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161. The diagnostic role of triple endoscopy in pediatric patients with chronic cough. (Abstract)

The diagnostic role of triple endoscopy in pediatric patients with chronic cough. Multi-disciplinary aero-digestive centers provide high quality health care through improved outcomes and treatment costs over separate sub specialty clinics. These outcomes are often the result of a common investigative tool known as triple endoscopy: a rigid bronchoscopy performed by an otolaryngologist, flexible bronchoscopy and lavage obtained by a pulmonologist, and an endoscopy with guided biopsies performed (...) by a gastroenterologist. Combining such procedures into one 'triple endoscopy' allows for diagnoses which otherwise might have been missed with just one procedure. The goal of our study was to describe the efficacy of the triple endoscopy procedure in diagnosing recalcitrant aero-digestive conditions, specifically chronic cough.Retrospective chart review METHODS: Multiple charts from children who underwent the triple endoscopy for chronic cough were retrospectively reviewed from 2005 and 2017. Complete data from

2019 International Journal of Pediatric Otorhinolaryngology

162. Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report Full Text available with Trip Pro

Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report Acute cough associated with the common cold (CACC) causes significant impairment in quality of life. Effective treatment approaches are needed for CACC. We conducted a systematic review on the management of CACC to update the recommendations and suggestions of the CHEST 2006 guideline on this topic.This systematic review of randomized controlled trials (RCTs) asked

2017 EvidenceUpdates

163. Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study. Full Text available with Trip Pro

Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: prospective cough complication cohort (3C) study. Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic

2017 BMJ

164. Effect of air, anesthetic gas mixture, saline, or 2% lignocaine used for tracheal tube cuff inflation on coughing and laryngotracheal morbidity after tracheal extubation. (Abstract)

Effect of air, anesthetic gas mixture, saline, or 2% lignocaine used for tracheal tube cuff inflation on coughing and laryngotracheal morbidity after tracheal extubation. Coughing and sore throat postoperatively are common clinical problems during general anesthesia which can be avoided by various methods including topicalization of airway with local anesthetics, endotracheal tube cuff (ETT) inflation with local anesthetics, use of intravenous drugs such as dexamethasone, maintaining ETT cuff (...) pressure, intubation by an experienced anethesiologist, etc. The aims of the study were to compare postextubation coughing response, mean number of cuff deflations required intraoperatively, and postoperative airway morbidity in terms of sore throat (2 h and 18-24 h), hoarseness of voice, and dysphagia following inflation of ETT cuff with air, anesthetic gas mixture, saline, and 2% lignocaine during general anesthesia.One hundred and four patients were randomized into 1 of 4 groups depending on whether

2019 Journal of anaesthesiology, clinical pharmacology Controlled trial quality: uncertain

165. The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study. Full Text available with Trip Pro

The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study. 30951372 2019 10 27 1535-4970 200 5 2019 Sep 01 American journal of respiratory and critical care medicine Am. J. Respir. Crit. Care Med. The Effect of Aclidinium on Symptoms Including Cough in Chronic Obstructive Pulmonary Disease: A Phase 4, Double-Blind, Placebo-controlled, Parallel-Group Study. 642-645 10.1164/rccm.201901-0048LE (...) Lancet Respir Med. 2014 Mar;2(3):195-203 24621681 Respir Med. 2015 Jan;109(1):88-95 25528948 Respir Res. 2014 Oct 07;15:124 25287629 Chest. 2009 Apr;135(4):975-982 19017866 Handb Exp Pharmacol. 2009;(187):311-20 18825348 Cough. 2013 Jun 24;9:17 23799979 COPD. 2014 Aug;11(4):451-8 24127996 Chest. 2000 Nov;118(5):1294-302 11083677 Chronic Obstr Pulm Dis. 2015 Dec 22;3(1):435-445 28848864 Eur Respir J. 2012 Oct;40(4):830-6 22441743 Chest. 2004 May;125(5):1726-34 15136383 Prim Care Respir J. 2012 Sep;21

2019 American Journal of Respiratory and Critical Care Medicine Controlled trial quality: uncertain

166. A 49-Year-Old Woman With Chest Pain, Cough, and Hypoxemia After a Seizure. Full Text available with Trip Pro

A 49-Year-Old Woman With Chest Pain, Cough, and Hypoxemia After a Seizure. A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once (...) but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.Copyright © 2018

2019 Chest

167. Chronic cough in the elderly. (Abstract)

Chronic cough in the elderly. Chronic cough is a multi-factorial syndrome commonly presenting as cough hypersensitivity in adult patients. It is a common medical condition in the communities but is more prevalent in older adults. Elderly patients (≥65 years) frequently suffer from multiple comorbidities, which may lead to more clinical heterogeneity in chronic cough and pose diagnostic and therapeutic challenges. Hyposensitivity in cough reflex, probably resulting from central nervous system (...) illnesses, is another potential concern. Despite these complexities and challenges, elderly-specific issues have rarely been addressed in current clinical practice guidelines for chronic cough. Considering recent trends in global population aging, the burden of elderly chronic cough is expected to increase into the near future. This review aimed to respond to following clinical questions: (1) is chronic cough a more heterogeneous condition in the elderly compared to younger adults; and (2

2019 Pulmonary Pharmacology & Therapeutics

168. The Effect of Gefapixant, a P2X3 antagonist, on Cough Reflex Sensitivity: A randomised placebo-controlled study. (Abstract)

The Effect of Gefapixant, a P2X3 antagonist, on Cough Reflex Sensitivity: A randomised placebo-controlled study. We evaluated the effect of gefapixant on cough reflex sensitivity to evoked tussive challenge.In this Phase 2, double-blind, 2-period study, chronic cough subjects (CC) and healthy volunteers (HV) were randomised to single-dose gefapixant 100 mg or placebo in crossover fashion. Sequential inhalational challenges with ATP, citric acid, capsaicin, and distilled water were performed 1 (...) , 3 and 5 h after dosing. Mean concentrations evoking ≥2 (C2) and ≥5 (C5) coughs post dose versus baseline were co-primary endpoints. Objective cough frequency (coughs·hr-1) over 24 h, and Cough Severity Visual Analogue Scale (VAS) were assessed in CC. Adverse events (AE) were monitored.24 CC and 12 HV were randomised (mean age 61 and 38 years, respectively). Cough challenge threshold increased for ATP by 4.7-fold (C2, p=<0.001) and 3.7-fold (C5, p=0.007) for gefapixant versus placebo in CC; in HV

2019 European Respiratory Journal Controlled trial quality: uncertain

169. Clinical Updates in Women's Health Care Summary: Acute Cough: Primary and Preventive Care Review. (Abstract)

Clinical Updates in Women's Health Care Summary: Acute Cough: Primary and Preventive Care Review. Acute cough is a common presenting symptom in the ambulatory care setting in the United States. It imposes a significant symptom burden on patients and financial burden on the health care system. In most cases, acute cough is caused by a benign viral infection that will resolve without intervention. When needed, there are few evidence-based interventions to hasten the resolution of cough symptoms (...) . Patients may request antibiotics or prescription cough syrups; however, these medications have little evidence of benefit and can be potentially harmful to the patient. It can be challenging for the clinician to provide reassurance while minimizing unnecessary prescriptions. The health care provider also must be alert to signs and symptoms that could signal a high-risk diagnosis that requires urgent evaluation. This monograph provides a review of the differential diagnosis for acute cough

2019 Obstetrics and Gynecology

170. Chronic cough and obesity. (Abstract)

Chronic cough and obesity. With respective prevalence of 13% and 9.6%, obesity and chronic cough are two common conditions worldwide. The crucial role of obesity has been highlighted in the development and progression of many respiratory diseases. According to the results of epidemiological studies, obesity, particularly abdominal obesity, may also be associated with chronic cough (CC). CC seems to be more severe in obese patients compared to normal-weight subjects. The management of CC may (...) differ slightly in obese patients compared to non-obese patients. Indeed, asthma and reflux diseases, which are considered key factors in the onset of CC, are characterised by more severe symptoms in obese patients. Asthma is associated with a resistance to usual treatments in obese patients but no data are available on the effect of inhaled therapies in obese subjects with cough variant asthma. Other emergent causes of CC have been reported in obese patients. Obstructive sleep apnoea and diabetes

2019 Pulmonary Pharmacology & Therapeutics

171. Randomised clinical trial: gabapentin vs baclofen in the treatment of suspected refractory gastro-oesophageal reflux-induced chronic cough. (Abstract)

Randomised clinical trial: gabapentin vs baclofen in the treatment of suspected refractory gastro-oesophageal reflux-induced chronic cough. Neuromodulators are considered potential therapeutic options for refractory gastro-oesophageal reflux-induced chronic cough.To compare the efficacy of gabapentin and baclofen in patients with suspected refractory gastro-oesophageal reflux-induced chronic cough.Two hundred and thirty-four patients with suspected refractory gastro-oesophageal reflux-induced (...) chronic cough, who failed an 8-week course of omeprazole and domperidone, were recruited into the open-labelled study and randomly assigned to receive either gabapentin (maximum daily dose of 900 mg) or baclofen (maximum daily dose of 60 mg) for 8 weeks as add-on therapy to the previous treatment. The primary end point was the successful rate of cough resolution; and the secondary end-points included cough sensitivity to capsaicin and gastro-oesophageal reflux disease questionnaire score and reported

2019 Alimentary Pharmacology & Therapeutics Controlled trial quality: uncertain

172. Development and validation of the COugh Assessment Test (COAT). Full Text available with Trip Pro

Development and validation of the COugh Assessment Test (COAT). A cough-specific quality-of-life questionnaire is recommended to assess the impact of cough; however, a simple instrument to quantify cough is required for everyday clinical practice. This study was aimed to develop a short patient-completed questionnaire (COugh Assessment Test, COAT).The COAT was developed and validated by comparison with the Korean version of Leicester Cough Questionnaire (K-LCQ) and cough numeric rating scale (...) (NRS, 0-10, 11-point scale) for chronic cough patients.Item selection identified five items regarding cough frequency, daily activity, sleep disturbance, fatigue and cough hypersensitivity (0-4 scaling of items, 0-20 score range) through reliability test cohort (n = 78). Test-retest reliability was strong (intra-class correlation coefficient = 0.88). The final COAT was compared with K-LCQ and cough NRS in a validation cohort (n = 323). In Rasch analysis, COAT fitted well to a unidimensional model

2019 Respirology

173. Allergen challenge increases capsaicin evoked cough responses in allergic asthma. Full Text available with Trip Pro

Allergen challenge increases capsaicin evoked cough responses in allergic asthma. Cough is a common and troublesome symptom in asthmatic patients, but little is known about the neuronal pathways that trigger cough. The mechanisms by which airway inflammation, airway hyperresponsiveness, and variable airflow obstruction cause cough are unclear.We sought to investigate the effects of allergen exposure on cough reflex sensitivity.We performed a 9-visit, randomized, single-blind, placebo-controlled (...) , 2-way crossover study comparing cough responses to inhaled capsaicin in patients with mild atopic asthma after allergen challenge compared with diluent control. Full-dose capsaicin challenge was performed at screening to determine the capsaicin dose inducing a half-maximal response, which was subsequently administered at 30 minutes and 24 hours after inhaled allergen/diluent challenge. Spontaneous coughing was measured for 24 hours after allergen/diluent. Methacholine challenge and sputum

2019 Journal of Allergy and Clinical Immunology Controlled trial quality: uncertain

174. Heterogeneity of cough neurobiology: Clinical implications. (Abstract)

Heterogeneity of cough neurobiology: Clinical implications. Cough is an important protective mechanism for clearing the airways but becomes a troublesome, and often difficult to treat, symptom in respiratory disease. Although cough can be produced as a reflex in response to the presence of irritants within the airways, emerging research demonstrates an unappreciated complexity in the peripheral and central neural systems that regulate cough. This complexity includes multiple primary sensory (...) neurons that can induce or facilitate reflex coughing, different ascending central circuits in the brain that contribute to cough sensory discrimination and the perception of the urge-to-cough, and several descending brain systems for inducing, facilitating and inhibiting cough responses. Consequently, the mechanisms responsible for cough becoming dysregulated in disease are not likely homogeneous across all patients with chronic cough. The available data suggests that changes in primary sensory

2019 Pulmonary Pharmacology & Therapeutics

175. Stratifying asthma severity in children using cough sound analytic technology. (Abstract)

Stratifying asthma severity in children using cough sound analytic technology. Introduction: Asthma is a common childhood respiratory disorder characterized by wheeze, cough and respiratory distress responsive to bronchodilator therapy. Asthma severity can be determined by subjective, manual scoring systems such as the Pulmonary Score (PS). These systems require significant medical training and expertise to rate clinical findings such as wheeze characteristics, and work of breathing (...) . In this study, we report the development of an objective method of assessing acute asthma severity based on the automated analysis of cough sounds.Methods: We collected a cough sound dataset from 224 children; 103 without acute asthma and 121 with acute asthma. Using this database coupled with clinical diagnoses and PS determined by a clinical panel, we developed a machine classifier algorithm to characterize the severity of airway constriction. The performance of our algorithm was then evaluated against

2019 Journal of Asthma

176. A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma. (Abstract)

A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma. Introduction: Chronic cough is a common problem faced by pediatricians, with a reported prevalence of 20% among preschoolers. It is also the most frequent symptom of asthma. Many causes of chronic cough may also be possible causes of asthma exacerbations.Case study: We describe a 10-year-old boy with asthma, which was admitted to the hospital with a persistent dry cough for five months. Initially (...) , he was treated as an exacerbation of asthma; however, a subsequent chest X-ray identified a wire during the next hospitalization. Although the wire was not found during bronchoscopy, a CT scan located the wire in the mediastinum.Results: The patient required urgent thoracic surgery, ending with the extraction of a 3 cm-long metallic wire. The history revealed that he had choked on a pizza shortly before the onset of coughing: it is most likely that the foreign body had been aspirated

2019 Journal of Asthma

177. Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study. Full Text available with Trip Pro

Relationship between microbiology of throat swab and clinical course among primary care patients with acute cough: a prospective cohort study. Acute lower respiratory tract infections (ALRTIs) account for most antibiotics prescribed in primary care despite lack of efficacy, partly due to clinician uncertainty about aetiology and patient concerns about illness course. Nucleic acid amplification tests could assist antibiotic targeting.In this prospective cohort study, 645 patients presenting (...) to primary care with acute cough and suspected ALRTI, provided throat swabs at baseline. These were tested for respiratory pathogens by real-time polymerase chain reaction and classified as having a respiratory virus, bacteria, both or neither. Three hundred fifty-four participants scored the symptoms severity daily for 1 week in a diary (0 = absent to 4 = severe problem).Organisms were identified in 346/645 (53.6%) participants. There were differences in the prevalence of seven symptoms between

2019 Family Practice

178. Clinical significance of self-reported cough intensity and frequency in patients with interstitial lung disease: a cross-sectional study. Full Text available with Trip Pro

Clinical significance of self-reported cough intensity and frequency in patients with interstitial lung disease: a cross-sectional study. The intensity and frequency of cough remain unclear in interstitial lung disease (ILD). The aim of this study was to evaluate the intensity and frequency of cough in idiopathic interstitial pneumonias (IIPs), connective tissue disease-associated interstitial lung disease (CTD-ILD), and chronic hypersensitivity pneumonia (CHP), and examine their associations (...) with clinical indices.In this cross-sectional study, the intensity and frequency of cough were evaluated using a 100-mm visual analogue scale. Scores on the Leicester Cough Questionnaire, chronic dyspnoea scale, and a frequency scale for symptoms of gastro-oesophageal reflux disease (FSSG) were collected. The correlations of cough intensity and frequency with potential predictor variables were tested using bivariate and multiple logistic regression analysis.The study included 70 patients with IIPs, 49

2019 BMC pulmonary medicine

179. Antibiotics for persistent cough or wheeze following acute bronchiolitis in children. Full Text available with Trip Pro

Antibiotics for persistent cough or wheeze following acute bronchiolitis in children. Bronchiolitis is a common acute respiratory infectious condition, with a high prevalence worldwide. It is a clinically diagnosed syndrome, manifested by tachypnoea (rapid breathing), with crackles or wheeze in young children. In the acute phase of bronchiolitis (< 14 days), antibiotics have only been recommended when a secondary bacterial infection is suspected. Although bronchiolitis is usually a self (...) -limiting condition, a number of children have persistent respiratory symptoms such as cough and wheezing in post-acute bronchiolitis, and they present or re-present to secondary care.To determine the effectiveness of antibiotics compared to a control (no treatment or placebo) for persistent respiratory symptoms (within six months), following acute bronchiolitis.The following databases were searched, The Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials (CENTRAL

2012 Cochrane

180. Honey for acute cough in children. (Abstract)

Honey for acute cough in children. Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms.To evaluate the effectiveness of honey for acute cough in children in ambulatory settings.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2011) which contains (...) the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to December week 4, 2011); EMBASE (1990 to January 2012); CINAHL (1981 to January 2012); Web of Science (2000 to January 2012); AMED (1985 to January 2012); LILACS (1982 to January 2012); and CAB abstracts (2009 to January 2012).Randomised controlled trials (RCTs) comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged

2012 Cochrane

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