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81. Translating cough mechanisms into better cough suppressants. (Abstract)

Translating cough mechanisms into better cough suppressants. Chronic cough is a significant problem, and in many patients cough remains refractive to both disease-specific therapies and current cough-suppressing medicines, creating a need for improved antitussive therapies. Most patients with chronic cough also display heightened sensitivity so that they experience a persistent sense of the need to cough, and often innocuous stimuli can trigger their coughing. This hypersensitivity underpins (...) the newly described concept of cough hypersensitivity syndrome (CHS), a term that encapsulates the notion of common underlying mechanisms producing neuronal activation, sensitization and/or dysfunction, which are at the core of excessive coughing. Understanding these mechanisms has been a focus of recent research efforts in the field in the hope that new therapies can be developed to selectively target sensitized unproductive cough while maintaining the reflexive cough essential for airway protection

2017 Chest

82. Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis. Full Text available with Trip Pro

Health seeking behavior among individuals presenting with chronic cough at referral hospitals in Uganda; Missed opportunity for early tuberculosis diagnosis. Tuberculosis (TB) is the 9th leading cause of death from a single infectious agent. Patients live in a complex health care system with both formal and informal providers, and it is important that a TB diagnosis is not missed at the first interaction with the health care system. In this study, we highlight the health seeking behavior (...) of patients and missed opportunities for early TB diagnosis for which interventions could be instituted to ensure early TB diagnosis and prompt TB treatment initiation.This study was nested in a cross-sectional study that assessed the accuracy of different Xpert MTB/Rif implementation strategies in programmatic settings at the referral hospitals in Uganda. We documented the symptom profile of presumptive TB patients and assessed the health seeking behavior of those with chronic cough by calculating

2019 PLoS ONE

83. An advanced recording and analysis system for the differentiation of guinea pig cough responses to citric acid and prostaglandin E2 in real time. Full Text available with Trip Pro

An advanced recording and analysis system for the differentiation of guinea pig cough responses to citric acid and prostaglandin E2 in real time. Cough number and/or sound have been used to assess cough sensitivity/intensity and to discriminate cough patterns in clinical settings. However, to date, only manual counting of cough number in an offline manner is applied in animal cough studies, which diminishes the efficiency of cough identification and hinders the diagnostic discrimination (...) of cough patterns, especially in animals with pulmonary diseases. This study aims to validate a novel recording/analysis system by which cough numbers are automatically counted and cough patterns are comprehensively differentiated in real time. The experiment was carried out in conscious guinea pigs exposed to aerosolized citric acid (CA, 150 mM) and prostaglandin E2 (PGE2, 0.43 mM). Animal body posture (video), respiratory flow, and cough acoustics (audio) were simultaneously monitored and recorded

2019 PLoS ONE

84. Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report Full Text available with Trip Pro

Treatment of Interstitial Lung Disease Associated Cough: CHEST Guideline and Expert Panel Report Chronic cough in interstitial lung disease (ILD) causes significant impairment in quality of life. Effective treatment approaches are needed for cough associated with ILD.This systematic review asked: Is there evidence of clinically relevant treatment effects for therapies for cough in ILD? Studies of adults aged > 18 years with a chronic cough ≥ 8 weeks' duration were included and assessed (...) for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using CHEST guideline methodology.Eight randomized controlled trials and two case series (≥ 10 patients) were included that reported data on patients with idiopathic pulmonary fibrosis, sarcoidosis, and scleroderma-related ILD who received a variety of interventions. Study quality was high in all eight randomized controlled trials. Inhaled corticosteroids were not supported for cough associated

2018 EvidenceUpdates

85. Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report Full Text available with Trip Pro

Cough Due to TB and Other Chronic Infections: CHEST Guideline and Expert Panel Report Cough is common in pulmonary TB and other chronic respiratory infections. Identifying features that predict whether pulmonary TB is the cause would help target appropriate individuals for rapid and cost-effective screening, potentially limiting disease progression and preventing transmission to others.A systematic literature search for individual studies to answer eight key questions (KQs) was conducted (...) according to established Chest Organization methods by using the following databases: MEDLINE via PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews from January 1, 1984, to April 2014. Searches for KQ 1 and KQ 3 were updated in February 2016. An updated KQ 2 search was undertaken in March 2017.Even where TB prevalence is greatest, most individuals with cough do not have pulmonary TB. There was no evidence that 1, 3, or 4 weeks' duration were better predictors than cough lasting ≥ 2

2018 EvidenceUpdates

86. Endotracheal tube cuff pressure change: Proof of concept for a novel approach to objective cough assessment in intubated critically ill patients. (Abstract)

Endotracheal tube cuff pressure change: Proof of concept for a novel approach to objective cough assessment in intubated critically ill patients. Cough strength assessment aids in predicting extubation failure. Peak expiratory flow rate during cough manoeuvre (CPF) is the gold-standard tool and flow rates of <60l/min suggest risk of failed extubation. We aimed to assess endotracheal tube cuff pressure change (ΔPcuff) as a novel method of objective cough strength assessment in intubated patients (...) considered for extubation.Paired measurements of CPF and ΔPcuff were sampled during cough manoeuvres by intubated recovering critically ill patients. Spearman's correlation was used to assess agreement between the variables. Categorical data and receiver operating characteristic (ROC) curve analysis were undertaken to assess discriminating ability of ΔPcuff to identify low CPF.In total, 42 patients yielded 81 paired measurements. Paired samples with the highest CPF per patient had a correlation

2020 Heart & Lung

87. Cough in hypereosinophilic syndrome: case report and literature review. Full Text available with Trip Pro

Cough in hypereosinophilic syndrome: case report and literature review. Cough and airway eosinophilic inflammation has not been highlighted in hypereosinophilic syndrome (HES).We report 2 further cases and reviewed the clinical features and treatment of HES present with cough from the literature. Both cases were middle age male, presenting with chronic cough, airway eosinophilic inflammation and hyper eosinophilia who have been previous misdiagnosed as cough-variant asthma and failed anti (...) -asthma treatment. PDGFRA fusion gene was confirmed in one case, but not in the other case. Both had evidence of myeloproliferative features. The tyrosine kinase inhibitor, imatinib, resulted in complete resolution of eosinophilia and cough. By searching PubMed, we found 8 HES cohorts of 411 cases between 1975 and 2013, where the incidence of cough was 23.11%. Sixteen case reports of HES presented with cough as predominant or sole symptom, with nine male patients with positive PDGFRA fusion gene, who

2020 BMC pulmonary medicine

88. Coughs and Sneezes: Their Role in Transmission of Respiratory Viral Infections, Including SARS-CoV-2. Full Text available with Trip Pro

Coughs and Sneezes: Their Role in Transmission of Respiratory Viral Infections, Including SARS-CoV-2. Coughs and sneezes disperse a large number of droplets of varying size into the environment, and they transmit respiratory viral infections by direct or indirect physical contact, by droplets or inhalation of fine particulate droplet nuclei. Larger droplets in the cloud produced by coughing and sneezing settle quickly, and the force with which they are expelled determines how far (...) they are dispersed. The respiratory droplets evaporate to form smaller droplet nuclei that carry infectious agents, remain suspended in air, and susceptible individuals farther away from the source could inhale them. The particle size distribution within the multi-phase cloud produced by coughs/sneezes changes with time and distance from the source depending on several environmental factors. After inhalation, larger respiratory droplets are filtered by the nose or deposit in the oropharynx, whereas smaller

2020 American journal of respiratory and critical care medicine

89. The Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm. (Abstract)

The Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm. Cough is one of the most common complaints encountered in every setting; however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous (...) system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. Reported cough-induced pathology ranges from rare (the majority) to common and from trivial (eg, lightheadedness, subconjunctival hemorrhage) to severe and life-threatening (eg, cervical artery dissection, rupture of a normal spleen). Other seemingly benign entities may mask a serious underlying pathology (eg, cough headache, cough syncope

2020 American Journal of Medicine

90. Inhaled Aztreonam improves symptoms of cough and sputum production in patients with bronchiectasis: a post-hoc analysis of the AIR-BX studies. (Abstract)

Inhaled Aztreonam improves symptoms of cough and sputum production in patients with bronchiectasis: a post-hoc analysis of the AIR-BX studies. Inhaled antibiotics may improve symptom scores but it is not known which specific symptoms improve with therapy. Item-level analysis of questionnaire data may allow us to identify which specific symptoms respond best to treatment.Post-hoc analysis of the AIR-BX1 and 2 trials of inhaled aztreonam versus placebo in bronchiectasis. Individual items from (...) the quality of life bronchiectasis respiratory symptom scale (QOL-B) were extracted, as representing severity of 9 distinct symptoms. Generalised linear models were used to evaluate changes in symptoms with treatment versus placebo from baseline to end of first on treatment cycle and mixed models used to evaluate changes across the full 16 week trial.Aztreonam improved cough (difference 0.22; 95%CI 0.08-0.37, p=0.002), sputum production (0.30; 95%CI 0.15-0.44, p<0.0001) and sputum colour (0.29; 95%CI 0.15

2020 European Respiratory Journal

91. Vagus Associated Neurogenic Cough Occurring Due to Unilateral Vascular Encroachment of Its Root: A Case Report and Proof of Concept of VANCOUVER Syndrome. (Abstract)

Vagus Associated Neurogenic Cough Occurring Due to Unilateral Vascular Encroachment of Its Root: A Case Report and Proof of Concept of VANCOUVER Syndrome. A patient is presented with neurogenic cough due to a unilateral vascular compression of a vagus nerve rootlet at the brainstem with complete resolution of cough following microvascular decompression of that nerve. This etiology of a neurogenic cough has not been previously reported to our knowledge. The proportion of patients with neurogenic (...) cough refractory to all current therapies and suffering with this treatable condition remains to be defined. We introduce the concept of Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Encroachment of its Root (VANCOUVER syndrome) and present the salient features of this condition.A case review is presented with details of the patient's history, examination, imaging, laryngoscopy, intraoperative findings, and long-term clinical outcome.A 60-year-old man presented with a 15

2020 Rhinology and Laryngology

92. Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis. Full Text available with Trip Pro

Long-term treatment with clarithromycin and carbocisteine improves lung function in chronic cough patients with chronic rhinosinusitis. Chronic cough is a common complaint. Because the pathophysiology of chronic cough is complicated, the management of chronic cough is challenging. To the best of our knowledge, no previous study has examined the effect of macrolide antibiotics in chronic cough patients with chronic rhinosinusitis. The purpose of this study is to determine the changes in lung (...) function for chronic cough patients with chronic rhinosinusitis who are treated by clarithromycin and carbocisteine.Thirty-two chronic cough patients with chronic rhinosinusitis were recruited. Patients using inhaled corticosteroids and/or a bronchodilator, asthmatic patients, and patients with abnormal findings on auscultation and/or chest X-ray examination were excluded from this study. The patients received low-dose clarithromycin treatment for 3 months. Both before and after the treatment

2020 American Journal of Otolaryngology

93. Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough. (Abstract)

Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough. Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27).The PC-QOL-27 survey was administered to ADC patients with chronic cough (...) at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months.Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary

2020 Rhinology and Laryngology

94. Honey for coughs in children with URTI

Honey for coughs in children with URTI RACGP - Honey and cough in children with URTI Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship Fellowship (...) Media Releases 2013 Media Releases 2012 Media Releases Search Honey and cough in children with URTI Honey and cough in children with URTI Introduction Cough associated with an URTI in children does not require treatment but treatment may be necessary when the cough interferes with sleep. Indication Honey may be used if a cough suppressant is sought for the short-term symptomatic relief of nocturnal cough in children (12 months to 18 years of age) with an URTI after other causes of the cough have

2014 Handbook of Non-Drug interventions (HANDI)

95. Clinical pathways for chronic cough in children. Full Text available with Trip Pro

Clinical pathways for chronic cough in children. Chronic cough (a cough lasting longer than four weeks) is a common problem internationally. Chronic cough has associated economic costs and is distressing to the child and to parents; ignoring cough may lead to delayed diagnosis and progression of serious underlying respiratory disease. Clinical guidelines have been shown to lead to efficient and effective patient care and can facilitate clinical decision making. Cough guidelines have been (...) designed to facilitate the management of chronic cough. However, treatment recommendations vary, and specific clinical pathways for the treatment of chronic cough in children are important, as causes of and treatments for cough vary significantly from those in adults. Therefore, systematic evaluation of the use of evidence-based clinical pathways for the management of chronic cough in children would be beneficial for clinical practice and for patient care. Use of a management algorithm can improve

2014 Cochrane

96. Whooping cough

Whooping cough Whooping cough - NICE CKS Share Whooping cough: Summary Whooping cough, also known as pertussis, is a highly infectious disease caused by the bacterium Bordetella pertussis . It is spread by aerosol droplets released during coughing, and disproportionately affects infants and young children. The name of the infection is derived from the characteristic 'whoops' that occur in younger children, caused by sharp inhalation of breath during bouts of paroxysmal cough. The incubation (...) period of whooping cough is usually about 7 days, and the person is infectious for 3 weeks after the onset of symptoms. Whooping cough has 3 phases of symptoms. The catarrhal phase lasts approximately a week and is characterized by the development of a dry, unproductive cough. The paroxysmal phase may last for a month or more and is characterized by coughing fits, whooping, and post-tussive vomiting. The person may be relatively well between paroxysms. The convalescent phase may last an additional 2

2018 NICE Clinical Knowledge Summaries

97. Mechanical insufflation-exsufflation assisted coughing in neuromuscular diseases

Mechanical insufflation-exsufflation assisted coughing in neuromuscular diseases Mechanical insufflation-exsufflation assisted coughing in neuromuscular diseases Mechanical insufflation-exsufflation assisted coughing in neuromuscular diseases Secco A, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality (...) of this assessment has been made for the HTA database. Citation Secco A, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A, Rey-Ares L. Mechanical insufflation-exsufflation assisted coughing in neuromuscular diseases. Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Documentos de Evaluación de Tecnologías Sanitarias, Informe de Respuesta Rápida N° 445. 2015 Authors' conclusions The existing evidence on mechanical insufflation-exsufflation

2015 Health Technology Assessment (HTA) Database.

98. Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia. Full Text available with Trip Pro

Posture and firmness changes in a pressure-relieving air mattress affect cough strength in elderly people with dysphagia. Dysphagia is the major pathophysiologic mechanism leading to aspiration pneumonia in the elderly. Elderly people with dysphagia who show low levels of the cough peak flow (CPF) are at greater risk for aspiration pneumonia. It has been reported that CPF values were significantly lower in the "soft" versus "hard" mode of a pressure-relieving air mattress in healthy volunteers (...) in a supine position. Parameters such as spinal curvature, however, were not evaluated in detail. In this study, we clarified whether the changes in posture associated with two different firmness levels of a pressure-relieving air mattress were associated with cough production and related factors in the elderly with dysphagia. The body sinking distance, pelvic tilt angle, and immersion of the lumbar spine were measured to evaluate changes in posture. Forty subjects met the study criteria for dysphagia

2018 PLoS ONE

99. Psychometric properties of the German version of the Leicester Cough Questionnaire in sarcoidosis. Full Text available with Trip Pro

Psychometric properties of the German version of the Leicester Cough Questionnaire in sarcoidosis. Cough is one of the most common symptoms in general and pulmonary medicine with profound negative impact on health-related quality of life (HRQL). The Leicester Cough Questionnaire (LCQ) is a validated HRQL questionnaire, yet a validated German version of the LCQ is not available and it has never been tested in a cohort with sarcoidosis.To translate the LCQ into German and determine its

2018 PLoS ONE

100. Computational Modelling of Cough Function and Airway Penetrant Behavior in Patients with Disorders of Laryngeal Function Full Text available with Trip Pro

Computational Modelling of Cough Function and Airway Penetrant Behavior in Patients with Disorders of Laryngeal Function Patients with laryngeal disorders often exhibit changes to cough function contributing to aspiration episodes. Two primary cough variables (peak cough flow: PCF and compression phase duration: CPD) were examined within a biomechanical model to determine their impact on characteristics that impact airway compromise.Computational study.A Computational Fluid Dynamics (CFD (...) ) technique was used to simulate fluid flow within an upper airway model reconstructed from patient CT images. The model utilized a finite-volume numerical scheme to simulate cough-induced airflow, allowing for turbulent particle interaction, collision, and break-up. Liquid penetrants at 8 anatomical release locations were tracked during the simulated cough. Cough flow velocity was computed for a base case and four simulated cases. Airway clearance was evaluated through assessment of the fate of particles

2017 Laryngoscope investigative otolaryngology

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