at least 5 coughs.
RESULTS
Biologics significantly improved C-CS (P = .03). Anti-IL-5 pathway therapies significantly improved C-CS, whereas other biologics did not (P < .01 and P = .89, respectively). The C-CS improved significantly more in the anti-IL-5 pathway group than in the group treated with other biologics (P = .02). Changes in C-CS significantly correlated with improvements in cough-specific QoL in the anti-IL-5 pathway group (r = 0.58, P = .01) but not in the group treated with other biologics (r = 0.35, P = .22).
CONCLUSION
Anti-IL-5 pathway therapies improve C-CS and cough-specific QoL, and targeting the IL-5 pathway may be a therapeutic strategy for cough hypersensitivity in patients with severe uncontrolled asthma.
Topics: Humans; Cough; Asthma; Interleukin-5; Biological Products; Capsaicin; Quality of Life; Male; Female; Adult; Middle Aged; Aged
PubMed: 37100279
DOI: 10.1016/j.anai.2023.04.022 -
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