Medicine Pulmonary and Respiratory Medicine

Respiratory and Cough-Related Research

Description

This cluster of papers focuses on the diagnosis and management of chronic cough, including topics such as cough reflex sensitivity, neuropathic disorder, vocal cord dysfunction, refractory chronic cough, cough hypersensitivity syndrome, laryngeal sensory neuropathy, airway afferent nerves, Pelargonium sidoides, and ambroxol.

Keywords

Chronic Cough; Cough Reflex Sensitivity; Neuropathic Disorder; Vocal Cord Dysfunction; Refractory Chronic Cough; Cough Hypersensitivity Syndrome; Laryngeal Sensory Neuropathy; Airway Afferent Nerves; Pelargonium Sidoides; Ambroxol

We have identified the tracheal and laryngeal afferent nerves regulating cough in anaesthetized guinea-pigs. Cough was evoked by electrical or mechanical stimulation of the tracheal or laryngeal mucosa, or by … We have identified the tracheal and laryngeal afferent nerves regulating cough in anaesthetized guinea-pigs. Cough was evoked by electrical or mechanical stimulation of the tracheal or laryngeal mucosa, or by citric acid applied topically to the trachea or larynx. By contrast, neither capsaicin nor bradykinin challenges to the trachea or larynx evoked cough. Bradykinin and histamine administered intravenously also failed to evoke cough. Electrophysiological studies revealed that the majority of capsaicin-sensitive afferent neurones (both Adelta- and C-fibres) innervating the rostral trachea and larynx have their cell bodies in the jugular ganglia and project to the airways via the superior laryngeal nerves. Capsaicin-insensitive afferent neurones with cell bodies in the nodose ganglia projected to the rostral trachea and larynx via the recurrent laryngeal nerves. Severing the recurrent nerves abolished coughing evoked from the trachea and larynx whereas severing the superior laryngeal nerves was without effect on coughing. The data indicate that the tracheal and laryngeal afferent neurones regulating cough are polymodal Adelta-fibres that arise from the nodose ganglia. These afferent neurones are activated by punctate mechanical stimulation and acid but are unresponsive to capsaicin, bradykinin, smooth muscle contraction, longitudinal or transverse stretching of the airways, or distension. Comparing these physiological properties with those of intrapulmonary mechanoreceptors indicates that the afferent neurones mediating cough are quite distinct from the well-defined rapidly and slowly adapting stretch receptors innervating the airways and lungs. We propose that these airway afferent neurones represent a distinct subtype and that their primary function is regulation of the cough reflex.
Cough and bronchoconstriction are airway reflexes that protect the lung from inspired noxious agents. These two reflexes can be evoked both from the larynx and tracheobronchial tree and also from … Cough and bronchoconstriction are airway reflexes that protect the lung from inspired noxious agents. These two reflexes can be evoked both from the larynx and tracheobronchial tree and also from some extrarespiratory sites. Within the airways, certain sites are particularly sensitive to stimulation of cough (larynx and points of proximal airway branching), whereas bronchoconstriction can be triggered from the whole of the tracheobronchial tree. In the larynx, "irritant" receptors with myelinated afferents mediate cough and bronchoconstriction. Little seems to be known about laryngeal nonmyelinated afferents and their reflexes. In the tracheobronchial tree and lung, slowly adapting stretch receptors (SARs) and rapidly adapting stretch receptors (RARs) have opposing effects on airway tone, the former mediating bronchodilation and the latter bronchoconstriction. In cough, on the other hand, they operate concurrently, a mediatory role for RARs and a facilitatory role for SARs. C-fiber endings (bronchial and pulmonary) mediate bronchoconstriction. Inhalation of so-called "selective" C-fiber stimulants induces cough, but excitation of RARs has not been eliminated, and the possibility also exists that the cough is secondary to other lung actions mediated by these nerve endings. Although cough and bronchoconstriction may be mediated by the same type of receptor, they seem to have separate afferent neural pathways.
Inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths) produced a 218 +/- 54.6 per cent (mean +/- SE) increase in airway resistance in 16 normal subjects with colds … Inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths) produced a 218 +/- 54.6 per cent (mean +/- SE) increase in airway resistance in 16 normal subjects with colds compared with a 30.5 +/- 5.5 per cent increase in 11 healthy control subjects (P less than 0.01). There was no significant difference in mean baseline airway resistance between the two groups. Inhalation of saline produced no significant change in airway resistance in either group. Isoproterenol hydrochloride (0.5 per cent, 1 breath) or atropine sulfate aerosol (0.2 per cent, 20 breaths) each reversed and prevented the increase in airway resistance by histamine, indicating that the bronchoconstriction was caused by smooth muscle contraction and that post-ganglionic, cholinergic pathways were involved in the mechanism. In 6 subjects with colds, citric acid aerosol (10 per cent, 5 breaths) caused bronchoconstriction that lasted up to 30 sec after inhalation, a significantly greater effect than that observed in control subjects or in the same subjects after recovery (P less than 0.05). Prior inhalation of atropine aerosol (0.2 per cent, 20 breaths) prevented the bronchoconstriction after citric acid aerosol in all 6 subjects. The threshold concentration of citric acid that produced cough in 7 subjects with colds was significantly lower than that in control subjects or in the 7 subjects after recovery (P less than 0.05), suggesting that the exaggerated cholinergic response was due to a decreased threshold for stimulation of the rapidly adapting sensory receptors in the airways. We have provided evidence that respiratory viral infections that produce airway epithelial damage temporarily cause these subjects to develop more bronchoconstriction after inhaling smaller doses of histamine than do healthy subjects. The fact that atropine prevents this response and that the threshold to cough is temporarily decreased is compatible with our hypothesis that airway epithelial damage by infection exposes and, thus, "sensitizes" the rapidly adapting airway receptors to inhaled irritants, causing increased bronchoconstriction via a vagal reflex. Damage to the airway epithelium may occur as a result of mechanical factors, inhaled chemicals, and pollutants, such as ozone, infections, or perhaps as a result of the action of materials released endogenously (e.g., from mast cells, white blood cells, or platelets). "Sensitization" of rapidly adapting sensory receptors in the airways may be an important factor in asthma and in other diseases of airways.
Using a diagnostic protocol based on the anatomy and distribution of cough receptors and afferent nerves, we sought to determine the causes and outcome of specific therapy of chronic persistent … Using a diagnostic protocol based on the anatomy and distribution of cough receptors and afferent nerves, we sought to determine the causes and outcome of specific therapy of chronic persistent cough in 49 consecutive and unselected patients. A specific diagnosis was made in all. Cough was due to chronic postnasal dip from a variety of conditions in 29%, asthma in 25%, postnasal drip plus asthma in 18%, chronic bronchitis in 12%, gastroesophageal reflux in 10%, and miscellaneous disorders in 6%. History, physical examination, and methacholine inhalational challenge diagnosed disease in 86% of all patients. Adjusted success rates for specific therapy, and average of 4.4 and 18.9 months after therapy had been prescribed, were 98% and 97%, respectively. We concluded the following about chronic persistent cough; using an anatomic, diagnostic protocol, the cause can be consistently determined; postnasal drip and/or bronchial asthma are very common causes of cough; the outcome of specific therapy, almost without exception, is successful and sustained.
1-(3949 Dichlorophenyl)-2-isopropylaminoethanol hydrochloride (20522), the dichloro analog of isoproterenol, selectively blocked some inhibitory effects of epinephrine and isoproterenol. The depressor action of isoproterenol and the secondary depressor action of epinephrine … 1-(3949 Dichlorophenyl)-2-isopropylaminoethanol hydrochloride (20522), the dichloro analog of isoproterenol, selectively blocked some inhibitory effects of epinephrine and isoproterenol. The depressor action of isoproterenol and the secondary depressor action of epinephrine were inhibited by the dichloro analog which of itself had at most caused a transient fall in blood pressure. The inhibitory effect of epinephrine on isolated rabbit intestine was blocked by 20522. On rat uterus, however, 20522 failed to block epinephrine relaxation except with doses in which the analog itself caused considerable decrease in tone. The dichloro analog caused only slight decrease of intrapulmonary resistance to air flow in the ergotoxine-treated decerebrate-pithed dog, but had no action on pilocarpine bronchoconstriction. The administration of 20522 blocked the usual epinephrine or isoproterenol release of this bronchoconstriction. On isolated guinea pig tracheal chain, 20522 inhibited epinephrine and isoproterenol relaxation of pilocarpine-induced spasm. This action appeared to be competitive since large doses of epinephrine could partially overcome the blocking action of 20522. Further, 20522 was washed off only with difficulty, suggesting a rather tight drug-receptor complex. It seemed probable that 20522 was combining with certain adrenergic inhibitory receptor without itself causing much physiological effect., and yet was competing for these sites with physiologically active amines.
The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed … The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use.To evaluate antibiotic-prescribing practices for children younger than 18 years who had received a diagnosis of cold, upper respiratory tract infection (URI), or bronchitis in the United States.Representative national survey of practicing physicians participating in the National Ambulatory Medical Care Survey conducted in 1992 with a response rate of 73%.Office-based physician practices.Physicians completing patient record forms for patients younger than 18 years.Principal diagnoses and antibiotic prescriptions.A total of 531 pediatric office visits were recorded that included a principal diagnosis of cold, URI, or bronchitis. Antibiotics were prescribed to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis. Extrapolating to the United States, 6.5 million prescriptions (12% of all prescriptions for children) were written for children diagnosed as having a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions for children) were written for children diagnosed as having bronchitis. After controlling for confounding factors, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92). Children aged 0 to 4 years received 53% of all antibiotic prescriptions, and otitis media was the most frequent diagnosis for which antibiotics were prescribed (30% of all prescriptions).Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.
Dextromethorphan hydrobromide, 25 mg po, was given to 268 unrelated Swiss subjects to study urinary drug and metabolite profiles. Rates of O-demethylation yielding the main metabolite dextrorphan were expressed by … Dextromethorphan hydrobromide, 25 mg po, was given to 268 unrelated Swiss subjects to study urinary drug and metabolite profiles. Rates of O-demethylation yielding the main metabolite dextrorphan were expressed by the urinary dextromethorphan/dextrorphan metabolic ratio. We found a bimodal distribution of this parameter in our population study, which indicates that there are two phenotypes for dextromethorphan O-demethylation. The antimode at a metabolic ratio of 0.3 separated the poor metabolizer (PM; n = 23; prevalence of 9%) from extensive metabolizer (EM) phenotypes. Urinary output of dextrorphan was <6% of the dose in all PMs and was 50% in the 245 EMs. Pedigree analysis of 14 family studies revealed an autosomal-recessive transmission of deficient dextromethorphan O-demethylation. In these families, 37 heterozygous genotypes could be identified; however, through use of the urinary drug and metabolite analysis it was not possible to identify the heterozygous genotypes within the EM phenotype group. Co-segregation of dextromethorphan O-demethylation with debrisoquin 4-hydroxylation was also studied. Complete concordance of the two phenotypic assignments was obtained, with a Spearman rank correlation coefficient of rs = 0.78 (n = 62; P < 0.0001) for dextromethorphan and debrisoquin metabolic ratios. Presumably the two drug oxidation polymorphisms are under the same genetic control. Thus the innocuousness and ubiquitous availability of dextromethorphan render it attractive for worldwide pharmacogenetic investigations in man. Clinical Pharmacology and Therapeutics (1985) 38, 618–624; doi:10.1038/clpt.1985.235
Cough is an essential defence mechanism [1]. However, chronic cough is a significant cause of morbidity, seriously impairing quality of life [2]. Previously, chronic cough was considered a consequence of … Cough is an essential defence mechanism [1]. However, chronic cough is a significant cause of morbidity, seriously impairing quality of life [2]. Previously, chronic cough was considered a consequence of various diseases, such as asthma/eosinophilic bronchitis, rhinitis and gastro-oesophageal acid reflux disease [3, 4]. Recent evidence, however, suggests that chronic cough is a clinical syndrome with distinct intrinsic pathophysiology characterised by neuronal hypersensitivity [5–7]. Here, we estimated the worldwide epidemiological burden of chronic cough irrespective of putative diagnosis in general adult populations using a comprehensive systematic literature review. Chronic cough has a high global epidemiological burden. A standard definition would facilitate further studies. <http://ow.ly/HPCnw> We gratefully acknowledge the help of GlaxoSmithKline (UK) in providing data translation assistance. We also wish to acknowledge the statistical advice from Soyeon Ahn (Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea).
A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, … A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 +/- 97 months (range, 3 wk to 50 yr). Utilizing the anatomic, diagnostic protocol modified to include prolonged esophageal pH monitoring (EPM), the causes of cough were determined in 101 of 102 (99%) patients, leading to specific therapy that was successful in 98%. Cough was due to one condition in 73%, two in 23%, and three in 3%. Postnasal drip syndrome was a cause 41% of the time, asthma 24%, gastroesophageal reflux (GER) 21%, chronic bronchitis 5%, bronchiectasis 4%, and miscellaneous conditions 5%. Cough was the sole presenting manifestation of asthma and GER 28 and 43% of the time, respectively. While history, physical examination, methacholine inhalational challenge (MIC), and EPM yielded the most frequent true positive results, MIC was falsely positive 22% of the time in predicting that asthma was the cause of cough. Laboratory testing was particularly useful in ruling out suspected possibilities. We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations.
CHRONIC or recurrent production of sputum on most days for at least three months a year for more than two years defines the disease called chronic bronchitis.1 Although the existence … CHRONIC or recurrent production of sputum on most days for at least three months a year for more than two years defines the disease called chronic bronchitis.1 Although the existence of states of chronic and recurrent sputum production has been recognized for a long time, adequate description of the pathology and epidemiology of chronic bronchitis has largely taken place over the past 25 years.1 2 3 4 5 During this period an extensive clinical literature has appeared detailing the role of infectious agents in the production of both the chronic and the recurrent aspects of chronic bronchitis and the effect of antimicrobial agents in . . .
<h3>Background</h3> Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. <h3>Objectives</h3> To determine whether chronic … <h3>Background</h3> Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. <h3>Objectives</h3> To determine whether chronic cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of chronic cough with specific therapy improved these adverse effects. <h3>Methods</h3> The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a chronic, persistently troublesome cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for cough, ACOS and SIP instruments were readministered. <h3>Results</h3> The ages, sex, duration, and spectra and frequencies of the causes of cough were similar to multiple other studies. At baseline, patients reported a mean±SD of 8.6±4.8 types of adverse occurrences related to cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (<i>P</i>&lt;.02). After cough disappeared with treatment, ACOS complaints decreased to a mean±SD of 1.9±3.2 (<i>P</i>&lt;.0001) as did total (mean±SD, 4.8±4.5 to 1.8±2.2) (<i>P</i>=.004), psychosocial (mean±SD, 4.2±6.8 to 0.8±2.3) (<i>P</i>=.004), and physical (mean±SD, 2.2±2.9 to 0.9±1.8) (<i>P</i>=.05) SIP scores. Multiple linear regression analysis showed that 54% of variability of the psychosocial SIP score was explained by 4 ACOS items while none of the physical score was explained. <h3>Conclusions</h3> Chronic cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of chronic cough.
To compare the degree of bronchial obstruction and the clinical manifestations of asthma, we correlated lung mechanics with subjective complaints and physical findings in 22 patients during acute attacks of … To compare the degree of bronchial obstruction and the clinical manifestations of asthma, we correlated lung mechanics with subjective complaints and physical findings in 22 patients during acute attacks of bronchospasm, and serially during therapy. Only the sign of retraction of the sternocleidomastoid muscle consistently identified those who had severe impairment of pulmonary function; dyspnea and wheezing did not. Regardless of the initial presentation of the patients, when they became asymptomatic, the overall mechanical function of their lungs ranged between 40 and 50 per cent of predicted normal values. When they were without signs of asthma, lung function was only 60 to 70 per cent of predicted values. These abnormalities appear to result from persistent airflow obstruction residing in peripheral airways that is not sufficient to induce symptoms at rest but compromises pulmonary function and may serve as a base for future recurrent episodes of asthma.
Transient receptor potential vanniloid-1 (TRPV-1) mediates the cough response induced by the pepper extract capsaicin and is expressed in sensory nerves that innervate the airway wall. We determined the expression … Transient receptor potential vanniloid-1 (TRPV-1) mediates the cough response induced by the pepper extract capsaicin and is expressed in sensory nerves that innervate the airway wall. We determined the expression of TRPV-1 in the airways of patients with chronic persistent cough of diverse causes and with an enhanced capsaicin cough response. We obtained airway mucosal biopsies by fiberoptic bronchoscopy in 29 patients with chronic cough and 16 healthy volunteers without a cough. Immunostaining for nerve profiles with anti-protein gene product (PGP)-9.5 antibody showed no increase in nerve profiles in the airway epithelium of patients with chronic cough; however, with an anti-TRPV-1 antibody, there was a fivefold increase of TRPV-1 staining nerve profiles (p < 0.001). There was a significant correlation between capsaicin tussive response and the number of TRPV-1-positive nerves within the patients with cough. Our findings indicate that TRPV-1 receptors may contribute to an enhanced cough reflex and the cough response in chronic persistent cough of diverse causes.
Pathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to … Pathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort who were born to mothers with asthma. Aspirates from the hypopharyngeal region of asymptomatic 1-month-old infants were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Blood eosinophil count and total IgE and specific IgE were measured at 4 years of age. Lung function was measured and asthma was diagnosed at 5 years of age.Hypopharyngeal samples were cultured from 321 neonates at 1 month of age. Twenty-one percent of the infants were colonized with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms; colonization with one or more of these organisms, but not colonization with S. aureus, was significantly associated with persistent wheeze (hazard ratio, 2.40; 95% confidence interval [CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazard ratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization for wheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophil counts and total IgE at 4 years of age were significantly increased in children colonized neonatally with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms, but specific IgE was not significantly affected. The prevalence of asthma and the reversibility of airway resistance after beta2-agonist administration at 5 years of age were significantly increased in the children colonized neonatally with these organisms as compared with the children without such colonization (33% vs. 10% and 23% vs. 18%, respectively).Neonates colonized in the hypopharyngeal region with S. pneumoniae, H. influenzae, or M. catarrhalis, or with a combination of these organisms, are at increased risk for recurrent wheeze and asthma early in life.
Vocal cord dysfunction (VCD) is a respiratory condition characterized by adduction of the vocal cords with resultant airflow limitation at the level of the larynx. Previously, this condition was described … Vocal cord dysfunction (VCD) is a respiratory condition characterized by adduction of the vocal cords with resultant airflow limitation at the level of the larynx. Previously, this condition was described in case reports and in small series. This study reviews all patients hospitalized from 1984 through 1991 in whom VCD was diagnosed. Demographic, historical, physiologic, laboratory, and psychiatric factors were statistically analyzed. Ninety-five patients met the criteria for proved VCD; of these, 53 also had asthma. All patients had laryngoscopic evidence of paradoxical vocal cord motion, with inspiratory and/or early expiratory vocal cord adduction. The patients with VCD without asthma were predominantly young women. In these patients, asthma had been misdiagnosed for an average of 4.8 years. Their medications were identical to those of a control group of patients with severe asthma. Thirty-four of the 42 patients with VCD without asthma were receiving prednisone regularly at an average daily dose of 29.2 mg. Medical utilization was enormous with the VCD group, averaging 9.7 emergency room visits and 5.9 admissions in the year prior to presentation. Also, 28% of the patients with VCD had been intubated. We conclude that VCD can masquerade as asthma and that it often coexists with asthma. This study helps to define the historical and clinical features of VCD.
<h3>Context.</h3> —Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of … <h3>Context.</h3> —Antibiotic use is associated with increased rates of antibiotic-resistant organisms. A previous study has shown that colds, upper respiratory tract infections, and bronchitis account for nearly one third of all antibiotic prescribing by ambulatory care physicians. How frequently antibiotics are prescribed for these conditions and for and by whom is not known. <h3>Objectives.</h3> —To measure antibiotic prescription rates and to identify predictors of antibiotic use for adults diagnosed as having colds, upper respiratory tract infections, and bronchitis in the United States. <h3>Design.</h3> —Sample survey of practicing physicians participating in the National Ambulatory Medical Care Survey, 1992. <h3>Setting.</h3> —Office-based physician practices. <h3>Subjects.</h3> —Physicians (n=1529) completing patient record forms for adult office visits (n=28 787). <h3>Main Outcome Measures.</h3> —Antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. <h3>Results.</h3> —Office visits for colds, upper respiratory tract infections, and bronchitis resulted in approximately 12 million antibiotic prescriptions, accounting for 21% of all antibiotic prescriptions to adults in 1992. A total of 51% of patients diagnosed as having colds, 52% of patients diagnosed as having upper respiratory tract infections, and 66% of patients diagnosed as having bronchitis were treated with antibiotics. Female sex (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.05-2.62) and rural practice location (OR, 2.25; 95% CI, 1.33-3.80) were associated with greater antibiotic prescription rates, whereas black race (OR, 0.44; 95% CI, 0.21-0.93) was associated with lower antibiotic prescription rates. Patient age, Hispanic ethnicity, geographic region, physician specialty, and payment sources were not associated with antibiotic prescription rates in the bivariate analysis. Multivariate logistic regression analysis identified only rural practice location (adjusted OR, 2.58; 95% CI, 1.39-4.76) to be independently associated with more frequent antibiotic prescriptions for colds, upper respiratory tract infections, and bronchitis. <h3>Conclusion.</h3> —Although antibiotics have little or no benefit for colds, upper respiratory tract infections, or bronchitis, these conditions account for a sizable proportion of total antibiotic prescriptions for adults by office-based physicians in the United States. Overuse of antibiotics is widespread across geographical areas, medical specialties, and payment sources. Therefore, effective strategies for changing prescribing behavior for these conditions will need to be broad based.
The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from … The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from The Copenhagen City Heart Study on 5,354 women and 4,081 men 30 to 79 yr of age with assessment of smoking habits, respiratory symptoms, and spirometry at two surveys 5 yr apart. Information on COPD hospitalization during 8 to 10 yr of subsequent follow-up was obtained from a nationwide register. Chronic mucus hypersecretion was significantly associated with FEV1 decline; the effect was most prominent among men, where chronic mucus hypersecretion at both surveys was associated with an excess FEV1 decline of 22.8 ml/yr (95% confidence interval, 8.2 to 37.4) compared with men without mucus hypersecretion, after adjusting for age, height, weight change, and smoking; in women, the excess decline was 12.6 ml/yr (0.7-24.6). Chronic mucus hypersecretion was associated with subsequent hospitalization due to COPD after adjusting for age and smoking; relative risk was 5.3 (2.9 to 9.6) among men and 5.1 (2.5 to 10.3) among women. After further adjusting for FEV1 at the second survey, the relative risk was reduced to 2.4 (1.3 to 4.5) for men and 2.6 (1.2 to 5.3) for women. Chronic mucus hypersecretion was significantly and consistently associated with both an excess FEV1 decline and an increased risk of subsequent hospitalization because of COPD.
We tested the effects of four eosinophil granule cationic proteins: major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), and eosinophil-derived neurotoxin (EDN), on guinea pig tracheal epithelium … We tested the effects of four eosinophil granule cationic proteins: major basic protein (MBP), eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), and eosinophil-derived neurotoxin (EDN), on guinea pig tracheal epithelium in vitro. Examination by inverted microscopy revealed that MBP, both the form stabilized by alkylation of sulfhydryl groups as well as the native form of the molecule, ECP, EPO by itself, as well as EPO + H2O2 + halide, but not EDN, cause dose-related damage to the tracheal epithelium. The lowest concentrations of MBP and ECP causing damage were 10 and 100 µg/ml, respectively. In contrast, EDN, although biochemically similar to ECP, did not damage the tracheal epithelium in concentrations of up to 200 µg/ml. MBP caused exfoliation, as well as bleb formation and ciliostasis. EPO in the presence of the H2O2-producing enzyme glucose oxidase (GO), Cl−, 0.11 M, and iodide caused ciliostasis, bleb formation, and exfoliation of epithelial cells at concentrations as low as 1 U/ml (3.9 µg/ml). EPO + GO in the presence of Cl− , 0.11 M, alone or with Cl− and I , 10−4 M, or Cl− and Br− , 5 × 10−5 M, were all toxic to epithelium. Surprisingly, EPO by itself caused partial ciliostasis, bleb formation, and exfoliation of epithelial cells in a dose-related manner at concentrations as low as 10 to 30 U/ml (39 to 121 (µg/ml). These results confirm prior observations showing the toxicity of MBP to tracheal epithelium and indicate that ECP and EPO alone, as well as EPO + GO + halide, cause damage. Thus, several eosinophil granule proteins are able to damage respiratory epithelium.
### 1.1 Background Patients with cough frequently present to clinicians working in both primary and secondary care.1,2 Acute cough, which often follows an upper respiratory tract infection, may be initially … ### 1.1 Background Patients with cough frequently present to clinicians working in both primary and secondary care.1,2 Acute cough, which often follows an upper respiratory tract infection, may be initially disruptive but is usually self-limiting and rarely needs significant medical intervention. Chronic cough is often the key symptom of many important chronic respiratory diseases but may be the sole presenting feature of a number of extrapulmonary conditions, in particular upper airway and gastrointestinal disease. Even with a clear diagnosis, cough can be difficult to control and, for the patient, can be associated with impaired quality of life.3,4 Sessions dedicated to cough at respiratory meetings are popular, suggesting that the pathophysiology, evaluation, and successful treatment of cough remain topics of keen interest to many medical practitioners. ### 1.2 Need and purpose of BTS recommendations on the management of cough The American College of Chest Physicians (ACCP) and the European Respiratory Society (ERS)5,6 have each endorsed their own set of guidelines on the management of cough; however, criticism7 of their content and breadth suggest the need for further concise recommendations. The British Thoracic Society guidelines cover not only chronic cough but also acute cough and the organisational issues of cough clinics. International differences in delivery of respiratory health care and management strategies support the notion that such guidelines would be desirable. The British Thoracic Society Standards of Care Committee agreed to the development of a Working Group tasked with the job of producing a set of guidelines for the management of cough with the following key objectives:
No risk factors for P. aeruginosa (see table 12) Nonantipseudomonal cephalosporin III+macrolide # or Nonantipseudomonal cephalosporin III+(moxifloxacin or levofloxacin) Risk factors for P. aeruginosa (see table 12) Anti-pseudomonal cephalosporin " … No risk factors for P. aeruginosa (see table 12) Nonantipseudomonal cephalosporin III+macrolide # or Nonantipseudomonal cephalosporin III+(moxifloxacin or levofloxacin) Risk factors for P. aeruginosa (see table 12) Anti-pseudomonal cephalosporin " or Acylureidopenicillin/b-lactamase inhibitor or Carbapenem + ciprofloxacin P. aeruginosa: Pseudomonas aeruginosa.# : new macrolides preferred to erythromycin
Cough 1) All basic scientific articles should refer to cough as a three-phase motor act.For the purposes of acoustic recordings in clinical studies, however, cough should be described as a … Cough 1) All basic scientific articles should refer to cough as a three-phase motor act.For the purposes of acoustic recordings in clinical studies, however, cough should be described as a forced expulsive manoeuvre or manoeuvres against a closed glottis that are associated with a characteristic sound or sounds.
<h3>Abstract</h3> <b>Objective:</b> To compare immediate with delayed prescribing of antibiotics for acute otitis media. <b>Design:</b> Open randomised controlled trial. <b>Setting:</b> General practices in south west England. <b>Participants:</b> 315 children aged … <h3>Abstract</h3> <b>Objective:</b> To compare immediate with delayed prescribing of antibiotics for acute otitis media. <b>Design:</b> Open randomised controlled trial. <b>Setting:</b> General practices in south west England. <b>Participants:</b> 315 children aged between 6 months and 10 years presenting with acute otitis media. <b>Interventions:</b> Two treatment strategies, supported by standardised advice sheets—immediate antibiotics or delayed antibiotics (antibiotic prescription to be collected at parents9 discretion after 72 hours if child still not improving). <b>Main outcome measures:</b> Symptom resolution, absence from school or nursery, paracetamol consumption. <b>Results:</b> On average, symptoms resolved after 3 days. Children prescribed antibiotics immediately had shorter illness (−1.1 days (95% confidence interval −0.54 to −1.48)), fewer nights disturbed (−0.72 (−0.30 to −1.13)), and slightly less paracetamol consumption (−0.52 spoons/day (−0.26 to −0.79)). There was no difference in school absence or pain or distress scores since benefits of antibiotics occurred mainly after the first 24 hours—when distress was less severe. Parents of 36/150 of the children given delayed prescriptions used antibiotics, and 77% were very satisfied. Fewer children in the delayed group had diarrhoea (14/150 (9%) <i>v</i> 25/135 (19%), χ<sup>2</sup>=5.2, P=0.02). Fewer parents in the delayed group believed in the effectiveness of antibiotics and in the need to see the doctor with future episodes. <b>Conclusion:</b> Immediate antibiotic prescription provided symptomatic benefit mainly after first 24 hours, when symptoms were already resolving. For children who are not very unwell systemically, a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitis media.
Inhalation of aerosols of citric acid, histamine phosphate, or carbon dust, or air cooled to - 20 degrees C or rapid respiratory maneuvers (inspiration or expiration) results in an increase … Inhalation of aerosols of citric acid, histamine phosphate, or carbon dust, or air cooled to - 20 degrees C or rapid respiratory maneuvers (inspiration or expiration) results in an increase in airway resistance in some patients with asthma or bronchitis. It has been shown previously in animals that stimulation of cough receptors results in bronchoconstriction through efferent cholinergic pathways. In the patients studied, the administration of atropine sulfate, which would block such pathways, abolished the bronchoconstrictor effects of all the stimuli except large doses of histamine, which may exert a direct effect on airway smooth muscle. These data suggest that sensitized cough receptors may be involved in triggering reflex airway constriction in such patients.
Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the … Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance.To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing.We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing.Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance.Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.
The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the … The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the normal bronchi the observed range of values for the percentage volume of mucous glands was between 7·6 and 16·7. In the status asthmaticus group the mucous gland volume was greatly increased and in no case was there an overlap with the normal subjects. In the 19 cases of chronic bronchitis, two cases had values of 15·2 and 15·4% respectively, but all the others had values higher than the normal range and, in two instances, values of over 40% were obtained. The values obtained for mucous gland volume in the bronchi in emphysema were variable, approximately half being within the normal range. The bronchial smooth muscle accounted for 4·6±2·2% of the volume of the normal bronchial wall. The values obtained in chronic bronchitis and emphysema did not differ significantly from this but in those dying of status asthmaticus there was a very significant increase with a mean value of 11·9±3·36.
Eosinophilic bronchitis presents with chronic cough and sputum eosinophilia, but without the abnormalities of airway function seen in asthma. It is important to know how commonly eosinophilic bronchitis causes cough, … Eosinophilic bronchitis presents with chronic cough and sputum eosinophilia, but without the abnormalities of airway function seen in asthma. It is important to know how commonly eosinophilic bronchitis causes cough, since in contrast to cough in patients without sputum eosinophilia, the cough responds to inhaled corticosteroids. We investigated patients referred over a 2-yr period with chronic cough, using a well-established protocol with the addition of induced sputum in selected cases. Eosinophilic bronchitis was diagnosed if patients had no symptoms suggesting variable airflow obstruction, and had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness (provocative concentration of methacholine producing a 20% decrease in FEV(1) ([PC(20)] > 8 mg/ml), and sputum eosinophilia (> 3%). Ninety-one patients with chronic cough were identified among 856 referrals. The primary diagnosis was eosinophilic bronchitis in 12 patients, rhinitis in 20, asthma in 16, post-viral-infection status in 12, and gastroesophageal reflux in seven. In a further 18 patients a diagnosis was established. The cause of chronic cough remained unexplained in six patients. In all 12 patients with eosinophilic bronchitis, the cough improved after treatment with inhaled budesonide 400 micrograms twice daily, and in eight of these patients who had a follow-up sputum analysis, the eosinophil count decreased significantly, from 16.8% to 1.6%. We conclude that eosinophilic bronchitis is a common cause of chronic cough, and that sputum induction is important in the investigation of cough.
Chronic cough is a common condition which has a significant impact on quality of life. Assessment and management are hampered by the absence of well validated outcome measures. The development … Chronic cough is a common condition which has a significant impact on quality of life. Assessment and management are hampered by the absence of well validated outcome measures. The development and validation of the Leicester Cough Questionnaire (LCQ), a self-completed health related quality of life measure of chronic cough, is presented.Patients with chronic cough were recruited from outpatient clinics. The development of the LCQ consisted of three phases: phase 1 (item generation); phase 2 (item reduction, allocation of items to domains and validation of questionnaire); phase 3 (repeatability and responsiveness testing of final version of questionnaire).Phase 1: Literature review, multidisciplinary team meeting and 15 structured interviews with chronic cough patients generated 44 items (LCQ1) with a 7 point Likert response scale. Phase 2: 104 chronic cough outpatients completed the LCQ1 along with an importance rating for each item. The clinical impact factor method was used for item reduction to 19 items (LCQ2: final version). These items were divided into three domains (physical, psychological and social) following expert opinion. Internal reliability, as assessed using Cronbach's alpha coefficients, varied between 0.79 and 0.89. Concurrent validity was high when the LCQ2 (n=56) was compared with a cough visual analogue score (r=-0.72). There was a moderate relationship with response to the St George's Respiratory Questionnaire (r=-0.54) and SF36 total score (r=0.46). Phase 3: Two week repeatability (n=24) was high with intraclass correlation coefficients for domains varying between 0.88 and 0.96. Responsiveness in nine patients whose cough was successfully treated varied within domains from an effect size of 0.84 to 1.75.The LCQ is a valid, repeatable 19 item self-completed quality of life measure of chronic cough which is responsive to change. It should be a useful tool in clinical trials and longitudinal studies.
Cough is one of the most common symptoms for which patients seek medical attention from primary care physicians and pulmonologists,1 probably because cough can so profoundly and adversely affect the … Cough is one of the most common symptoms for which patients seek medical attention from primary care physicians and pulmonologists,1 probably because cough can so profoundly and adversely affect the quality of patients' lives.2 In this review, we present an approach to managing cough in adults. With a systematic approach based on the guidelines we describe, it should be possible to diagnose and treat cough successfully in the great majority of cases. The cause of chronic cough can be determined in 88 to 100 percent of cases, and determination leads to specific therapies with success rates that range from 84 . . .
On a multiple‐dose schedule of oral aminophylline (200 to 300 mg. every 6 hours) “trough” levels of serum theophylline in 83 patients ranged from 2.9 to 32.6 µg per milliliter. … On a multiple‐dose schedule of oral aminophylline (200 to 300 mg. every 6 hours) “trough” levels of serum theophylline in 83 patients ranged from 2.9 to 32.6 µg per milliliter. Levels usually remained in the same range for each individual. Kinetic studies demonstrate dependence of the mean serum level during multiple dosing on the intravenous theophylline half‐life. Theophylline renal clearances are small and constant. Thus, wide variations in metabolism appear to be chiefly responsible. Specific studies are needed to document this and to assess the contribution of absorption variables. Persistent nausea, vomiting, or anorexia were common with trough levels over 20 flg per milliliter but were not seen when trough levels were under 13 µg per milliliter. This suggests that these gastrointestinal side effects usually arise by some mechanism mediated through serum theophylline levels rather than from direct irritation of the gastric mucosa. Serial airway resistances in 7 asthmatic patients following a large single oral dose of aminophylline indicated that the minimum theophylline level required for maximum bronchodilator effect ranged between eight and 20 µg per milliliter. To achieve trough concentrations of 10 to 20 µg per milliliter, final dosage adjustments ranged from 400 to 3,200 mg. of aminophylline per 24 hours, averaging 1,200 mg. General guidelines are offered for aminophylline dose adjustment.
Vagal sensory neurons constitute the major afferent supply to the airways and lungs. Subsets of afferents are defined by their embryological origin, molecular profile, neurochemistry, functionality, and anatomical organization, and … Vagal sensory neurons constitute the major afferent supply to the airways and lungs. Subsets of afferents are defined by their embryological origin, molecular profile, neurochemistry, functionality, and anatomical organization, and collectively these nerves are essential for the regulation of respiratory physiology and pulmonary defense through local responses and centrally mediated neural pathways. Mechanical and chemical activation of airway afferents depends on a myriad of ionic and receptor-mediated signaling, much of which has yet to be fully explored. Alterations in the sensitivity and neurochemical phenotype of vagal afferent nerves and/or the neural pathways that they innervate occur in a wide variety of pulmonary diseases, and as such, understanding the mechanisms of vagal sensory function and dysfunction may reveal novel therapeutic targets. In this comprehensive review we discuss historical and state-of-the-art concepts in airway sensory neurobiology and explore mechanisms underlying how vagal sensory pathways become dysfunctional in pathological conditions.
These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients … These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
This clinical practice guideline formulates recommendations for health care providers regarding the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute … This clinical practice guideline formulates recommendations for health care providers regarding the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute bacterial sinusitis. It was developed through a comprehensive search and analysis of the medical literature. Expert consensus opinion was used to enhance or formulate recommendations where data were insufficient. A subcommittee, composed of pediatricians with expertise in infectious disease, allergy, epidemiology, family practice, and pediatric practice, supplemented with an otolaryngologist and radiologist, were selected to formulate the practice parameter. Several other groups (including members of the American College of Emergency Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Asthma, Allergy and Immunology, as well as numerous national committees and sections of the American Academy of Pediatrics) have reviewed and revised the guideline. Three specific issues were considered: 1) evidence for the efficacy of various antibiotics in children; 2) evidence for the efficacy of various ancillary, nonantibiotic regimens; and 3) the diagnostic accuracy and concordance of clinical symptoms, radiography (and other imaging methods), and sinus aspiration. It is recommended that the diagnosis of acute bacterial sinusitis be based on clinical criteria in children </=6 years of age who present with upper respiratory symptoms that are either persistent or severe. Although controversial, imaging studies may be necessary to confirm a diagnosis of acute bacterial sinusitis in children >6 years of age. Computed tomography scans of the paranasal sinuses should be reserved for children who present with complications of acute bacterial sinusitis or who have very persistent or recurrent infections and are not responsive to medical management. There were only 5 controlled randomized trials and 8 case series on antimicrobial therapy for acute bacterial sinusitis in children. However, these data, plus data derived from the study of adults with acute bacterial sinusitis, support the recommendation that acute bacterial sinusitis be treated with antimicrobial therapy to achieve a more rapid clinical cure. Children with complications or suspected complications of acute bacterial sinusitis should be treated promptly and aggressively with antibiotics and, when appropriate, drainage. Based on controversial and limited data, no recommendations are made about the use of prophylactic antimicrobials, ancillary therapies, or complementary/alternative medicine for prevention and treatment of acute bacterial sinusitis. This clinical practice guideline is not intended as a sole source of guidance in the diagnosis and management of acute bacterial sinusitis in children. It is designed to assist pediatricians by providing an analytic framework for evaluation and treatment. It is not intended to replace clinical judgment or establish a protocol for all patients with this condition.
Chronic obstructive pulmonary disease (COPD) is characterized by the progressive development of airflow limitation that is not fully reversible.1 The term COPD encompasses chronic obstructive bronchitis, with obstruction of small … Chronic obstructive pulmonary disease (COPD) is characterized by the progressive development of airflow limitation that is not fully reversible.1 The term COPD encompasses chronic obstructive bronchitis, with obstruction of small airways, and emphysema, with enlargement of air spaces and destruction of lung parenchyma, loss of lung elasticity, and closure of small airways. Chronic bronchitis, by contrast, is defined by the presence of a productive cough of more than three months' duration for more than two successive years. The cough is due to hypersecretion of mucus and is not necessarily accompanied by airflow limitation. However, there is some epidemiologic evidence that . . .
Whooping cough remains an urgent health problem to date, despite a fairly good study of the pathogen, epidemiological features, clinical manifestations, as well as the development of effective means of … Whooping cough remains an urgent health problem to date, despite a fairly good study of the pathogen, epidemiological features, clinical manifestations, as well as the development of effective means of specific prevention. Objective : to assess the epidemiological situation of whooping cough in the Orenburg region in 2023, identify risk groups, formulate prevention directions. Materials and methods : the analysis of the incidence of whooping cough was carried out on the basis of statistical reporting data, a retrospective analysis of 126 outpatient records with a diagnosis of whooping cough was carried out, according to the data of the referral to polyclinic. Results : in 2023, there was a significant increase in the incidence of pertussis infection in all age groups. The risk group for high morbidity was children aged 15—17 years, with a history of vaccinated against whooping cough. Conclusion : monitoring of vaccination and revaccination in young children, the alertness of practical doctors in the diagnosis of whooping cough in adolescents and adults will reduce the incidence of whooping cough and prevent adverse outcomes.
Introduction Gastroesophageal reflux-induced chronic cough (GERC) is a common extraesophageal manifestation of gastroesophageal reflux disease (GERD). However, the mechanisms underlying GERC remain unclear, and current treatments with anti-reflux drugs do … Introduction Gastroesophageal reflux-induced chronic cough (GERC) is a common extraesophageal manifestation of gastroesophageal reflux disease (GERD). However, the mechanisms underlying GERC remain unclear, and current treatments with anti-reflux drugs do not provide significant benefits in the management of GERC. Therefore, safe and effective drugs to treat GERC are urgently needed. Methods and analysis We designed a randomized, double-blind, placebo-controlled, parallel, multi-center, investigator-initiated clinical trial to assess the efficacy, safety, and economics of combined Ojeok-san (OJS) and Saengmaek-san (SMS) in treating GERC. Our trial will be conducted in five hospitals in Korea, and a total of 138 participants will be enrolled, equally divided between the OJS plus SMS and placebo groups. All participants will be instructed to receive OJS plus SMS or a placebo for 6 weeks and visit hospitals every 2 weeks until week 8 to evaluate their efficacy or safety outcomes. For efficacy outcomes, the cough diary score, cough VAS, Leicester Cough Questionnaire, Gastroesophageal Reflux Disease Questionnaire, Hull Airway Reflux Questionnaire, and 5-level EuroQol 5-dimensional Questionnaire will be evaluated to observe symptoms of cough and GERD, as well as the quality of life in patients with GERC. Pattern identification for the Chronic Cough Questionnaire and gastroesophageal reflux disease will be measured as an additional exploratory outcome. Safety will be assessed in terms of laboratory tests, vital signs, and adverse events; economic evaluation will be simultaneously conducted through the healthcare system and societal perspectives by estimating cost-utility and cost-effectiveness. Conclusion Our study proposes a combination of OJS and SMS to manage the symptoms of GERC as a new insight and this study results will provide scientific evidence for the use of OJS plus SMS in the treatment of GERC.
The physical and subjective status of patients with acute throat pain has been developed and refined over the past 40 years as an acute pain model to measure changes in … The physical and subjective status of patients with acute throat pain has been developed and refined over the past 40 years as an acute pain model to measure changes in patient-reported symptoms attributed to active pharmacologic intervention when patients with painful pharyngitis are evaluated under randomized, double-blind, placebo-controlled conditions. Acute, painful pharyngitis is a familiar experience for the majority of adults and children (“a sore throat” is the most common example of the aches and pains of the common cold). As such, the condition has served as a general acute pain model to demonstrate the acute effects of non-prescription-strength analgesic agents (for mild-to-moderate pain) and prescription-strength analgesics (for moderate-to-severe pain). Here we discuss the methodologic features of this clinical pharmacology assay as it was refined from its original examinations of classic, orally administered, acute analgesics (aspirin, acetaminophen, aspirin with caffeine, ibuprofen) to its more recent evaluations of celecoxib, valdecoxib, topical benzydamine, and topical flurbiprofen.
Markus Rühle , Agnes Mühle , Tobias Albrecht +2 more | Zeitschrift für Pneumologie
Cough is a common symptom of respiratory diseases. The formation of mucus in the respiratory tract and the cough reflex are associated with a physiological protective function. Productive cough in … Cough is a common symptom of respiratory diseases. The formation of mucus in the respiratory tract and the cough reflex are associated with a physiological protective function. Productive cough in inflammatory diseases is caused by hypersecretion of mucus; which can lead to impaired mucociliary clearance; increased risk of infection; airway occlusion; decreased therapy effectiveness; severe impairment of quality of life; and other complications. The article presents clinical cases of acute bronchitis and exacerbation of chronic obstructive pulmonary disease; demonstrating management tactics; including approaches to antibacterial therapy; as well as the effectiveness of combined mucoactive drugs for productive cough. A clinical case of acute bronchitis demonstrates a cure without the use of antibacterial therapy and the effectiveness of the combined mucolytic drug salbutamol + bromhexine hydrochloride + guaifenesin to relieve productive cough. Using the example of a clinical case of COPD exacerbation; the criteria for prescribing antibacterial therapy; as well as the effectiveness of prescribing a combined mucoactive drug to relieve cough and improve sputum expectoration; are analyzed. The validity and effectiveness of the use of combined mucoactive drugs; given in clinical cases; are compared with domestic and foreign clinical recommendations. The results of clinical studies that have proven the effectiveness of using a fixed combination of salbutamol + bromhexine hydrochloride + guaifenesin for productive cough; as well as improved sputum characteristics compared with other groups of mucolytic drug combinations; are presented.
Despite significant advances in the diagnosis and treatment of acute and chronic respiratory pathology accompanied by cough, the development of algorithms for choosing the optimal therapeutic strategy is one of … Despite significant advances in the diagnosis and treatment of acute and chronic respiratory pathology accompanied by cough, the development of algorithms for choosing the optimal therapeutic strategy is one of the pressing problems of clinical pediatrics. In recent years, there has been a growing interest in herbal medicine as a supplement to traditional methods of treating respiratory diseases. This is due not only to the safety of herbal preparations, but also to their ability to have a complex effect on the body, which is especially important in pediatric practice. In this context, phytotherapy is a promising direction. Particular attention is paid to herbal preparations based on ivy extract ( Hedera helix ), which contain various biologically active components that provide a complex and multidirectional effect. Modern data confirm the advisability of including ivy extract-based drugs in the complex therapy of respiratory infections in children, due to their high efficiency and favorable safety profile. Ivybased preparations are used as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract, possessing proven effects such as secretolytic, mucolytic, bronchospasmolytic and anti-inflammatory action. Herbal preparations based on ivy extract can be used in various forms – syrup, drops, which allows you to choose the most convenient and acceptable option for children of different ages. Thus, promising results and detailed study of the effects of herbal medicines based on ivy extracts serve as a basis for their recommendation as part of the complex therapy of cough in children.
Background/Objectives: Levocetirizine (LCZ) is a second-generation antihistamine with minimal central nervous system effects. However, its short half-life necessitates daily dosing, potentially reducing adherence in pediatric populations. This study aimed to … Background/Objectives: Levocetirizine (LCZ) is a second-generation antihistamine with minimal central nervous system effects. However, its short half-life necessitates daily dosing, potentially reducing adherence in pediatric populations. This study aimed to develop a long-acting injectable LCZ formulation by synthesizing lipophilic prodrugs and evaluating their physicochemical stability, enzymatic hydrolysis, and pharmacokinetics in vivo. Methods: Two prodrugs of LCZ, LCZ decanoate (LCZ-D) and LCZ laurate (LCZ-L), were synthesized via esterification with alkyl alcohols. The compounds were characterized using NMR, FT-IR, and DSC. Prodrugs were formulated with an oil-based vehicle (castor oil and benzyl benozate), and their hydrolysis was evaluated using porcine liver esterase (PLE) and rat plasma. Pharmacokinetic profiles were assessed in Sprague Dawley rats after oral or intramuscular administration. Stability was tested at 25 °C, 40 °C, and 60 °C for 6 weeks. Results: LCZ-D and LCZ-L exhibited first-order hydrolysis kinetics, with rates following the order of PLE (2.0 &gt; 0.5 units/mL) &gt; plasma &gt; PLE (0.2 units/mL). The Cmax of LCZ-D and LCZ-L were 13.95 and 5.12 ng/mL, respectively, with corresponding AUC0–45d values of 6423.12 and 2109.22 h·ng/mL. Formulations containing excipients with lower log P values led to increased systemic exposure. All formulations maintained therapeutic plasma concentrations for over 30 days. The inclusion of the antioxidant BHT (0.03% v/v) improved oxidative stability, reducing degradation at 60 °C from 4.72% to 1.17%. Conclusions: All formulations demonstrated potential for the long-acting delivery of LCZ, maintaining therapeutic plasma levels for over 30 days. Moreover, the release behavior and systemic exposure could be effectively modulated by excipient selection.
The article presents updated clinical guidelines for diagnosing and treating acute bronchitis, focusing on modern approaches to etiotropic and symptomatic therapy, differential diagnosis, and prevention. Key aspects include viral etiology, … The article presents updated clinical guidelines for diagnosing and treating acute bronchitis, focusing on modern approaches to etiotropic and symptomatic therapy, differential diagnosis, and prevention. Key aspects include viral etiology, criteria for antibiotic prescription, the role of mucolytics, and non-specific preventive measures. The recommendations, based on recent research, aim to optimize patient management strategies in outpatient settings.
<title>Abstract</title> Introduction: Rhinovirus (RV) is the leading cause of exacerbations of lung disease. A sensory neuronal model, derived from human dental pulp stem cells and differentiated into peripheral neuronal equivalents … <title>Abstract</title> Introduction: Rhinovirus (RV) is the leading cause of exacerbations of lung disease. A sensory neuronal model, derived from human dental pulp stem cells and differentiated into peripheral neuronal equivalents (PNEs), was used to examine RV's effects on airway sensory nerves. We investigated whether RV can directly infect and alter PNEs or whether it exerts effects indirectly via the release of mediators from infected epithelial cells. Methods PNEs or primary bronchial epithelial cells (PBECs) were infected with the RV-A16 strain. Viral replication was confirmed by viral titration assays, immunofluorescence (IF) for the double-stranded RNA (dsRNA) replication intermediate and western blotting (WB). RNA sequencing was used to determine transcriptomic changes in PNEs, and inflammatory responses were assessed by inflammatory microarray. Calcium mobilisation assays were used to investigate the effect of interleukin-1β (IL-1β) on PNE transient receptor potential (TRP) A1 channel responses. Results Viral titrations, WB and IF confirm RV-A16 entry and replication in PNEs and PBECs. Gene signatures associated with antiviral immune responses, sensory neuropathies and N-Methyl-D-aspartic acid (NMDA) receptor activity were upregulated in RV infected PNEs. Several cytokines were increased from PNEs and PBECs following RV infection, most notably IL-1β. Treatment of PNEs with IL-1β resulted in heightened TRPA1 channel sensitivity. Conclusion We report the suitability of an airway neuronal model for the study of the direct effects of RV infection on nerves. RV induced release of IL-1β from airway epithelium heightens neuronal TRPA1 responses suggesting a mechanism for virus induced cough hypersensitivity.
Patients with lung cancer tend to suffer from cough, which is usually managed with antitussives and opioids. Some of these patients develop cough that do not respond to these first … Patients with lung cancer tend to suffer from cough, which is usually managed with antitussives and opioids. Some of these patients develop cough that do not respond to these first line medications. Nebulized lidocaine can be administered to help relieve this distressing symptom. We describe two patients with lung cancer who developed cough despite use of antitussives, opioids and antibiotics (Patient A) in an inpatient hospice. Both patients responded to the addition of nebulized lidocaine to manage cough. In this paper, we outline clinical considerations for its use in cough.
<title>Abstract</title> Based on data from the National Health and Nutrition Examination Survey (NHANES), this study analyzed the association between chronic cough and chronic diarrhea in 7,007 adults aged 40 years … <title>Abstract</title> Based on data from the National Health and Nutrition Examination Survey (NHANES), this study analyzed the association between chronic cough and chronic diarrhea in 7,007 adults aged 40 years and older. Results showed that 8.81% of participants had chronic diarrhea, and after adjusting for confounders such as smoking and sleep by binary logistic regression, patients with chronic cough had a 50% increased risk of chronic diarrhea compared to those without cough (OR = 1.50).9 Subgroup analyses showed that none of the covariates (e.g., age, gender) interacted with the outcome significantly (p &gt; 0.05 by interaction test), suggesting that these factors influenced the outcome independently rather than through an interaction. This study demonstrated for the first time in a large population the positive correlation between chronic cough and chronic diarrhea, supporting the “lung-gut axis” theory and emphasizing the need for synergistic interventions for gastrointestinal symptoms in the management of chronic cough.9 The results of this study provide new perspectives for the integrated management of the two co-morbidities in the clinical setting, including the synergistic effects of psychosocial co-morbidities, therapeutic strategies, and the potential for microbiological interventions. synergistic effects and the potential for microbial intervention.
Zusammenfassung Inhalative Kortikosteroide (ICS) werden als leitliniengerechte Therapie bei Asthma bronchiale sowie einer chronisch obstruktiven pulmonalen Erkrankung (COPD) eingesetzt. Unerwünschte Wirkungen dieser Arzneimitteltherapie sind oropharyngeale und laryngeale Candidosen und die … Zusammenfassung Inhalative Kortikosteroide (ICS) werden als leitliniengerechte Therapie bei Asthma bronchiale sowie einer chronisch obstruktiven pulmonalen Erkrankung (COPD) eingesetzt. Unerwünschte Wirkungen dieser Arzneimitteltherapie sind oropharyngeale und laryngeale Candidosen und die chronische Laryngitis. Das inhalative Kortikosteroid Ciclesonid entfaltet als Prodrug seine aktive Wirkung erst in der Lunge. Die Reduktion oropharyngealer Candidosen wurde bereits unter Ciclesonid beschrieben, und ein möglicher positiver Effekt auf Kehlkopfschleimhäute sollte nun geprüft werden. Videolupenlaryngoskopische und -stroboskopische Aufzeichnungen sowie Stimmanalysen wurden nach ICS-Umstellung retrospektiv befundet. Die Kontrollgruppen beinhalteten Patienten*innen, die keine Umstellung vorgenommen oder ihr ICS abgesetzt hatten. Die statistische Auswertung zeigte, dass alle 3 Patient*innengruppen zwischen Erstdiagnose und Verlaufskontrolle eine Tendenz zur Funktions- und Befundbesserung des Larynx aufwiesen. Die Ergebnisse waren nicht von statistischer Signifikanz. Die Ursachen für eine chronische Laryngitis sind häufig multifaktoriell (Rauchen, ICS, Reflux, Diabetes). Die Umstellung des ICS auf Ciclesonid ist ein Teilaspekt bei der Therapie der chronischen Laryngitis, dessen Anwendung anstelle eines anderen ICS zur Therapie pulmonaler Erkrankungen scheint unerwünschte laryngeale Wirkungen zu reduzieren. Bereits eine umfassende fachärztliche Beratung und Anleitung zur Schleimhauthygiene scheint einen positiven Therapieeffekt zu haben.
Background &amp; Aims: Localised acidification from immune cell infiltration and heightened glycolysis contributes to colitis pathology by activating acid-sensing receptors such as GPR68, a proton-sensing GPCR expressed on immune and … Background &amp; Aims: Localised acidification from immune cell infiltration and heightened glycolysis contributes to colitis pathology by activating acid-sensing receptors such as GPR68, a proton-sensing GPCR expressed on immune and stromal cells. Single-cell RNAseq analysis revealed GPR68 is also expressed in colonic sensory neurons, prompting us to investigate its role in acid-induced colonic nociception. Methods: Expression of GPR68 in colonic nociceptors and tissue from people with colitis was confirmed by in silico analysis of our RNAseq databases. Its contribution to disease activity was assessed using the acute dextran sulphate sodium (DSS) model of colitis. Acid-evoked sensory signalling was evaluated via colonic afferent recordings and Ca2+; imaging in DRG neurons from wild-type and GPR68-/- mice, supported by pharmacological studies using Ogerin (a GPR68 positive allosteric modulator) and Ogremorphin (a GPR68 antagonist). Results: RNAseq analysis showed GPR68 is robustly expressed in Trpv1+; colonic nociceptors and upregulated in tissue from people with inflammatory bowel disease, consistent with reduced disease activity in DSS-treated GPR68-/- mice. Genetic deletion of GPR68 abolished colonic afferent responses to acid, which were also attenuated by Ogremorphin and enhanced by Ogerin. In Ca2+;-free buffer, DRG neurons from GPR68-/- mice or those pre-treated with Ogremorphin showed significantly reduced acid-evoked intracellular Ca2+; responses. By contrast the colonic afferent and DRG Ca2+ response (in Ca2+-containing buffer) to capsaicin was comparable between tissue from wild-type and GPR68-/- mice highlighting the involvement of divergent proton-dependent cellular signalling cascades. Conclusions: These findings identify GPR68 as a key mediator of acid-induced colonic nociception and highlight its potential as a therapeutic target for the treatment of pain in colitis.
Background: Opioid-induced cough (OIC) during anesthetic induction represents a significant clinical challenge with potential adverse physiological effects. Although dexamethasone has emerged as a potential preventive agent, individual studies have shown … Background: Opioid-induced cough (OIC) during anesthetic induction represents a significant clinical challenge with potential adverse physiological effects. Although dexamethasone has emerged as a potential preventive agent, individual studies have shown inconsistent results. This meta-analysis aimed to evaluate the efficacy of dexamethasone pretreatment in preventing OIC during anesthetic induction. Methods: We conducted a systematic search of the Medline, EMBASE, Cochrane Library, and Google Scholar databases from inception to December 2024. Randomized controlled trials comparing dexamethasone pretreatment with placebo or no treatment in adult patients undergoing general anesthesia were included. The primary outcome was the overall incidence of OIC. Secondary outcomes included the severity of cough, which was categorized as mild, moderate, or severe. Results: Seven randomized controlled trials involving 591 patients were included. In these studies, dexamethasone dosages ranged from 0.1 to 0.15 mg/kg or fixed 10 mg, administered 1 to 5 minutes before opioid administration. Dexamethasone pretreatment significantly reduced the overall incidence of OIC compared to the control (risk ratio [RR]: 0.48, 95% confidence interval [CI]: 0.26–0.87, P = .02, I 2 = 91%). For secondary outcomes, dexamethasone showed no significant effect on mild cough (RR: 0.75, 95% CI: 0.41–1.37, P = .35, I 2 = 66%) and severe cough (RR: 0.28, 95% CI 0.08–0.99, P = .05, I 2 = 0%), but significantly reduced moderate cough (RR: 0.45, 95% CI 0.29–0.71, P = .0005, I 2 = 0%). All included studies demonstrated a low risk of bias, although funnel plot analysis suggested potential publication bias. Trial sequential analysis suggests that the current evidence base remains insufficient to draw firm conclusions. Conclusion: Dexamethasone pretreatment effectively reduced the overall incidence of OIC during anesthetic induction, with particular efficacy in preventing moderate cases. These findings support the use of dexamethasone as a preventive strategy in anesthetic practice, particularly for patients at a higher risk of complications from cough episodes. Because the current evidence remains inconclusive, further studies are needed to confirm these findings, determine optimal dosing strategies, and assess the effectiveness in broader patient populations beyond American Society of Anesthesiologists I–II status.
The United States Food and Drug Administration (FDA) proposed removing oral phenylephrine (PE) from over-the-counter single-agent and combination products because it is ineffective at FDA-approved doses to treat sinonasal congestion. … The United States Food and Drug Administration (FDA) proposed removing oral phenylephrine (PE) from over-the-counter single-agent and combination products because it is ineffective at FDA-approved doses to treat sinonasal congestion. Health care providers make thousands of recommendations per month for phenylephrine-containing over-the-counter products to treat adults and children with signs and symptoms of the common cold, specifically nasal congestion. Health care providers may feel compelled by parents to recommend over-the-counter medications to treat the common cold in children, despite resources suggesting those products may be mildly effective, ineffective, or possibly unsafe. The objective of this Pharmacotherapy Update is to suggest alternative treatments to PE in children with the common cold and nasal congestion.
Background: Cough reflex sensitivity during cough challenge testing has been found to be modifiable with distraction in groups of healthy individuals. The purpose of this study was to examine this … Background: Cough reflex sensitivity during cough challenge testing has been found to be modifiable with distraction in groups of healthy individuals. The purpose of this study was to examine this phenomenon in healthy controls and patients with refractory chronic cough (RCC) to advance our understanding of the role attention plays in cough modulation and shed light on avenues for therapeutic advances for RCC. Methods: Thirteen adults with RCC (mean age = 60, 12 women) and twelve healthy controls (mean age = 60, 11 women) participated in this study. The participants completed cough challenge testing with nebulized capsaicin doses tailored to their individual cough reflex sensitivity under distraction and no-distraction conditions. The distraction condition consisted of cough challenge testing while completing a cognitive (visual memory) task on a tablet. Capsaicin doses included the dose that elicited two coughs (C2), and up to three doubling doses above C2. Capsaicin doses were administered in serial order with a placebo dose randomized into the order to control for an anticipation effect during each condition. For each dose administered, the participants were instructed to cough if they needed to. Cough frequency within 15 s and maximal urge-to-cough with each dose were recorded. The order of conditions (distraction or no distraction) was alternated, and all testing was completed within one session. Results: There were no meaningful differences in the dose–response rate parameters for cough frequency or urge-to-cough, respectively, when comparing the results from the RCC group in the condition without distraction to the condition with distraction (p = 0.647, 95% CI = −2.25, 1.15; p = 0.783, 95% CI = −1.94, 0.84), and to the healthy control group without distraction (p = 0.921, 95% CI = −2.11, 2.73, p = 0.887, 95% CI = −1.40, 0.80), and with distraction (p = 0.970, 95% CI = −2.16, 3.36), p = 0.808, 95% CI = −1.49, 0.89). Conclusions: Distraction with the cognitive task chosen in this study did not influence cough reflex sensitivity in either group, which is contrary to studies on healthy volunteers and anecdotal evidence reported by RCC patients. Attentional resources may not have been sufficiently taxed, or too few capsaicin doses were administered to capture an effect as there was high individual variability in cough frequency and urge-to-cough. Additional research is needed to tailor the difficulty of the cognitive task to each participant and incorporate a real-world distraction scenario that may better reveal how attentional manipulation could be harnessed to optimize the effectiveness of behavioral cough suppression therapy for patients with refractory chronic cough.
John A. Smith | American Journal of Respiratory and Critical Care Medicine
Aim To determine the safety and efficacy of a 0.5% povidone-iodine nasal spray (Nasodine) as a treatment for the common cold (ACTRN12619000764134). Methods A multi-center, randomized, controlled, double-blind Phase III … Aim To determine the safety and efficacy of a 0.5% povidone-iodine nasal spray (Nasodine) as a treatment for the common cold (ACTRN12619000764134). Methods A multi-center, randomized, controlled, double-blind Phase III study was conducted to assess the impact of Nasodine on the common cold. Two hundred and sixty (260) euthyroid adults with qualifying cold symptoms and meeting inclusion/exclusion criteria were randomized 2:1 to Nasodine or matching saline nasal spray (SNS), each applied 4 times daily for 5 days. Cold severity was reported using the WURSS-21 survey. The primary endpoint was impact on nasal symptoms (4-item scale), with the validated 19-item Global Severity Score (GSS) as the key secondary endpoint. Results All cold severity outcomes pointed in favor of Nasodine over SNS. In the ITT ( n = 260), the Nasodine benefit over SNS on nasal symptoms was 8.4% ( p = 0.217). For GSS, the benefit was 12.6% ( p = 0.054) in the ITT population. Post hoc subset analyses showed markedly improved benefits of Nasodine: In subjects with stronger symptoms at enrollment (ES), the GSS benefit was 17.1% ( p = 0.023); for those with confirmed viral infection (VES), GSS benefit was 23.0% ( p = 0.048); and for those enrolled within 24 h of symptom onset (24S), GSS benefit was 39.7% ( p = 0.024). In terms of functional impairment, the Nasodine benefit was greater in all subsets, with 16.1% ( p = 0.041) benefit in ITT, 22.2% in ES ( p = 0.012), 32.1% in VES ( p = 0.023) and 37.1% in 24S ( p = 0.093). Nasodine was well tolerated, with mild transient nasopharyngeal discomfort being a common adverse effect. Conclusion Nasodine treatment had a consistently positive and clinically meaningful benefit on overall cold severity when compared with saline nasal spray. Early treatment after symptom onset is an important efficacy factor. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377353&amp;amp;isReview=true , identifier ACTRN12619000764134.
Thomas Meißner | HNO Nachrichten
ABSTRACT Purpose Onset of pediatric exercise induced laryngeal obstruction (EILO) often occurs in athletic contexts. This study investigated athletic coach awareness of EILO in children and adolescents. Strategies employed by … ABSTRACT Purpose Onset of pediatric exercise induced laryngeal obstruction (EILO) often occurs in athletic contexts. This study investigated athletic coach awareness of EILO in children and adolescents. Strategies employed by coaches when working with athletes with EILO and exercise induced dyspnea (EID) of unknown etiology were also examined. Methods EILO awareness was assessed using an anonymous electronic survey distributed to three types of athletic coaches: sport coaches, dance instructors, and physical education teachers. Survey distribution occurred via social media, Reddit, and sport coach/dance instructor association email listservs. Results Three‐hundred and two athletic coaches responded to the survey (mean age = 43.4 years). Overall, only 22.5% ( N = 68) of survey respondents indicated familiarity with EILO. Twelve percent ( N = 38) of coaches reported that they had worked directly with an athlete diagnosed with EILO. Neither sport coached, respondent age, nor years of experience predicted which coaches were familiar with EILO. Fifty‐eight percent ( N = 176) of athletic coaches indicated that they worked with athletes with EID of unknown etiology “often.” Coaches were significantly more confident working with athletes with EID as compared to EILO ( p = 0.021). Coaches reported that working with athletes with dyspnea was common, however, athletes rarely disclosed breathing symptom etiology. Conclusion Less that one fourth of athletic coaches reported any awareness of EILO. Coaches overwhelmingly indicated that better communication with athletes and increased knowledge of EILO would allow them to coach athletes more effectively. Future work should determine whether coordinating EILO and EID treatment with athletic coaches can improve treatment outcomes.
Chronic cough in children is an increasingly important public health issue. It typically involves diseases related to the upper respiratory tract, lower respiratory tract, and reflux. Due to its often … Chronic cough in children is an increasingly important public health issue. It typically involves diseases related to the upper respiratory tract, lower respiratory tract, and reflux. Due to its often multifactorial nature, the diagnosis and treatment of chronic cough present significant challenges, necessitating multidisciplinary collaboration among otolaryngology, pulmonology, and gastroenterology. This article aims to review the unique role of otolaryngology in the diagnosis and treatment of conditions associated with chronic cough in children.