Antitussive Research Articles

Inhaled alkaline hypertonic divalent salts reduce refractory chronic cough frequency.

Treatment of chronic cough remains a challenge. We hypothesised that inhaled alkaline hypertonic divalent salts (alkaline HDS) might provide relief for refractory chronic cough by laryngeal and tracheal hydration. We conducted an exploratory, single-blinded, nasal saline-controlled study in 12 refractory chronic cough patients to examine cough suppression efficacy of an alkaline HDS composition (SC001) at pH 8 or pH 9 administered by nasal inhalation. As control, we used nasal saline with the same hand-held pump spray aerosol device. Each subject was monitored continuously using a digital cough monitor watch for 1 week of baseline, 1 week of control treatment and 1 week of active treatment. Baseline daily cough rates ranged from 4 to 34 coughs·h-1 with mean visual analogue score 65±17 pre- and post-baseline testing. Control-adjusted efficacy of cough rate reduction ranged from 15% (p=0.015) (from Day 1) to 23% (p=0.002) (from Day 3). Control-adjusted efficacy was highest with SC001 pH 9 (n=5), ranging from 25% (p=0.03) (from Day 1) to 35% (p=0.02) (from Day 3), and lowest for SC001 pH 8 (n=7), ranging from 9% (p=0.08) (from Day 1) to 16% (p=0.02) (from Day 3). Hourly cough counts and visual analogue score correlated for baseline (r=0.254, p=0.02) and control (r=0.299, p=0.007) monitoring weeks. Treatment improved this correlation (r=0.434, p=0.00006). No adverse events were reported. Alkaline (pH 9) HDS aerosol is a promising treatment for refractory chronic cough and should be further evaluated.

A Continuous Intestinal Absorption Model to Predict Drug Enterohepatic Recirculation in Healthy Humans: Nalbuphine as a Model Substrate.

Nalbuphine (NAL) is a κ-agonist/μ-antagonist opioid being developed as an oral extended formulation (ER) for the treatment of chronic cough in idiopathic pulmonary fibrosis and itch in prurigo nodularis. NAL is extensively glucuronidated and likely undergoes enterohepatic recirculation (EHR). The purpose of this work is to develop pharmacokinetic models for NAL absorption and enterohepatic recirculation (EHR). Clinical pharmacokinetic (PK) data sets in healthy subjects from three trials that included IV, oral solution, and ER tablets in fed and fasted state and two published trials were used to parametrize a novel partial differential equation (PDE)-based model, termed "PDE-EHR" model. Experimental inputs included in vitro dissolution and permeability data. The model incorporates a continuous intestinal absorption framework, explicit liver and gall bladder compartments, and compartments for systemic drug disposition. The model was fully PDE-based with well-stirred compartments achieved by rapid diffusion. The PDE-EHR model accurately reproduces NAL concentration-time profiles for all clinical data sets. NAL disposition simulations required inclusion of both parent and glucuronide recirculation. Inclusion of intestinal P-glycoprotein efflux in the simulations suggests that NAL is not expected to be a victim or perpetrator of P-glycoprotein-mediated drug interactions. The PDE-EHR model is a novel tool to predict EHR and food/formulation effects on drug PK. The results strongly suggest that even intravenous dosing studies be conducted in fasted subjects when EHR is suspected. The modeling effort is expected to aid in improved prediction of dosing regimens and drug disposition in patient populations.

Insight into the Synthesis, Biological Activity, and Structure-activity Relationship of 1,2,4-Oxadiazole and Analogs: A Comprehensive Review

Abstract: A five-membered heterocyclic compound known as 1,2,4-oxadiazole has one oxygen, two carbon, and two nitrogen atoms within a ring. Numerous studies have shown that 1,2,4-oxadiazole has the potential to be an essential moiety in many harmful pharmacological conditions. 1,2,4-oxadiazole and its derivatives have been used as an antiviral, cough suppressant, vasodilator, anxiolytic, etc. To synthesize a single molecule with potent pharmacological action, two or more pharmacophores are combined currently. This enhances pharmacological effects, facilitates interaction possible with many targets, and reduces the adverse effects related to them. It has been reported that synthesis of 1,2,4-oxadiazole and its analog is possible using a variety of methods. In this present review, we emphasized recently accepted synthetic methods for 1,2,4-oxadiazole and its analogs synthesis. Additionally, the structure-activity relationship concerning several pharmacological effects, interactions with various targets, and the utility of different techniques for the analysis and purification has been described. On the behalf of the above study, the researchers can use this review study to better understand their 1,2,4-oxadiazole research in the future.

Diagnostic value of the pepsin concentration in saliva and induced sputum for gastroesophageal reflux-induced chronic cough: a prospective clinical study.

Finding a simple, effective and rapid diagnostic method to improve the diagnosis of gastroesophageal reflux-induced chronic cough (GERC) is indicated. Our objective was to determine the diagnostic value of the pepsin concentration in saliva and induced sputum for GERC. 171 patients with chronic cough were enrolled. The diagnosis and treatment followed the chronic cough diagnosis and treatment protocol. Saliva and induced sputum were collected, and the pepsin concentration was determined using Peptest. A Gastroesophageal Reflux Diagnostic Questionnaire (GerdQ) was completed. The diagnostic value of the pepsin concentration in saliva and induced sputum for GERC was analysed and compared. The salivary pepsin concentration predicted GERC with an area under the receiver operating characteristic curve (AUC) of 0.845. The optimal cut-off value was 76.10 ng·mL-1, the sensitivity was 83.58% and the specificity was 82.69%. The pepsin concentration in the induced sputum supernatant for GERC had an AUC of 0.523. When GerdQ was used for GERC diagnosis, the AUC was 0.670 and the diagnostic value of salivary pepsin was better compared to GerdQ (DeLong test, p=0.0008). Salivary pepsin had a comparable diagnostic value to GerdQ (AUC 0.779 versus 0.826; p=0.4199) in acidic GERC. Salivary pepsin had superior diagnostic value compared to GerdQ (AUC 0.830 versus 0.533; p<0.0001) in non-acidic GERC. A salivary pepsin concentration >76.10 ng·mL-1 is of good diagnostic value for GERC, especially in non-acidic GERC. The pepsin concentration in induced sputum has a low diagnostic value.

Experience in Treating Prolonged Cough with Deficiency of Lung, Spleen and Qi by Stopping Coughing Powder and Combining with Liujunzi Decoction

This article analyzes the main points of the formulae of Stop Coughing Powder and Six Gentlemen Soup, and cites the case of Stop Coughing Powder combined with Six Gentlemen Soup in the treatment of prolonged cough with deficiency of the lungs, spleen and qi, so as to guide the clinical application. External wind-cold for a long time does not solve and invade the lungs and spleen, resulting in abnormal qi transportation and digestion, so the cough is prolonged and not cured. Therefore, in the treatment of this type of chronic cough, the focus is on the benefit of qi to dispel the evil, in order to restore the normal function of the lungs and spleen. Clinical practice has shown that the combination of Cushioning Powder and Six Gentlemen's Tonic has significant efficacy in the treatment of prolonged cough with deficiency of the lungs, spleen and qi. The combination of the two formulas is safe and can not only effectively relieve cough symptoms, but also improve the overall health and quality of life of the patient.

What causes cough in pulmonary fibrosis, and how should we treat it?

To review the current understanding of the impact, mechanisms and treatments for cough in patients with interstitial lung disease (ILD). Evidence suggests that cough is a prevalent symptom in patients with ILD and has a significant impact on patients. There is increasing interest in the role of cough hypersensitivity as seen in chronic refractory cough in patients with ILD, and encouraging recent results suggest that ILD-associated cough responds to opiate therapy. Understanding the aetiology of cough in patients with ILD is crucial to continue to develop therapies which might be effective in reducing cough and increasing quality of life.

Re-processing of pharmaceutical herb residues using isolated probiotics from plant sources and their beneficial effects on diarrhea

This study aims to use hot aqueous extract of herbal residue (HRE) to enhance bacterial growth and possess anti-diarrheal effects. In this study, lactobacillus species L. brevis (SAM-1), Lactobacillus plantarum (SAM-2), and Lactobacillus herbinensis (SAM-3) were isolated from date palm sap (collected in winter season). Square Pharmaceuticals PLC, Bangladesh provided herbal residues ‘Adovas’ which is non-sedating herbal cough syrup with sixteen common herbs including Adhatoda vasica. In our observation, HRE increased the number of colonies in MRS media. In the anti-diarrheal study by castor oil and magnesium sulphate-induced diarrheal mouse model, SAM-1 and 2 with or without HRE showed almost similar results. After initial morphological characterization, tests such as resistance to low pH, bile salt and survival capability in gastric simulated fluid (GSF) were performed to confirm them as a probiotic candidate. All three isolates were gram-positive bacteria and could grow in a mesophilic range of temperatures. The isolates were catalase-negative and were able to coagulate milk after overnight incubation. As the isolates exhibited resistance to low pH and could tolerate bile salts, they may survive in the stomach and intestine, thus making them a promising probiotic candidate. The isolated probiotics and HRE inhibited diarrheal and restored the body's electrolytes. Interestingly, SAM-2 showed higher efficacy than the standard drug (Loperamide), while SAM-1 showed a similar effect and SAM-3, had less effect than Loperamide. The findings suggest that probiotics and herbal residue could contribute to diarrhoeal disease prevention, which might be an alternative to a synthetic standard drug (Loperamide).

A Review Article on Formulation And Evaluation of Herbal Cough Syrup

The majority of oral Ayurvedic formulations are for liquid dose forms of drugs or medicinal combinations. Oral Ayurvedic formulations are mostly administered by mouth. Herbal goods must, nevertheless, meet all legal standards for quality, including stability testing. Since herbal syrup is easy for patients to take, it is a widely used and well-liked dosage form for treating fever, cough, and colds. The prepared herbal syrup in this study contains ginger macerated in a honey basis, along with other ingredients that are used as expectorants and antipyretics, such as tulsi, licorice, neem, amla, cinchona, fennel, peppermint, turmeric, brahmi, and clove. Density, specific gravity, pH, and other organoleptic properties were among the pre- and post-formulation criteria used to assess the final herbal syrup's quality. The final herbal syrup's stability research revealed that, over the course of 24 hours, no changes were seen in any of the physiochemical parameters that were studied, nor in the turbidity or homogeneity

ВОЗМОЖНОСТИ ТЕРАПИИ КАШЛЯ У ДЕТЕЙ

Acute respiratory infections (ARI) are the main reason for morbidity in childhood. In ca. 90% of cases, they are accompanied by cough. The purpose of this research was to study the effectiveness and safety of the STODAL® drug in the treatment of cough in children. Materials and methods used: a multicenter prospective observational non-randomized clinical study was conducted involving 1000 outpatients with ARI aged 2 to 7 y/o and whose cough duration did not exceed 3 days from the onset of the disease. All of them were prescribed and treated with the complex homeopathic anticough drug on the day of their visit to pediatric practitioner in the outpatient hospital facilities. The patients were divided into two age groups as follows: G1 (n=500) of children aged 2 to 4 y/o and G2 (n=500) of children aged 4 years and 1 day old to 7 y/o. Results: on the 7th day of the therapy, a statistically significant decrease in the severity of daytime cough was noted: in G1 the severity of cough decreased by 1.51 points (from 2.16 to 0.65 points, p&lt;0.001) and by 1.56 points (from 2.24 to 0.68 points, p&lt;0.001) in G2. There was no difference in the reduction in daytime cough severity between the groups (p=0.158). The severity of night cough in G1 decreased by 1.16 points (from 1.64 to 0.48 points, p&lt;0.001) and by 1.25 points (from 1.71 to 0.46 points, p&lt;0.001) in G2. There were no differences in the dynamics of the severity of night cough between the groups as well (p=0.135). The proportion of patients whose cough resolved completely or became clinically insignificant on the 7th day of treatment was 98%, these patients were therefore considered recovered. Cough treatment was rated positively by 95.1% of parents/caretakers. Adverse events (AEs) were reported in 5 patients (0.5% of all cases) and there were no serious AEs among them. Conclusion: the effectiveness and safety of the STODAL® drug in the treatment of cough in ARI in children aged 2 to 7 y/o allows recommending a homeopathic drug with complex anti-inflammatory, antitussive and antimicrobial action for its inclusion in the treatment regimens starting from the first days of the disease.

INCREASING ADOLESCENT KNOWLEDGE ABOUT RATIONAL COMMON COLD SELF-MEDICATION

Background: Knowledge of self-medication is associated with engaging in self-medication. Choosing the wrong common cold medication not only fails to deliver the best results but also leads to higher treatment expenses. Based on previous research in 2023, it was reported that 19.88% student in Yogyakarta had low knowledge about common cold self-medication. Objective: This service activity aims to increase teenagers' knowledge about rational self-medication for common cold. Method: The activity involved directly educating partners about rational self-medication for the common cold through the use of posters and leaflets, followed by their understanding with pre-tests and post-tests. Results: Following schooling, partners’ knowledge increased. Conclusion: Education can raise public awareness of rational self-medication for the common cold, allowing people to make more informed decision when taking medications in their regular self-medication practices.

Randomized double-blind placebo-controlled trial evaluating pregabalin for chronic cough in patients with lung cancer.

LBA12082 Background: Chronic cough is a distressing symptom that detracts from the quality of life (QoL) of patients with cancer. Developing effective therapies for cough is an unmet need, with no approved medicines available. Neuromodulators like pregabalin may act centrally as cough suppressants. Methods: Randomized double-blind placebo-controlled study in the Department of Medical Oncology at Tata Memorial Hospital (Mumbai, India) in patients with locally advanced/metastatic non-small-cell lung cancer (NSCLC) with at least 2 weeks history of moderate or severe cough. Patients had ECOG PS 0-2, and creatinine clearance &gt; 60 mL/min. Randomization was 1:1 to pregabalin 300 mg orally daily or matching placebo, both administered for 9 weeks. Primary endpoint was the difference in cough severity as measured by Visual Analog Scale (VAS) after 9 weeks treatment with pregabalin versus placebo. Secondary endpoints included cough severity on day 7 and week 9 measured by VAS, and Manchester Cough in Lung Cancer Scale (MCLCS); side-effects, and QoL assessed by EORTC QLQ C30 and LC13. Means of the change from baseline scores were calculated for patients in each arm, and compared between two arms by independent samples Mann Whitney U test. P &lt; 0.05 was considered significant. Results: Between Jul 2022 and Dec 2023, we enrolled 166 patients: 83 to each arm. Median age was 56 years (IQR, 47-62.5); 112 (67.5%) were male, and 149 (89.8%) had metastatic NSCLC. Baseline cough severity was grade 2 in 127 (76.5%) and grade 3 in 37 (22.6%); median cough duration was 163 days. The therapy (pregabalin/placebo) was well tolerated in both arms, with no difference in grade &gt; 3 toxicities between the two arms; P=0.908. Systemic cancer-directed therapy was started in 95.2% and 91.4% of patients in the pregabalin and placebo arms, respectively; P=0.328. By week 9, subjective improvement in cough was reported by 45 (57%) patients in pregabalin arm, and 40 (52.6%) patients in placebo arm; P=0.846. The mean VAS score (in mm) decreased from 71.58 at baseline, to 45.32 at day 7, and 19.73 by week 9 in the pregabalin arm; corresponding values in the placebo arm were 71.74, 46.23, and 21.18, respectively; P=0.530. Cough assessment by mean MCLCS scores showed a similar decrease throughout the course of the study, with no statistically significant differences between the two arms (Pregabalin-Baseline: 27.63, Day 7: 23.49, Week 9: 17.39; Placebo-Baseline: 27.28, Day 7: 23, Week 9: 17.34); P=0.455. There was no significant difference in QoL between the two arms. Mean LCCO (cough symptom question on QLQ LC13) score decreased from 75.9 (baseline) to 54.2 (day 7) to 36.4 (week 9) in pregabalin arm, vs 66.3, 54, and 31.4, respectively, in placebo arm; P=0.150. Conclusions: Pregabalin does not lead to a significant decrease in cough in patients with lung cancer. Systemic cancer-directed therapy is the most effective antitussive therapy for cancer-induced cough. Clinical trial information: CTRI/2020/11/029275 .

Cough at the doctor’s office

Сough is a common symptom that requires medical attention. The range of diseases in which cough occurs is quite large. These are not only patients with bronchopulmonary pathology, cough can also occur in diseases of the gastrointestinal tract, cardiovascular system, diseases of the upper respiratory tract, taking medications and a number of other reasons. Cough has different developmental mechanisms and clinical characteristics. Treatment of cough should be primarily aimed at eliminating the cause of cough, the nosological form that triggered the development of this symptom. However, cough often requires a complex long-term diagnosis and personalized approach to therapy. Symptomatic treatment is often required before the cause of chronic cough is established and for patients with acute and subacute cough. When choosing symptomatic cough therapy, it is necessary to focus on a specific clinical situation and take a differentiated approach to the choice of medications. Combination medications are an effective symptomatic remedy in the treatment of cough, especially in situations where the patient has several symptoms at the same time (cough, viscous, difficult-to-separate sputum, bronchial obstruction). An example of such a combination are drugs that include bromhexine (mucolytic), guaifenesine (mucolytic/mucokinetic) and salbutamol (β2-adrenomimetic). The drugs have a synergistic effect, have an antitussive effect, improve mucociliary clearance, improve the rheological properties of bronchial secretions, reducing excessive bronchial tone, which leads to rapid cleansing of the bronchi from altered bronchial secretions and a decrease / cessation of coughing.

Benefit-Risk Profile of P2X3 Receptor Antagonists for Treatment of Chronic Cough: Dose-Response Model-Based Network Meta-Analysis

BackgroundRefractory or unexplained chronic cough disrupts quality of life and burdens healthcare systems around the world. The P2X3 receptor antagonist gefapixant is approved in many countries for its antitussive effects, but taste disturbances are a common adverse effect. Four newer, more selective P2X3 receptor antagonists have been developed to address this problem. Research QuestionHow does the benefit-risk profile vary across the five available P2X3 receptor antagonists? Study Design and MethodsA systematic review and network meta-analyses were conducted to evaluate the efficacy of P2X3 receptor antagonists, including gefapixant, sivopixant, eliapixant, camlipixant, and filapixant. Primary outcomes were a reduction rate in 24-hour cough frequency and incidence of taste disturbance. Dose-response curves, and median effective dose (ED50) were calculated. Effect size at ED50 was ranked according to SUCRA. The confidence was evaluated by CINeMA. ResultsSixteen randomized controlled trials involving 4,904 participants were analyzed. The gefapixant regimen demonstrated an ED50 of 90.7 mg/day for cough frequency reduction. Gefapixant showed the highest antitussive effectiveness at ED50 (reduction rate in 24-h cough frequency, median 28.1%; 95% Credible Interval 21.0 to 35.6%; ranked 1/5; moderate certainty) but the highest prevalence of taste disturbance (absolute risk difference per 100 patients, median 38; 95%CrI 27 to 51; ranked 5/5; high certainty) and the highest prevalence of discontinuation. Camlipixant had a well-balanced profile (reduction rate in 24-h cough frequency, median 14.7%; 95%CrI 5.4 to 26.0%; ranked 3/5; low certainty; and taste disturbance, absolute risk difference per 100 patients, median 2; 95%CrI 1 to 6; ranked 2/5; low certainty). Placebo had a mean of 33.1% reduction in 24-h cough frequency. InterpretationWhen used at safe doses, gefapixant had a favorable risk-benefit profile compared to the other four agents. Camlipixant showed initial promise, which may be further investigated by phase III trials currently underway. Clinical Trial RegistrationUMIN000050622

Temporary gains and permanent costs in methamphetamine precursor control

James Cunningham and co-authors did pioneering work in evaluating the impact of precursor control on methamphetamine markets and related harms. We discuss their studies, as well as others that followed, and review what is known of precursor control's short-run and long-run impacts. We interpret the evidence to suggest that precursor control was likely cost-effective initially. However, long-run supply adjustments by illicit meth producers weakened the controls' efficacy. Meanwhile, regulations on legal consumers of cold medications were permanent and unavoidable, which may have closed the gap on the positive net benefits that had accrued initially in the short run. Our review underscores the challenges policymakers face in achieving their goals when supply can adjust long-term, but non-participants in illegal markets cannot.

Enhancement of production of glycoalkaloids by elicitors along with characterization of gene expression of pathways in Solanum xanthocarpum

Solanum xanthocarpum fruits are used in the treatment of cough, fever, and heart disorders. It possesses antipyretic, hypotensive, antiasthmatic, aphrodisiac and antianaphylactic properties. In the present study, 24 elicitors (both biotic and abiotic) were used to enhance the production of glycoalkaloids in cell cultures of S. xanthocarpum. Four concentrations of elicitors were added into the MS culture medium. The maximum accumulation (5.56-fold higher than control) of demissidine was induced by sodium nitroprusside at 50 mM concentration whereas the highest growth of cell biomass (4.51-fold higher than control) stimulated by systemin at 30 mM concentration. A total of 17 genes of biosynthetic pathways of glycoalkaloids were characterized from the cells of S. xanthocarpum. The greater accumulation of demissidine was confirmed with the expression analysis of 11 key biosynthetic pathway enzymes e.g., acetoacetic-CoA thiolase, 3- hydroxy 3-methyl glutaryl synthase, β-hydroxy β-methylglutaryl CoA reductase, mevalonate kinase, farnesyl diphosphate synthase, squalene synthase, squalene epoxidase, squalene-2,3- epoxide cyclase, cycloartenol synthase, UDP-glucose: solanidine glucosyltransferase and UDP-rhamnose: solanidine rhamno-galactosyl transferase. The maximum expression levels of UDP-rhamnose: solanidine rhamno-galactosyl transferase gene was recorded in this study.

Antibacterial Activity of Sungkai Leaf Extract (Peronema canescens Jack) Against Streptococcus Pneumonia ATCC Bacteria. 49619 In Vitro

Pneumonia is an infectious disease of the respiratory tract that is transmitted through the air. Young leaves of the sungkai plant of the Verbenaceae tribe, traditionally often used as a cold medicine, worms (ringworms), prevent toothache by gargling, as a febrifuge. In addition, sungkai leaves are a traditional medicine to improve the immune system of patients with Covid-19. The purpose of this study was to determine the antibacterial activity of sungkai leaf extract in inhibiting the growth of Streptococcus pneumonia at bacteria.49619 The research methodology used was experimental. This research method starts with tool preparation, sampling, the extraction process, the photochemical process, and further extraction antibacterial activity testing is carried out by disk diffusion method using disc paper. The results of the study of the antibacterial activity of sungkai leaf extract have antibacterial activity in Streptococcus pneumonia atcc.49619 with a concentration of 25% categorized as medium, 50%, and 75% categorized as strong, while in Control + categorized as very strong. Based on the results of the conclusions showed that sungkai leaf extract has antibacterial activity.

A Semi-Mechanistic Population Pharmacokinetic Model of Noscapine in Healthy Subjects Considering Hepatic First-Pass Extraction and CYP2C9 Genotypes.

Noscapine is a commonly used cough suppressant, with ongoing research on its anti-inflammatory and anti-tumor properties. The drug has a pronounced pharmacokinetic variability. This evaluation aims to describe the pharmacokinetics of noscapine using a semi-mechanistic population pharmacokinetic model and to identify covariates that could explain inter-individual pharmacokinetic variability. Forty-eight healthy volunteers (30 men and 18 women, mean age 33 years) were enrolled in a randomized, two-period, two-stage, crossover bioequivalence study of noscapine in two different liquid formulations. Noscapine plasma concentrations following oral administration of noscapine 50 mg were evaluated by a non-compartmental analysis and by a population pharmacokinetic model separately. Compared to the reference formulation, the test formulation exhibited ratios (with 94.12% confidence intervals) of 0.784 (0.662-0.929) and 0.827 (0.762-0.925) for peak plasma concentrations and area under the plasma concentration-time curve, respectively. Significant differences in p values (<0.01) were both observed when comparing peak plasma concentrations and area under the plasma concentration-time curve between CYP2C9 genotype-predicted phenotypes. A three-compartmental model with zero-order absorption and first-order elimination process best described the plasma data. The introduction of a liver compartment was able to describe the profound first-pass effect of noscapine. Total body weight and the CYP2C9 genotype-predicted phenotype were both identified as significant covariates on apparent clearance, which was estimated as 958 ± 548 L/h for extensive metabolizers (CYP2C9*1/*1 and *1/*9), 531 ± 304 L/h for intermediate metabolizers with an activity score of 1.5 (CYP2C9*1/*2), and 343 ± 197 L/h for poor metabolizers and intermediate metabolizers with an activity score of 1.0 (CYP2C9*1/*3, *2/*3, and*3/*3). The current work is expected to facilitate the future pharmacokinetic/pharmacodynamic development of noscapine. This study was registered prior to starting at "Deutsches Register Klinischer Studien" under registration no. DRKS00017760.

Guaifenesin: The Ubiquitous Orphan.

Guaifenesin, a widely used ingredient in over-the-counter cough and cold medications, has been a subject of debate regarding its efficacy in treating respiratory conditions. Despite its historical use and US Food and Drug Administration approval, recent studies have questioned its claimed expectorant effect and its effectiveness in managing symptoms. This article examines the available evidence, highlighting the lack of significant benefits over placebo for upper respiratory disease. The rationale for clinical use is examined alongside the potential downside and alternatives to recommending guaifenesin as a treatment option.

#2358 Impact of COVID-19 on the clinical course of nephrotic syndrome in children: a single-center study

Abstract Background and Aims Children with nephrotic syndrome may experience disease relapse or aggravation triggered by various viral infections. Limited studies on the clinical implications of the coronavirus disease 2019 (COVID-19) pandemic in children with nephrotic syndrome have been published worldwide. Therefore, this study aimed to investigate the effects of COVID-19 on the clinical course of nephrotic syndrome in children. Method The medical records of pediatric patients with idiopathic nephrotic syndrome who visited our hospital between February and June 2022 were retrospectively analyzed. Patients aged &amp;lt;1 year and &amp;gt;19 years and those with inadequate medical records were excluded. Finally, total 59 patients (20 pediatric patients diagnosed with COVID-19 and 39 pediatric patients who did not have COVID-19) were included in the study. Results Twenty of the total 59 patients with nephrotic syndrome were diagnosed with COVID-19 during the study period. The mean age at the time of the diagnosis of nephrotic syndrome and COVID-19 in all 20 patients was 4.6 ± 3.5 and 8.9 ± 3.9 years, respectively. Three patients (15%) were diagnosed with nephrotic syndrome relapse during COVID-19 and the relapse rate was similar to them without COVID-19 (20.5%, 8/39 patients). At the time of the COVID-19 diagnosis, fever (85%) and cough (40%) were the most common symptoms. After the diagnosis of COVID-19, all patients showed improvement with symptomatic treatment, including antipyretic analgesics and cold medicine. None of the critical patients required hospitalization or oral antiviral medications. Conclusion Despite the use of immunosuppressants, the clinical manifestations of COVID-19 in children with nephrotic syndrome were not severe and are expected to be similar to that in the general population. The relapse rate of nephrotic syndrome in children with COVID-19 was also not different from them without COVID-19.

Chronic cough diagnosis, treatment, and referral practices among family physicians in the United States: a survey study

BackgroundCough is one of the most common presenting problems for patients in primary care and is largely managed in primary care clinical settings. Family physicians’ familiarity with chronic cough guidelines and the extent to which these guidelines translate into everyday practice have not been well described. The objective of this study was to characterize current diagnosis, treatment, and referral practices among family physicians and to identify potentially impactful strategies to optimize chronic cough management in primary care.MethodsWe conducted a cross-sectional survey of 5,000 family physicians to explore diagnosis, treatment, and referral practices related to chronic cough management in adults in primary care. Respondents completed the survey via paper or online. The outcome measures were self-reported numeric ratings and responses related to the survey elements.Results588 surveys were completed (11.8% response rate). About half (49.6%) of respondents defined chronic cough in a manner consistent with the American College of Chest Physicians (ACCP) chronic cough guidelines, with the rest differing in opinion primarily regarding duration of symptom presentation. Respondents reported trying to rule out most common causes of chronic cough themselves before referring (mean 3.41 on a 4-point scale where 4 is “describes me completely”) and indicated a desire for more resources to help them manage and treat chronic cough. Years in practice and rural/urban setting influenced diagnosis and referral practices.ConclusionsFamily physicians see chronic cough as a complicated condition that can be and is often diagnosed and treated entirely in a primary care setting. They also value the ability to refer in complex cases. Our results support that family physicians provide evidence-based management of chronic cough.