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British Journal of Hospital Medicine... Mar 2022Rhinitis and rhinosinusitis are common conditions which have a significant burden on healthcare services and can lead to reduced productivity in patients across the... (Review)
Review
Rhinitis and rhinosinusitis are common conditions which have a significant burden on healthcare services and can lead to reduced productivity in patients across the entire age spectrum. Three disease-specific quality of life tools were analysed in hospital and community settings to explore prevalence, disease characteristics and financial costs to sufferers, and to compare these aspects between cohorts (young children, young adult and adults). These tools were Modified Sino-Nasal Outcome Test-20 (MSNOT-20) questionnaire for adults, MSNOT-20 Young Persons Questionnaire (MSYPQ) for 11-16-year-olds and Sami's Rhinosinusitis Diagnosis and Impact questionnaire for 5-10-year-olds. One of the top three symptoms in children aged 5-10 years was cough, which is a much less common symptom in adults. These validated, disease-specific, quality of life questionnaires provide a fuller illustration of the patient experience, allowing comprehensive comparative analysis across the ages.
Topics: Child; Child, Preschool; Cough; Hospitals; Humans; Quality of Life; Sinusitis; Young Adult
PubMed: 35377198
DOI: 10.12968/hmed.2021.0589 -
Chest Oct 2021Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the... (Review)
Review
BACKGROUND
Cough characteristics vary between patients, and this can impact clinical diagnosis and care. The purpose of part two of this state-of-the-art review is to update the American College of Chest Physicians (CHEST) 2006 guideline on global physiology and pathophysiology of cough.
STUDY DESIGN AND METHODS
A review of the literature was conducted using PubMed and MEDLINE databases from 1951 to 2019 using prespecified search terms.
RESULTS
We describe the demographics of typical patients with cough in the clinical setting, including how cough characteristics change across age. We summarize the effect of common clinical conditions impacting cough mechanics and the physical properties of mucus on airway clearance.
INTERPRETATION
This is the second of a two-part update to the 2006 CHEST cough guideline; it complements part one on basic phenomenology of cough by providing an extended clinical picture of cough along with the factors that alter cough mechanics and efficiency in patients. A greater understanding of the physiology and pathophysiology of cough will improve clinical management.
Topics: Age Factors; Aging; Biomechanical Phenomena; Chronic Disease; Cough; Humans; Mucociliary Clearance; Neuromuscular Diseases; Reflex; Sex Factors
PubMed: 33905678
DOI: 10.1016/j.chest.2021.04.039 -
MBio Jun 2022What causes the cough in whooping cough (pertussis) has been a longstanding question in the field but has been difficult to answer because of the perceived lack of...
What causes the cough in whooping cough (pertussis) has been a longstanding question in the field but has been difficult to answer because of the perceived lack of convenient small animal models. Y. Hiramatsu, K. Suzuki, T. Nishida, N. Onoda, et al. (mBio 13:e01397-21, 2022, https://doi.org/10.1128/mbio.03197-21) used a mouse model and cellular studies to investigate bacterial and host factors that contribute to cough production during Bordetella pertussis infection. In elegant studies, they found that the bacterial factors pertussis toxin, lipooligosaccharide, and Vag8 function cooperatively to produce cough. These factors induce production of host bradykinin, a known cough inducer that sensitizes the ion channel TRPV1 on neurons, and they investigated host signaling pathways altered by the bacterial factors that exacerbate cough responses. This is a highly significant and important finding that not only elucidates mechanisms underlying the pathophysiology of the severe cough, but also may reveal potential novel therapeutic approaches to treat individuals suffering from the debilitating effects of cough in pertussis.
Topics: Animals; Bordetella Infections; Bordetella pertussis; Cough; Mice; Whooping Cough
PubMed: 35604095
DOI: 10.1128/mbio.00917-22 -
BMJ Clinical Evidence Jun 2008Each year, children suffer up to 5 colds and adults have 2-3 infections, leading to time off school or work, and considerable discomfort. Most symptoms resolve within a... (Review)
Review
INTRODUCTION
Each year, children suffer up to 5 colds and adults have 2-3 infections, leading to time off school or work, and considerable discomfort. Most symptoms resolve within a week, but coughs often persist for longer.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for common cold? We searched: Medline, Embase, The Cochrane Library and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics or anti-inflammatory drugs, antibiotics, antihistamines, decongestants (norephedrine, oxymetazoline, or pseudoephedrine), decongestants plus antihistamine, echinacea, steam inhalation, vitamin C, and zinc (intranasal gel or lozenges).
Topics: Acute Disease; Common Cold; Cough; Echinacea; Humans; Nasal Decongestants; Phenylpropanolamine
PubMed: 19450292
DOI: No ID Found -
Physiological Research Mar 2020Cough is one of the most important defensive reflexes. However, extensive non- productive cough is a harmful mechanism leading to the damage of human airways. Cough is... (Review)
Review
Cough is one of the most important defensive reflexes. However, extensive non- productive cough is a harmful mechanism leading to the damage of human airways. Cough is initiated by activation of vagal afferents in the airways. The site of their convergence is particularly the nucleus of the solitary tract (nTS). The second-order neurons terminate in the pons, medulla and spinal cord and there is also the cortical and subcortical control of coughing.Upper airway cough syndrome (UACS) - previously postnasal drip syndrome - is one of the most common causes of chronic cough together with asthma and gastroesophageal reflux. The main mechanisms leading to cough in patients with nasal and sinus diseases are postnasal drip, direct irritation of nasal mucosa, inflammation in the lower airways, upper airway inflammation and the cough reflex sensitization. The cough demonstrated by UACS patients is probably due to hypersensitivity of the upper airways sensory nerve or lower airways sensory nerve, or a combination of both. Further studies are needed to clarify this mechanism.
Topics: Animals; Capsaicin; Chronic Disease; Cough; Humans; Nasal Mucosa; Sensory Receptor Cells; Syndrome; TRPA1 Cation Channel; TRPV Cation Channels; Trachea; Vagus Nerve
PubMed: 32228010
DOI: 10.33549/physiolres.934400 -
Clinical and Translational Medicine Aug 2023Chronic cough is a burdensome condition characterized by persistent cough lasting longer than 8 weeks. Chronic cough can significantly affect quality of life, physical... (Review)
Review
BACKGROUND
Chronic cough is a burdensome condition characterized by persistent cough lasting longer than 8 weeks. Chronic cough can significantly affect quality of life, physical function and productivity, with many people troubled with a cough that lasts for months or even years. People with chronic cough commonly report a persistent urge to cough with frequent bouts of coughing triggered by innocuous stimuli, which has led to the concept of cough hypersensitivity.
MAIN BODY
Both central and peripheral neural pathways regulate cough, and although mechanisms driving development of cough hypersensitivity are not fully known, sensitization of these neural pathways contributes to excessive cough triggering in cough hypersensitivity. Effective therapies that control chronic cough are currently lacking. Recent therapeutic development has focused on several ion channels and receptors involved in peripheral activation of cough (e.g., transient receptor potential channels, P2 × 3 receptors and voltage-gated sodium channels) or central cough processing (e.g., neurokinin-1 [NK-1] receptors and nicotinic acetylcholine receptors).
CONCLUSION
These targeted therapies provide novel insights into mechanisms underlying cough hypersensitivity and may offer new treatment options for people with chronic cough. In this review, we explore preclinical and clinical studies that have improved our understanding of the mechanisms responsible for chronic cough and discuss the most promising targeted approaches to date, including trials of P2 × 3-receptor antagonists and NK-1-receptor antagonists.
Topics: Humans; Cough; Quality of Life; Hypersensitivity; Chronic Disease
PubMed: 37501282
DOI: 10.1002/ctm2.1343 -
Tuberculosis (Edinburgh, Scotland) Jul 2019Cough has long been implicated in the production of infectious aerosol leading to transmission of tuberculosis (TB). However, prevalence studies frequently identify... (Review)
Review
Cough has long been implicated in the production of infectious aerosol leading to transmission of tuberculosis (TB). However, prevalence studies frequently identify radiographic evidence of TB in subclinical individuals in the absence of reported coughing. Elucidating the role of cough in transmission depends on understanding the physical process of aerosolizing and expelling mycobacterium tuberculosis (Mtb) bacilli. In the last decade, human aerosol studies have progressed with improved precision of particle detection and greater sophistication of experimental protocols. Combining principles of respiratory physiology, the site and mechanism of aerosolization of respiratory lining fluids during phases of the respiratory cycle has been investigated in detail. Additionally, recent success in the direct detection of naturally generated Mtb aerosols has allowed more detailed characterization in terms of their rate of production and size distribution. We propose that TB transmission depends on the coincidence of the site of aerosol generation with the presence of Mtb bacilli. This review will examine the evidence for site of aerosol production during cough and respiratory activities in conjunction with the characteristics of detectable Mtb aerosols and locations of tuberculosis infection. Furthermore, we propose respiratory activities that are likely to optimise aerosol sampling for investigation of transmission.
Topics: Aerosols; Cough; Humans; Mycobacterium tuberculosis; Respiratory Physiological Phenomena; Respiratory System; Tuberculosis, Pulmonary
PubMed: 31378265
DOI: 10.1016/j.tube.2019.05.003 -
COPD Apr 2018The binary approach to the diagnosis of Chronic Bronchitis (CB) is a major barrier to the study of the disease. We investigated whether severity of productive cough can...
The binary approach to the diagnosis of Chronic Bronchitis (CB) is a major barrier to the study of the disease. We investigated whether severity of productive cough can be graded using symptoms and presence of fixed airflow obstruction (FAO), and whether the severity correlates with health status, exposures injurious to the lung, biomarkers of inflammation, and measures of airway wall thickening. Findings from a cross-sectional sample of 1,422 participants from the Lovelace Smokers Cohort (LSC) were validated in 4,488 participants from the COPDGene cohort (COPDGene). Health status was based on the St. George's Respiratory Questionnaire, and Medical Outcomes Study 36-Item Short Form Health Survey. Circulating CC16 levels were quantified by ELISA (LSC), and airway wall thickening was measured using computed tomography (COPDGene). FAO was defined as postbronchodilator FEV/FVC <0.7. The presence and duration of productive cough and presence of FAO or wheeze were graded into Healthy Smokers, Productive Cough (PC), Chronic PC, PC with Signs of Airflow Obstruction, and Chronic PC with Signs of Airflow Obstruction. In both cohorts, higher grade of severity correlated with lower health status, greater frequency of injurious exposures, greater airway wall thickening, and lower circulating CC16 levels. Further, longitudinal follow-up suggested that disease resolution can occur at every grade of severity but is more common in groups of lower severity and least common once airway remodeling develops. Therefore, severity of productive cough can be graded based on symptoms and FAO and early intervention may benefit patients by changing the natural history of disease.
Topics: Adult; Aged; Airway Remodeling; Bronchitis, Chronic; Cough; Cross-Sectional Studies; Environmental Exposure; Female; Forced Expiratory Volume; Health Status; Humans; Logistic Models; Lung; Male; Middle Aged; Multivariate Analysis; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index; Smoking; Tomography, X-Ray Computed; Uteroglobin; Vital Capacity
PubMed: 29697285
DOI: 10.1080/15412555.2018.1458218 -
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 -
Ugeskrift For Laeger Apr 2015Cough in children is a common problem of various aetiologies. In the presence of specific findings diagnostics may be easy, but often the symptoms are few and unclear.... (Review)
Review
Cough in children is a common problem of various aetiologies. In the presence of specific findings diagnostics may be easy, but often the symptoms are few and unclear. Management involves specific diagnosing and it should be considered if the cough is acute, prolonged or chronic. The diagnosis depends on the quality of the cough evaluated as dry cough or wet, productive cough. Trials of treatment are often used to make a diagnosis, and any trial should be time-limited because natural resolution of cough is so common. Finally, giving thorough information to parents is crucial.
Topics: Child; Chronic Disease; Cough; Diagnosis, Differential; Health Education; Humans; Parents
PubMed: 25872676
DOI: No ID Found