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American Journal of Respiratory and... Jul 2022Interrupting tuberculosis (TB) transmission requires an improved understanding of how and when the causative organism, (), is aerosolized. Although cough is commonly...
Interrupting tuberculosis (TB) transmission requires an improved understanding of how and when the causative organism, (), is aerosolized. Although cough is commonly assumed to be the dominant source of aerosols, recent evidence of cough-independent release implies the contribution of alternative mechanisms. To compare the aerosolization of bacilli and total particulate matter from patients with TB during three separate respiratory maneuvers: tidal breathing (TiBr), FVC, and cough. Bioaerosol sampling and enumeration by live-cell, fluorescence microscopy were combined with real-time measurement of CO concentration and total particle counts from 38 patients with GeneXpert-positive TB before treatment initiation. For all maneuvers, the proportions of particles detected across five size categories were similar, with most particles falling between 0.5-5 μm. Although total particle counts were 4.8-fold greater in cough samples than either TiBr or FVC, all three maneuvers returned similar rates of positivity for . No correlation was observed between total particle production and count. Instead, for total counts, the variability between individuals was greater than the variability between sampling maneuvers. Finally, when modelled using 24-hour breath and cough frequencies, our data indicate that TiBr might contribute more than 90% of the daily aerosolized among symptomatic patients with TB. Assuming the number of viable organisms released offers a reliable proxy of patient infectiousness, our observations imply that TiBr and interindividual variability in release might be significant contributors to TB transmission among active cases.
Topics: Aerosols; Cough; Humans; Mycobacterium tuberculosis; Respiratory System; Sensitivity and Specificity; Sputum; Tuberculosis
PubMed: 35584342
DOI: 10.1164/rccm.202110-2378OC -
Pulmonary Pharmacology & Therapeutics Apr 2009Acute cough is a major symptom of viral respiratory tract infection and causes excessive morbidity in human populations across the world. A wide variety of viruses play... (Review)
Review
Acute cough is a major symptom of viral respiratory tract infection and causes excessive morbidity in human populations across the world. A wide variety of viruses play a role in the development of cough after acute infection and all of these manifest a similar clinical picture across different age groups. Despite the large disease burden surprisingly little is known about the mechanism of acute cough following viral infection. Both in vitro and in vivo experiments show that increased production of neuropeptides and leukotrienes mediate cough after viral infection, along with altered expression of neural receptors. Increased airway mucus production is also likely to play a significant role. This work is reviewed in this article. Following the recent development of a mouse model for rhinovirus infection and the establishment of experimental models of rhinovirus challenge in human subjects with both asthma and COPD the field is expanding to translate in vitro research into clinical studies and hopefully eventually into clinical practice. Developing a clearer understanding of the mechanisms underlying virus induced cough may lead to more specific and effective therapies.
Topics: Acute Disease; Animals; Asthma; Common Cold; Cough; Disease Susceptibility; Humans; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Rhinovirus
PubMed: 19480062
DOI: 10.1016/j.pupt.2008.12.022 -
Pediatric Pulmonology Mar 2016Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough... (Review)
Review
Cough is the single most common reason for primary care physician visits and, when chronic, a frequent indication for specialist referrals. In children, a chronic cough (>4 weeks) is associated with increased morbidity and reduced quality of life. One common cause of childhood chronic cough is protracted bacterial bronchitis (PBB), especially in children aged <6 years. PBB is characterized by a chronic wet or productive cough without signs of an alternative cause and responds to 2 weeks of appropriate antibiotics, such as amoxicillin-clavulanate. Most children with PBB are unable to expectorate sputum. If bronchoscopy and bronchoalveolar lavage are performed, evidence of bronchitis and purulent endobronchial secretions are seen. Bronchoalveolar lavage specimens typically reveal marked neutrophil infiltration and culture large numbers of respiratory bacterial pathogens, especially Haemophilus influenzae. Although regarded as having a good prognosis, recurrences are common and if these are frequent or do not respond to antibiotic treatments of up to 4-weeks duration, the child should be investigated for other causes of chronic wet cough, such as bronchiectasis. The contribution of airway malacia and pathobiologic mechanisms of PBB remain uncertain and, other than reduced alveolar phagocytosis, evidence of systemic, or local immune deficiency is lacking. Instead, pulmonary defenses show activated innate immunity and increased gene expression of the interleukin-1β signalling pathway. Whether these changes in local inflammatory responses are cause or effect remains to be determined. It is likely that PBB and bronchiectasis are at the opposite ends of the same disease spectrum, so children with chronic wet cough require close monitoring.
Topics: Adolescent; Bacterial Infections; Bronchiectasis; Bronchitis; Bronchoalveolar Lavage; Bronchoscopy; Child; Child, Preschool; Cough; Haemophilus influenzae; Humans; Quality of Life; Recurrence
PubMed: 26636654
DOI: 10.1002/ppul.23351 -
BMC Pulmonary Medicine May 2023Most patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study...
BACKGROUND
Most patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study was to compare chronic cough in early stage IPF patients to cough in subjects with chronic cough from a community-based sample and, especially, to investigate whether cough in IPF is less productive than chronic cough in a community-based sample.
METHODS
The IPF cough population consisted of 46 biopsy-confirmed patients who complained of chronic cough. Control population consisted of subjects with chronic cough, gathered by a community-based email survey sent to public service employees and the Finnish Pensioners' Federation. A case-control setting was applied by having four age, gender, and smoking-status matched subjects from the community sample for each IPF cough patient. A cough specific quality of life questionnaire (Leicester Cough Questionnaire (LCQ)) was filled in by all subjects. The LCQ questionnaire contains 19 questions, each question is scored from 1 to 7 and total score from 3 to 21 with a smaller value indicating more severe impairment.
RESULTS
The sputum production frequency, as assessed by LCQ question 2, was 5.0 (3.0-6.0) in the IPF chronic cough population and 5.0 (3.0-6.0) in the community-based chronic cough population (median and interquartile range p= 0.72). The LCQ total score was 14.8 (11.5-18.1) in the IPF chronic cough population and 15.4 (13.0-17.5) in the community-based chronic cough population (p=0.76). The domain impact scores were physical, 4.9 (3.9-6.1) vs. 5.1 (4.5-5.6) (p=0.80); psychological, 4.6 (3.7-5.9) vs. 4.7 (3.9-5.7) (p=0.90); and social, 5.5 (3.7-6.5) vs. 5.5 (4.5-6.3) (p=0.84), respectively. Furthermore, cough response to paint or fumes, cough disturbing sleep, and cough frequency per day did not differ between the groups.
CONCLUSION
Cough in early stage IPF patients was not distinguishable from chronic cough in the community-based population by LCQ. Especially, there was no difference in the self-reported frequency of cough-associated sputum production.
Topics: Humans; Case-Control Studies; Cough; Quality of Life; Idiopathic Pulmonary Fibrosis; Self Report
PubMed: 37221535
DOI: 10.1186/s12890-023-02476-7 -
Internal Medicine (Tokyo, Japan) Sep 1998There are two types of coughs, productive and non-productive; the former is caused by excess airway secretions. The analysis of cough may provide important clues not... (Comparative Study)
Comparative Study
There are two types of coughs, productive and non-productive; the former is caused by excess airway secretions. The analysis of cough may provide important clues not only to aid diagnosis, but also for the selection of drugs for treatment. In this study, cough sounds recorded in a free acoustic field from patients with productive cough and non-productive cough due to chronic airway diseases were compared with those of voluntary cough of healthy subjects and were analyzed by sound spectrogram and time-expanded waveform. All cough sounds could be separated into two or three phases. The implementation of the novel technique to record cough sounds in the free acoustic field and to analyze the sounds of the high frequency range enable recognition of the characteristics of the cough sounds in phase 2 of the cough.
Topics: Acoustics; Adult; Aged; Bronchitis; Cough; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Sound Spectrography; Speech; Sputum
PubMed: 9804079
DOI: 10.2169/internalmedicine.37.732 -
International Journal of Chronic... 2023GOLD 2023 defines an exacerbation of COPD (ECOPD) by a deterioration of breathlessness at rest (BaR), mucus and cough. The severity of an ECOPD is determined by the...
BACKGROUND
GOLD 2023 defines an exacerbation of COPD (ECOPD) by a deterioration of breathlessness at rest (BaR), mucus and cough. The severity of an ECOPD is determined by the degree of BaR, ranging from 0 to 10. However, it is not known which symptom is the most important one to detect early of an ECOPD, and which symptom that predicts future ECOPDs best. Thus, the purpose of the present study was to find out which symptom is the most important one to monitor.
METHODS
We analysed data on COPD symptoms from the telehealth study The eHealth Diary. Frequent exacerbators (n = 27) were asked to daily monitor BaR and breathlessness at physical activity (BaPA), mucus and cough, employing a digital pen and symptom scales (0-10). Twenty-seven patients with 105 ECOPDs were analysed. The association between symptom development and the occurrence of exacerbations was evaluated using the Andersen-Gill formulation of the Cox proportional hazards model for the analysis of recurrent time-to-event data with time-varying predictors.
RESULTS
According to the criteria proposed by GOLD 2023, 42% ECOPDs were mild, 48% were moderate and 5% were severe, while 6% were undefinable. Mucus and cough improved over study time, while BaR and BaPA deteriorated. Mucus appeared earliest, which was the most prominent feature of the average exacerbation, and worsening of mucus increased the risk for a future ECOPD. There was a 58% increase in the risk of exacerbation per unit increase in mucus score.
CONCLUSION
This study suggests that mucus worsening is the most important COPD symptom to monitor to detect ECOPDs early and to predict future risk för ECOPDs. In the present study, we also noticed a pronounced difference between GOLD 2022 and 2023. Hence, GOLD 2023 defined the ECOPD severity much lower than GOLD 2022 did.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Cough; Disease Progression; Telemedicine; Dyspnea
PubMed: 37492490
DOI: 10.2147/COPD.S417735 -
Respiratory Medicine May 2023Bronchiectasis (BE) is a chronic condition characterized by airway dilation as a consequence of a variety of pathogenic processes. It is often associated with persistent... (Review)
Review
Bronchiectasis (BE) is a chronic condition characterized by airway dilation as a consequence of a variety of pathogenic processes. It is often associated with persistent airway infection and an inflammatory response resulting in cough productive of purulent sputum, which has an adverse impact on quality of life. The prevalence of BE is increasing worldwide. Treatment guidelines exist for managing BE, but they are generally informed by a paucity of high-quality evidence. This review presents the findings of a scientific advisory board of experts held in the United States in November 2020. The main focus of the meeting was to identify unmet needs in BE and propose ways to identify research priorities for the management of BE, with a view to developing evidence-based treatment recommendations. Key issues identified include diagnosis, patient evaluation, promoting airway clearance and appropriate use of antimicrobials. Unmet needs include effective pharmacological agents to promote airway clearance and reduce inflammation, control of chronic infection, clinical endpoints to be used in the design of BE clinical trials, and more accurate classification of patients using phenotypes and endotypes to better guide treatment decisions and improve outcomes.
Topics: Humans; Quality of Life; Bronchiectasis; Cough; Chronic Disease
PubMed: 36931575
DOI: 10.1016/j.rmed.2023.107217 -
British Journal of Pharmacology Sep 2020Cough is an adverse effect that may hinder the delivery of drugs into the lungs. Chemical or mechanical stimulants activate the transient receptor potential in some... (Review)
Review
Cough is an adverse effect that may hinder the delivery of drugs into the lungs. Chemical or mechanical stimulants activate the transient receptor potential in some airway afferent nerves (C-fibres or A-fibres) to trigger cough. Types of inhaler device and drug, dose, excipients and formulation characteristics, including pH, tonicity, aerosol output and particle size may trigger cough by stimulating the cough receptors. Release of inflammatory mediators may increase the sensitivity of the cough receptors to stimulants. The cough-provoking effect of aerosols is enhanced by bronchoconstriction in diseased airways and reduces drug deposition in the target pulmonary regions. In this article, we review the factors by which inhalation products may cause cough.
Topics: Administration, Inhalation; Aerosols; Bronchoconstriction; Cough; Humans; Lung; Particle Size
PubMed: 32668011
DOI: 10.1111/bph.15197 -
Sarcoidosis, Vasculitis, and Diffuse... 2020Cough is frequent symptom in sarcoidosis and its impact on patient's quality of life (QoL) has not been adequately addressed so far. (Observational Study)
Observational Study
BACKGROUND
Cough is frequent symptom in sarcoidosis and its impact on patient's quality of life (QoL) has not been adequately addressed so far.
OBJECTIVES
The goal of this study was to determine the significant predictors of cough-specific and generic QoL in sarcoidosis patients.
METHODS
In the prospective study 275 sarcoidosis patients administered Patient Reported Outcomes instruments for measurement of dyspnea (Borg and MRC scales) and fatigue (Fatigue Assessment Scale (FAS) and Daily Activity List (DAL)), as well as patients' QoL (cough-specific Leicester Cough Questionnaire (LCQ) and generic tool - 15D). The LCQ contains 3 domains covering physical, psychological and social aspects of chronic cough. Pulmonary function tests (spirometry and diffusing capacity for carbon monoxide) and serum angiotensin converting enzyme (sACE) were also measured.
RESULTS
Dyspnea measured by Borg scale and impairment of daily activities determined by DAL instrument as well as sACE were the strongest predictors of all cough-specific QoL domains. Mental aspect of patients' fatigue was significantly correlated with all domains except with psychological LCQ domain. Regarding the generic QoL, the following significant predictors were: dyspnea measured by MRC scale, overall fatigue determined by FAS and physical domain of the LCQ.
CONCLUSION
It is important to measure both cough-specific and generic QoL in sarcoidosis patients since they measure different health aspects and their predictors can be different. We demonstrated that physical domain of cough-specific QoL is significant predictor of generic QoL. .
Topics: Activities of Daily Living; Adult; Aged; Cost of Illness; Cough; Dyspnea; Fatigue; Female; Health Status; Humans; Lung; Male; Mental Health; Middle Aged; Patient Reported Outcome Measures; Predictive Value of Tests; Prospective Studies; Quality of Life; Risk Factors; Sarcoidosis, Pulmonary; Severity of Illness Index
PubMed: 33093779
DOI: 10.36141/svdld.v37i2.9234 -
Respiratory Medicine Aug 2011Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in developed countries, and its prevalence is projected to increase over the... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in developed countries, and its prevalence is projected to increase over the coming decades. According to the World Health Organization, COPD will become the third leading cause of death worldwide by 2020. COPD has a chronic and progressive course, and is often aggravated by exacerbations, which typically arise as a result of bronchial infection. Exacerbations are characterised by periods of increasing acute symptoms, particularly cough, dyspnoea and production of sputum, which worsen airflow obstruction, further impair quality of life and generally require a change in regular medication. Exacerbations are the most common cause of medical visits, hospital admissions and death in patients with COPD, and frequent exacerbations worsen health status and may cause a permanent decline in lung function. Chronic cough and sputum production are common in the general population, but significantly more prevalent in patients with respiratory disorders; these symptoms have been suggested as a risk factor for exacerbations of COPD. This article will review the consequences of chronic cough and sputum production in patients with COPD and analyse whether these risk factors may be useful for identifying a specific phenotype of patient that requires different management to reduce the occurrence of exacerbations.
Topics: Adolescent; Adult; Aged; Biomarkers; Child; Cough; Disease Progression; Female; Humans; Male; Middle Aged; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sputum; Young Adult
PubMed: 21353517
DOI: 10.1016/j.rmed.2011.02.003