Chronic Cough Research Articles

Aspiration From Dysphagia Associated With the Presence of Pantoea agglomerans in a Horse

Pantoea agglomerans is a gram-negative bacterium that usually lives in symbiosis in soil and plants. However, it may also lead to serious diseases in plants, animals and humans. We describe a case of aspiration from dysphagia associated with the isolation of P. agglomerans in a horse admitted to an Italian hospital. The patient was presented to the hospital for the onset of chronic cough after an acute episode of pulmonary hemorrhage during a race recorded two months before and was treated with dexamethasone and penicillin. The cough was accentuated during meals, leading to a suspicion of aspiration from dysphagia. A bronchoalveolar lavage was collected, and cytological examination showed the presence of vegetable fibers, rod bacteria, and a high macrophage population (89%). From the tracheal wash collected for bacteriological culture, P. agglomerans was isolated in monoculture, and the antimicrobial susceptibility test revealed that the isolate was susceptible to all tested antimicrobials except sulfonamide. The horse recovered well after 10 days of enrofloxacin treatment. The present report highlights the role of P. agglomerans as an opportunistic respiratory pathogen in horses, especially in the presence of plants or their parts.

Patient-reported assessments of chronic cough in clinical trials: accessory or primary endpoints?

Patient-reported assessments of chronic cough in clinical trials: accessory or primary endpoints?

Prescription patterns and symptom relief of antitussives and expectorants in patients with cough: a nationwide study in Korea.

Limited data are available on the prescription patterns and efficacy of antitussives and expectorants for patients with acute and chronic cough. This study examined the use and efficacy of these medications in a nationally representative sample of Korean patients. We examined 4,206,016 individuals from the National Health Insurance Service (NHIS)-National Health Information Database (NHID) between 2015 and 2017. Among them, a sample of 10% (n=420,602) was retrieved for the diagnosis of respiratory diseases using the International Classification of Diseases, 10th edition (ICD-10; J00-J99), or the prescription of antitussives and expectorants for cough (ICD-10; R05). The acute cough group included those who were prescribed medications within 4 weeks of initial diagnosis (prescription within 14 days), whereas the chronic cough group included patients who were prescribed medications within 16 weeks of initial diagnosis (prescription within 56 days). If the prescription was discontinued or not changed to an alternative drug after the initial prescription, these cases were considered to have achieved symptom relief. This study included 288,460 patients (971,065 cases) with acute cough and 5,888 patients (15,399 cases) with chronic cough. 'Expectorants, excluding combinations with cough suppressants' had the highest prescription rates in both groups (acute cough, 63.8%; chronic cough, 61.7%), and showed the highest symptom relief regardless of the number of medications prescribed (acute cough, 84.3%; chronic cough, 70.4%). 'Expectorants, excluding combinations with cough suppressants' were the most prescribed and effective medications for relieving cough symptoms in Korea patients. Further studies are needed to determine the optimal duration for using antitussives and expectorants in cough management.

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): a family with five affected sibs from Turkey

BackgroundCerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS), a relatively common cause of late-onset progressive ataxia, is a genetic disease characterised by biallelic pentanucleotide AAGGG repeat expansion in intron 2 of the replication factor complex subunit 1 gene. Herein, we describe the first molecularly confirmed CANVAS family with five affected siblings from Turkey.Case presentationThe family comprised seven siblings born from healthy non-consanguineous parents. CANVAS phenotype was present in five of them; two were healthy and asymptomatic. Chronic cough was the first symptom reported in all five siblings, followed by the development of sensory symptoms, oscillopsia and imbalance. Clinical head impulse test (HIT) was positive in all cases and video HIT performed on three patients revealed very low vestibulo-ocular reflex gains bilaterally. Magnetic resonance imaging and nerve conduction studies revealed cerebellar atrophy and sensory neuronopathy, respectively. RP-PCR confirmed the homozygous presence of the AAGGG repeat expansion in all five cases.ConclusionGenetic screening for CANVAS should be considered in all patients with late-onset ataxia, sensory disturbances and vestibular involvement, especially in the presence of chronic cough.

Chronic Cough Related to Thyroid Cartilage Superior Cornu Abnormality.

Chronic cough is a common troublesome symptom in otolaryngology head and neck surgery practice. In rare cases, chronic cough may be related to anatomical abnormalities. In this article, we report the history of a 64-year-old female with a chronic course due to a curved superior cornu of the thyroid cartilage and related irritation of the laryngeal superior nerve. The cough was atypical and resolved after the surgical resection of the abnormal cornu. There was no recurrence at 9 months post-surgery. The findings of the present case report highlight the need to explore the laryngeal anatomy in patients with chronic cough to identify potential abnormalities, which may be treated surgically.

Alternative Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Moving Cupping along Meridians.

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition characterized by persistent and progressive airflow obstruction, resulting in chronic respiratory symptoms like dyspnea, cough, and sputum production, accompanied by wheezing, chest tightness, fatigue, and reduced physical activity. Under the influence of various factors, patients with COPD often experience acute exacerbations, which have a significant negative impact on the prognosis, quality of life, and life span of patients. As a branch of cupping therapy, moving cupping along meridians is an essential complementary therapy of the traditional Chinese medicine system. Cupping plays a unique role in treating and preventing many diseases by stimulating the local skin with negative pressure. This article elaborately describes the procedure of moving cupping along meridians therapy in the treatment of AECOPD. The effectiveness and feasibility of moving cupping along meridians therapy in relieving symptoms and enhancing the quality of life is demonstrated by comparing the changes in the 36-item Short-Form (SF-36) health survey questionnaire, the modified Medical Research Council dyspnea scale (mMRC), and the COPD Assessment Test (CAT) score before and after the treatment. As a cost-effective complementary treatment, the protocol for the moving cupping along meridians treatment described in this article is expected to provide a reference for non-pharmacological treatment options for AECOPD.

Are Otolaryngologists Seeing More Cough? Longitudinal Trends and Patterns.

Otolaryngologists play an increasing role in managing cough, but little data exists examining the demographics of this patient population and the referral patterns that influence their access to care. This study sought to elucidate these factors using a longitudinal, nationwide database to minimize sampling bias and identify trends representative of the national population. Nationally representative survey. National Ambulatory Medical Care Survey (NAMCS). Visits with a diagnosis and chief complaint of cough between 2005 and 2019 in NAMCS were examined. Univariable and multivariable analyses were performed to compare patient demographics between visits to surgical specialists, medical specialists, and primary care physicians. Otolaryngologists made up more than 84% of surgical specialist visits. There was a 0.52% [0.20%-0.84%] increase per year in the proportion of visits attributed to surgical specialists. Based on a sensitivity analysis of the multivariable model, Hispanic patients (adjusted odds ratio, aOR: 0.88 [0.78-0.99] vs White) and patients living outside of metropolitan areas (aOR: 0.77 [0.61-0.99] vs living within) were less likely to see surgical specialists than primary care doctors for their cough. Patients who were referred (aOR: 1.47 [1.28-1.72] vs not referred) and with chronic cough (aOR: 1.47 [1.23-1.75] vs acute/subacute) were more likely to see a surgical specialist. Otolaryngologists are increasingly called upon to evaluate and consider treatment for cough. Identifying patient groups with limited access underscores the need for enhanced education about otolaryngologists' roles and integrated care approaches to improve access to specialized cough treatment. Level 4.

Managing chronic cough in adults in primary care.

Managing chronic cough in adults in primary care.

Role of Spirometry, Radiology, and Flexible Bronchoscopy in Assessing Chronic Cough in Children.

Chronic cough in children is a common and multifaceted symptom, often requiring a comprehensive approach for accurate diagnosis and effective management. This review explores the use of spirometry, radiology (chest X-rays and computed tomography (CT) scans), and flexible bronchoscopy in the assessment of chronic cough in children through current guidelines and studies. The strengths, clinical indications, and limitations of each modality are examined. Spirometry, radiology, and in some cases flexible bronchoscopy are integral to the assessment of chronic cough in children; however, a tailored approach, leveraging the strengths of each modality and guided by clinical indications, enhances diagnostic accuracy and therapeutic outcomes of pediatric chronic cough.

Very Rare Case of Pulmonary Lepidic Adenocarcinoma at a Young Age Man

Introduction: Lung cancer remains one of the higher prevalence of cancer and leading cause of death in the world. Smoking and genetic factors are two important etiologies in lung cancer. Adenocarcinoma is the most common type of non-small cell lung carcinoma. Lepidic predominant adenocarcinoma is one type of adenocarcinoma that has a good prognosis. Case Illustration: A 24-year-old male came with chronic cough and chest pain. He had a history of smoking and no prior family history of cancer. Plain chest Xray and Thorax computed tomography (CT) showed pleural effusion and presence of lung mass with suggestion of bone and liver involvement, respectively. The cytology from pleural effusion and bronchial lavage initially found no malignancy cell. Later thoracostomy biopsy and pathology study suggested lepidic adenocarcinoma. Discussion: Lung cancer is still one of the leading causes of death in men. Even though rarely found in young male, patients with a history of smoking or genetic factor with clinical manifestation suggestive chronic respiratory condition with weight loss should be suspected of the diagnosis. Adenocarcinoma, as the most common non-small cell lung carcinoma, could be later divided into several subtypes. Lepidic adenocarcinoma is distinguished by the pathology finding of a large invasion focus of stromal, lymphatic, vascular, or pleural space. Considered one of the most favorable, lepidic predominant adenocarcinoma has a very high rate of 5 year survival when diagnosed early and responds well to lobe resection. Advanced state however has poor outcome due to limited choice of therapy. Promising trial of targeted chemotherapy have been reported and could improve outcome in the future. Conclusion: Lung cancer in young male is a rare disease but should be suspected in those with chronic cough, chest pain and weight loss. The history of smoking and family history are crucial for this suspicion. Lepidic predominant adenocarcinoma has a good prognosis when diagnosed early. Studies in the future could enhance overall survival in these patients.

Implementasi Data Mining Klasifikasi Gejala Penyakit TB Menggunakan Algoritma Naive Bayes pada Studi Kasus Puskesmas Pegangsaan Dua B

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The bacteria can enter the lungs, causing the patient to experience shortness of breath and chronic coughing. The infection process in TB progresses through three main stages: primary infection, latent infection, and active infection. During the primary infection stage, the bacteria enter the lungs through inhaled air. If the immune system successfully controls the bacteria, the infection becomes latent, where the bacteria remain inactive and cause no symptoms. However, if the immune system fails, the infection becomes active, and the bacteria attack healthy lung cells, leading to severe symptoms. Tuberculosis remains a major cause of global morbidity and mortality. According to the 2022 WHO report, Indonesia ranks second in the world with an estimated 969,000 TB cases, or 354 per 100,000 people, and a mortality rate of 144,000, or 52 per 100,000 people. This study aims to improve the accuracy of TB diagnosis through the application of the Naive Bayes algorithm, applied to patient data from the Pegangsaan Dua B Community Health Center. The dataset includes 1,527 training data and 1,029 testing data, covering attributes such as patient name, gender, age, identification number, registration date, address, diagnosis status, and diagnosis results. The results indicate that the Naive Bayes algorithm achieved an accuracy of 99.71%, showing its potential for early and accurate TB diagnosis prediction.

Living with chronic cough: experiences, burden, and management in ILD: A mixed methods study

Living with chronic cough: experiences, burden, and management in ILD: A mixed methods study

HYDIN variants cause primary ciliary dyskinesia in the Finnish population.

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by chronic respiratory tract infections and in some cases laterality defects and infertility. The symptoms of PCD are caused by malfunction of motile cilia, hair-like organelles protruding out of the cell. Thus far, disease causing variants in over 50 genes have been identified and these variants explain around 70% of all known cases. Population specific genetics underlying PCD has been reported highlighting the importance of characterizing gene variants in different populations for development of gene-based diagnostics and management. Whole exome sequencing was used to identify disease causing variants in Finnish PCD cohort. The effect of the identified HYDIN variants on cilia structure and function was confirmed by high-speed video analysis, immunofluorescence and electron tomography. In this study, we identified three Finnish PCD patients carrying homozygous loss-of-function variants and one patient with compound heterozygous variants within HYDIN. The functional studies showed defects in the axonemal central pair complex. All patients had clinical PCD symptoms including chronic wet cough and recurrent airway infections, associated with mostly static airway cilia. Our results are consistent with the previously identified important role of HYDIN in the axonemal central pair complex and improve specific diagnostics of PCD in different national populations.

Investigating genotype-phenotype correlations in primary ciliary dyskinesia: a sibling cohort study.

Primary Ciliary Dyskinesia (PCD) is a complex mostly autosomal recessive disorder characterized by dysfunction of primary motor cilia, leading to multisystemic manifestations, primarily affecting the rhino-sinopulmonary system. Despite advancements in understanding its pathogenesis, genotype-phenotype correlations are not fully elucidated. Utilizing sibling cohorts offers a promising approach to investigate these genotype-phenotype correlations in PCD. This retrospective cohort study, conducted from 2010 to 2023 at Soroka University Medical Center in Be'er-Sheva, Israel, included patients with a confirmed diagnosis of PCD. Variables and outcomes compared include typical presenting symptoms, lung function, structural changes in chest tomography (CT), and anthropometric data. Seventeen sibling patients from eight families met the inclusion criteria. At the last follow-up visit, the median age was 16 years. Genetic diagnosis revealed homozygous pathogenic variants including DNAH11, DNAAF3, DNAL1, and ZMYND10. Full concordance rates were observed for unexplained neonatal respiratory distress, chronic cough, and rhinosinusitis in patients with DNAH11 mutations. The family with the DNAAF3 mutation exhibited the lowest difference in Forced Expiratory Volume in 1 s (FEV1) Z-scores (0.48), but the highest differences in Forced Vital Capacity (FVC) Z-scores (3.39). High differences in FEV1 Z-scores were identified in the family with the DNAL1 mutation (2.06), while the lowest differences in FVC Z-scores (0.39) were observed in the same family. High concordance rates for certain mutations in clinical features suggest potential genotype-phenotype correlations, in contrast to weak concordance in lung function. Challenges remain in establishing direct correlations between genetic mutations and clinical outcomes.

Chronic Cough: a Symptom between Pulmonary and Psychogenic Disease. A Case of Misdiagnosed Endobronchial Hamartoma

Chronic Cough: a Symptom between Pulmonary and Psychogenic Disease. A Case of Misdiagnosed Endobronchial Hamartoma

Repeat expansions inRFC1gene in Refractory Chronic Cough

IntroductionRefractory chronic cough (RCC), persisting despite addressing contributory diagnoses, is likely underpinned by neurally-mediated cough hypersensitivity.RFC1-disorders are genetic neurodegenerative conditions caused by biallelicRFC1repeat expansion sequences, commonly presenting with cough, followed by neurological features including cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). The prevalence and identifying clinical characteristics ofRFC1repeat-expansion disorders in patients with RCC are unknown.MethodsConsecutive patients with RCC underwentRFC1genotyping, cough severity visual analogue scale (VAS), and cough-specific health status assessment (Leicester Cough Questionnaire, LCQ). Participants with biallelicRFC1repeat expansions (RFC1++) also underwent nerve conduction studies, brain imaging (MRI), and cough reflex sensitivity testing.ResultsFifty-one participants with RCC were recruited; 36 (71%) female, median (IQR) age 65 (56–70) years, duration of cough 12.8 (6.9–20.0) years. Four (8%) wereRFC1++, five (10%) monoallelic carriers (RFC1+−), and 42 (82%) of wild type genotype (RFC1−−). No difference was observed in age, sex, cough duration, spirometry, VAS or LCQ scores between RFC1++ and RFC1--subjects (p>0.05). The symptom of pins and needles was more frequent in RFC1++ (n=4, 100%) compared to RFC1−− (n=12, 33%) (p=0.01). RFC1++ participants had impaired sensory action potentials, and one had cerebellar atrophy. RFC1++ participants had heightened cough reflex sensitivity to capsaicin, similar to previous CANVAS and RCC studies.ConclusionBiallelic RFC1 repeat expansions (RFC1++) were present in 8% of RCC patients. RFC1++ participants demonstrated features of cough reflex hypersensitivity. RFC1++ chronic cough had few identifying features, although symptoms of pins and needles were more common.

Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance

BackgroundThe perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported.Case presentationA 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms.ConclusionsThis case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.

Parental smoking and respiratory outcomes in young childhood cancer survivors.

Passive exposure to cigarette smoke has negative effects on respiratory health. Childhood cancer survivors (CCS) are at increased risk for respiratory disease due to treatment regimens that may harm the respiratory system. The objective of this study was to assess the prevalence of parental smoking among CCS and investigate its association with respiratory outcomes. As part of the Swiss Childhood Cancer Survivor Study, between 2007 and 2022, we sent questionnaires to parents of children aged ≤16 years who had survived ≥5 years after a cancer diagnosis. Parents reported on their children's respiratory outcomes including recurrent upper respiratory tract infections (otitis media and sinusitis), asthma, and lower respiratory symptoms (chronic cough persisting>3 months, current and exercise wheeze), and on parental smoking. We used multivariable logistic regression to investigate associations between parental smoking and respiratory outcomes. Our study included 1037 CCS (response rate 66%). Median age at study was 12 years (interquartile range 10-14 years). Eighteen percent of mothers and 23% of fathers reported current smoking. CCS exposed to smoking mothers were more likely to have recurrent upper respiratory tract infections (OR 2.1; 95%CI 1.1-3.7) and lower respiratory symptoms (OR 2.0; 95%CI 1.1-3.7). We found no association with paternal smoking. A substantial proportion of CCS in Switzerland have parents who smoke. Exposure to maternal smoking was associated with higher prevalence of upper and lower respiratory problems. Healthcare providers can support families by addressing caregiver smoking behaviors and providing referrals to smoking cessation programs.

493. EFFECTIVENESS OF TRANSORAL INCISIONLESS FUNDOPLICATION (TIF) WITHOUT OR WITH HIATAL HERNIA REPAIR (CTIF) IN PATIENTS WITH GERD AND CHRONIC COUGH

Abstract Background GERD is a common cause of chronic cough. Although barrier therapy with laparoscopic fundoplication is highly effective for typical GERD symptoms, the response rates are variable for chronic cough. We hypothesized that transoral incisionless fundoplication (TIF) or TIF with hiatal hernia repair (cTIF) may be a suitable alternative for medically refractory cough associated with GERD. Aim We prospectively s studied the effectiveness and safety of TIF/cTIF in patients with chronic cough and proven GERD. Methods Patients with GERD and extra-esophageal symptoms from 10 academic and community medical centers (TIF Registry), elevated GERD-HRQL score +/- Reflux Symptom Index (RSI) >13 and pathologic reflux by esophageal pH-metry, or erosive esophagitis/Barrett’s esophagus were evaluated before and after a minimum 6 months post TIF/cTIF performed by gastroenterologists and surgeons. Patients with history of prior foregut/bariatric surgery, chronic obstructive or interstitial lung disease, or prior lung transplant were excluded. The primary outcome was improvement in RSI score at last follow-up compared to baseline. Secondary outcomes were: 1) normalization of RSI (<13), 2) improvement in cough sub-scores of RSI (decrease ≥ 2 points or to 0 on a 5-point scale), 3) GERD symptom improvement (>50% decrease in GERD-HRQL, or < 2 in all sub-scores) 4) discontinuation of proton pump inhibitor (PPI), and 5) overall patient satisfaction. We further analyzed response in patients with cough-predominant phenotype (chief complaint of cough and RSI troublesome cough subscore ≥2). Results 198 patients with cough and GERD successfully underwent TIF/cTIF (Table 1) without serious adverse events. Greater than 6-month follow-up was available for 177 patients at a median of 12 months [IQR 6,12]. Median RSI score decreased from 18 [IQR 13, 27] to 5 [IQR 2, 11] (p < 0.0001), median change 11 [IQR5,11]. 83% of patients with elevated baseline RSI normalized their scores. 75% of patients had improvement of cough when lying down (median: 1 point [IQR 0,3]), and 72% of patients had improvement of troublesome cough (median: 1 point [IQR 1,3]). 83% of patients successfully discontinued or decreased PPI to occasional use. Patient satisfaction improved from a baseline of 5.6% to 68.8% (p <0.0001). Compared to patients without cough-predominant symptoms, cough-predominant patients (n=108) experienced an additional 4.2-point decrease in in RSI score (p = 0.01) and 1.5-point decrease in troublesome cough sub-scores (p<0.0001). Patients with regurgitation phenotype were more likely to have a favorable cough response at 6 months (p<0.0001). In appropriately selected patients, cTIF and TIF were comparable for cough, GERD-HRQL, RSI, and PPI responses. Conclusion TIF/cTIF are effective and safe alternative barrier therapies for patients with pH-positive cough-predominant GERD.

Correlation between Respiratory Symptoms Questionnaire and Pulmonary Function Test in Chronic Obstructive Lung Disease Patients: A Tertiary Care Hospital Study

Abstract Objective: This study aimed to investigate the correlation between respiratory symptoms assessed by the Respiratory Symptoms Questionnaire (RSQ) and pulmonary function test (PFT) results in patients diagnosed with chronic obstructive pulmonary disease (COPD) at a tertiary care hospital. Methods: This analytical, cross-sectional study was conducted at Sree Balaji Medical College and Hospital, Chennai, involving 130 COPD patients presenting with symptoms of breathlessness, chronic cough, and wheeze. Data collection instruments used were: (1) RSQ: The RSQ was utilized to assess respiratory symptoms, including breathlessness, cough, and wheeze, (2) PFT: PFT assessments, including spirometry, were performed to measure lung function impairment objectively. Participants completed the RSQ under supervision, followed by PFT assessments conducted by trained respiratory technologists using standardized procedures. Results: Descriptive statistics were computed for demographic variables and questionnaire scores. Pearson correlation analysis was employed to assess the association between respiratory symptoms measured by RSQ and PFT parameters. The Chi-square analysis determined the overall association between symptom scores and PFT results across the COPD severity groups. Significant correlations were observed between severe COPD and St. George’s Respiratory Questionnaire, moderate COPD and Clinical COPD Questionnaire, and moderate-to-severe COPD and COPD Assessment Test (P < 0.05). Nonsignificant correlations were found between mild COPD and symptom scores (P > 0.05). The Chi-square analysis confirmed a strong association between respiratory symptoms and PFT results (P = 0.04). Conclusion: This study highlights the importance of comprehensive symptom assessment alongside the objective measures of lung function in COPD management. Integrating tools such as RSQ with PFTs enables clinicians to obtain a holistic understanding of patients’ disease status and tailor treatment strategies accordingly.