Management Of Cough Research Articles

Effect of various modes of tracheal mechanical stimulation on the cough motor pattern

The relationship between the level (rate) of stimulus and the characteristics of the cough response was studied on 15 spontaneously breathing anesthetized cats. Three modes of stimulation were used to elicit cough. ‘High’ vs. ‘low’ level of stimulation was accomplished: 1st mode by 1 vs. 4 penetrations of the soft catheter through the trachea (approximately 10cm), 2nd mode by 2 penetrations with the soft catheter equipped with 4 fine cross nylon fibers vs. 4 penetrations by the stimulator with 8 fibers, and 3rd mode by a similar stimulator with 4 cross fibers probing 4cm of the trachea either right below the larynx or deeper under the upper part of the sternum (data were pooled) vs. stimulating both areas at the same time. ‘High’ stimulation rate in each stimulation mode resulted in a higher number of coughs, increased cough efforts, and shortened several temporal cough features. Mechanical stimulation resulting in higher cough afferent drive induces more vigorous coughing with shorter temporal cough characteristics. Modulation of cough afferent input affects both spatial and temporal components of the cough motor pattern, representing a crucial point in cough management.

The Relationship Between Chronic Cough and Laryngopharyngeal Reflux: A Professional Voice User’s Guide on Diagnosis and Treatment

Abstract: Chronic cough is multifactorial in origin, affects quality of life adversely, including preventing singers from performing, and poses a diagnostic challenge. Laryngopharyngeal reflux (LPR) is one common cause of chronic cough, but there are many causes of which singing teachers should be aware. Recently, research has been completed to investigate the relationship between chronic cough and LPR to help with treatment and management of this complicated disease process, and that new information is summarized; but awareness of other causes is stressed because many physicians are not expert in cough management. Singers and teachers need to be informed health care consumers.

Management of chronic cough

Management of chronic cough

An expert consensus on managing cough in Indian pediatric practice: airway disease education and expertise 2.0 (2024)

Cough in children is one of the most frequent presenting symptoms in health care settings. Coughing can significantly affect a child's sleep and level of activity, which often causes parents’ distress. Promptly addressing chronic cough may enhance the quality of life in children and reduce the considerable stress on parents. In 2017, airway disease education and expertise (ADEX) NEXT recommendations for diagnosis, management, and follow-up of persistent (chronic) cough were published. For the present work 27 modified Delphi consensus statements were prepared, and a survey was undertaken involving 30 expert pediatricians from across India. The opinions of the expert panel on the updates related to pediatric chronic cough awareness, diagnosis, and management were collected. Consensus was predetermined to be obtained if more than 75% of the participants agreed or remained neutral for the statement. All the statements were supported by the latest data from the literature search. All the statements reached consensus after an agreement of more than 75%. Consequently, all the opinions from experts were consolidated and expert recommendations were framed. Children presenting with cough should be treated in accordance with child-specific guidelines. The present expert recommendations can be utilized by pediatricians to make well-informed decisions when treating pediatric patients with cough. The management of cough in children should be determined by the underlying cause, where a prompt and efficient therapy can result in early resolution.

Neuromodulators in Acute and Chronic Cough in Children: An Update From the Literature

Cough is one of the most common reasons leading to pediatric consultations, negatively impacting the quality of life of patients and caregivers. It is defined as a sudden and forceful expulsion of air from the lungs through the mouth, typically triggered by irritation or the stimulation of sensory nerves in the respiratory tract. This reflex is controlled by a neural pathway that includes sensory receptors, afferent nerves, the brainstem’s cough center, efferent nerves, and the muscles involved in coughing. Based on its duration, cough in children may be classified as acute, lasting less than four weeks, and chronic, persisting for more than four weeks. Neuromodulators have shown promise in reducing the frequency and severity of cough by modulating the neural pathways involved in the cough reflex, although they require careful monitoring and patient selection to optimize the outcomes. This review aims to examine the rationale for using neuromodulators in the management of cough in children.

Association of Physicians of India: National Expert Opinion and Clinical Practice Recommendations for Primary Care Cough Management in India.

Pathological cough in primary care is a significant concern. With a prevalence ranging from 5 to 10% in India, cough is the second most common symptom seen by general practitioners (GPs). The existing algorithms and tools that are available are generally meant for cough categorization in specialized fields; their limited adoption by GPs results in insufficient screening and categorization of cough, which results in the use of irrational fixed drug combination formulations. Formulation of recommendations for GPs to enable them to appropriately screen and categorize cough for efficient management and avoid irrational treatments. An expert panel (seven experts specializing in pulmonology and internal medicine) held a virtual discussion to assess the necessity for cough categorization and develop user-friendly tools, along with a simplified format for history taking in cough evaluation and management. Panel discussions were based on a questionnaire that contained items related to the categorization of cough, assessment tools, and approaches to treating cough. After deliberations, simplified clinical practice recommendations and assessment tools were developed by the experts to facilitate the categorization of cough into wet or dry categories, thereby helping in the symptom-based management of cough. By adhering to these principles and using assessment tools, primary care practitioners can optimize cough management, avoid irrational drug combinations, minimize potential risks, and improve patient well-being.

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.

The discovery and development of gefapixant as a novel antitussive therapy

ABSTRACT Introduction Gefapixant, a P2X 3 receptor antagonist, shows considerable potential in managing refractory or unexplained chronic cough. Clinical trials have consistently demonstrated its efficacy in significantly reducing cough frequency and alleviating associated symptoms. However, its adverse effect profile, particularly taste disturbances such as dysgeusia and hypogeusia, the incidence of which is dose-dependent, poses a significant challenge to patient compliance and overall treatment satisfaction. Areas covered The authors review the mechanism of action of gefapixant, the dose-dependent nature of its adverse effects and the findings from various clinical trials, including Phase 1, Phase 2, and Phase 3 studies. The authors also cover its regulatory status, post-marketing data, and its main competitors. Expert opinion Gefapixant represents a significant advancement in treating chronic cough. However, balancing efficacy and tolerability is crucial. Lower effective doses and potential combination therapies may mitigate taste disturbances. Patient education and close monitoring during treatment are also important for optimal outcomes. Further research is needed to refine dosing strategies to minimize side effects while maintaining therapeutic efficacy. This research and personalized treatment approaches are key to optimizing gefapixant therapy, ensuring improved management of chronic cough while reducing adverse effects. However, pharmaceutical trials and proposals must be adapted to align with each regulatory body’s specific requirements and concerns.

Efficacy and Safety of Combination of Noscapine and Chlorpheniramine in Management of Cold and Cough

Cough is one of the most common symptoms for which patients visit the doctor. Because of its broad differential diagnosis,cough is a challenging condition to manage. Antitussives or cough suppressants are indicated if cough interferes with dailyactivities. Cough suppressants not only provide symptomatic relief by decreasing cough, they also prevent the spread ofinfection. Noscapine is a non-narcotic cough suppressant, which relieves cough by acting at the level of the cough centerin the brain. It does not cause significant sedative, euphoric, or hypnotic effects, and other side effects such as respiratorysuppression and constipation that are typically associated with opioids. Hence, unlike other opioid antitussives such ascodeine, noscapine is nonaddictive.

Need for sex-stratified reference values for exhaled nitric oxide as biomarker in chronic cough.

The implementation of exhaled nitric oxide fraction (F ENO) as a biomarker in patients with chronic cough requires sex-stratified F ENO reference values in general and sex-stratified cut-off levels in the management of unexplained chronic cough https://bit.ly/3JHi0vb.

How to distinguish PPI-refractory from PPI-responsive in gastroesophageal reflux-induced chronic cough: post reflux swallow induced peristaltic wave index and mean nocturnal baseline impedance provide new predictive factors

The results of empirical trials with proton pump inhibitors (PPIs) for management of gastroesophageal reflux-induced chronic cough (GERC) have resulted in considerable controversy and the mechanism of PPI refractoriness remain unclear. In total, 128 GERC patients were enrolled between March 2018 and October 2022. The post-reflux swallow-induced peristaltic wave index (PSPWI) was lower in the PPI-refractory group than the PPI-responsive group (33.89±7.38versus39.45±9.47, respectively, p<0.001), as were the mean nocturnal baseline impedance (MNBI) and proximal MNBI [2092.11 (IQR: 652.23)]versus2426.52 (IQR: 917.39) Ω, respectively, p=0.012; 1599.50 (IQR: 1206.63)versus2274.50 (IQR: 1775.29) Ω, respectively, p=0.001). Multivariate logistic regression analysis identified the PSPWI (odds ratio=0.919, p=0.001) as an independent predictor of PPI-refractory GERC. The diagnostic value of both proximal MNBI≤39.90% and MNBI≤2233.58 Ω had moderate sensitivity (71.67%) and specificity (75.00%) to identify PPI-refractory GERC.

Drugs Targeting Cough Receptors: New Therapeutic Options in Refractory or Unexplained Chronic Cough.

Refractory chronic cough is a disabling disease with very limited therapeutic options. A better understanding of cough pathophysiology has led to the development of emerging drugs targeting cough receptors. Recent strides have illuminated novel therapeutic avenues, notably centred on modulating transient receptor potential (TRP) channels, purinergic receptors, and neurokinin receptors. By modulating these receptors, the goal is to intervene in the sensory pathways that trigger cough reflexes, thereby providing relief without compromising vital protective mechanisms. These innovative pharmacotherapies hold promise for improvement of refractory chronic cough by offering improved efficacy and potentially mitigating adverse effects associated with current recommended treatments. A deeper comprehension of their precise mechanisms of action and clinical viability is imperative for optimising therapeutic interventions and elevating patient care standards in respiratory health. This review delineates the evolving landscape of drug development in this domain, emphasising the significance of these advancements in reshaping the paradigm of cough management.

Divergences in chronic cough management among healthcare professionals in Southern Italy: A comprehensive survey

Divergences in chronic cough management among healthcare professionals in Southern Italy: A comprehensive survey

Management of cough in children

Management of cough in children

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.

Factors associated with the use of antibiotics for children presenting with illnesses with fever and cough obtained from prescription and non-prescription sources: a cross-sectional study of data for 37 sub-Saharan African countries

IntroductionFever and cough in under-five children are common and predominately self-limiting illnesses. Inappropriate prescribing of antibiotics in sub-Saharan Africa is a significant public health concern. However, prescription sources and use among children with fever or cough have not been explored. Therefore, we explored the factors associated with the use of antibiotics obtained from prescription and non-prescription sources for children with illnesses associated with fever and cough.MethodsA secondary data analysis was conducted based on the Demographic and Health Survey (DHS) data from 37 sub-Saharan African countries. A total weighted sample of 18,866 under-five children who had a fever/cough and took antibiotics were considered for this study. Given the hierarchical nature of DHS data and the use of antibiotics prescribed from the formal healthcare setting (> 10%), a multilevel modified poisson regression model was fitted. Deviance was used for model comparison and the model with the lowest deviance value was chosen as the best-fitted model. Variables with p ≤ 0.2 in the bivariable analysis were considered for the multivariable modified poisson regression model. In the multivariable multilevel modified poisson regression model, the Adjusted Prevalence Odds Ratio (APOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were reported to declare a significant association with taking antibiotics for fever/cough prescribed from formal healthcare setting.ResultsIn sub-Saharan Africa, the proportion of use of antibiotics from informal healthcare setting for fever and cough among under-five children was 67.19% (95% CI: 66.51%, 67.85%). In the multilevel modified poisson regression analysis; residing in a rural area (APOR = 1.08, 95% CI: 1.04, 1.12), a child aged 36–47 months (APOR = 0.94, 95% CI: 0.90, 0.98), a child aged 48–59 months (APOR = 0.89, 95% CI: 0.84, 0.94), maternal primary education (APOR = 0.96, 95% CI: 0.93, 0.99), maternal secondary education (APOR = 0.95, 95% CI: 0.92, 0.99), belonged the middle household wealth status (APOR = 1.07, 95% CI: 1.02, 1.11), maternal exposure to news/electronic media (APR = 1.06, 95% CI: 1.02, 1.10), being from a household with 2 under-five children (APR = 0.94, 95% CI: 0.91, 0.97), being from a household with 3 under-five children (APR = 0.89, 95% CI: 0.85, 0.93), being from a household with 4 under-five children (APR = 0.90, 95% CI: 0.83, 0.98), and children of caregivers who were not involved in decision-making for their child health issues were significantly associated with taking antibiotics prescribed from formal healthcare setting for fever/cough among under-five children.ConclusionOnly two-thirds of the antibiotics used for children under five who had fever and cough were prescribed from formal healthcare setting. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education, and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in under-five children.

A massive primary spontaneous pneumothorax during the recovery phase of H1N1 pneumonia – An issue of concern

The H1N1 or swine flu outbreak in 2009 was a major pandemic. It is a subtype of influenza A virus that affects humans and has two surface antigens, which led to it being called the novel H1N1 flu. Some patients with swine flu may develop lower respiratory tract infections, which can result in respiratory failure and acute respiratory distress syndrome (ARDS). In this case report, a patient with H1N1 pneumonia developed massive spontaneous pneumothorax during the recovery phase and concludes that, high pressure mechanical ventilation during the management of H1N1 pneumonia and persistent cough could be the reason for spontaneous development of pneumothorax. However, spontaneous development of pneumothorax in patients with swine flu pneumonia is rarely reported. We present an uncommon case of H1N1 pneumonia-induced pneumothorax that occurred during the recovery phase of the patient. This case report highlights the need for clinicians and healthcare teams to be aware of this potential complication during the post-recovery phase of the patient.

Antibiotic prescription sources and use among under-5 children with fever/cough in sub-Saharan Africa.

Childhood febrile illness is among the leading causes of hospital admission for children <5y of age in sub-Saharan Africa (SSA). Antibiotics have played a pivotal role in enhancing health outcomes, especially for children <5y of age. Antibiotics prescription pattern evidence exists for SSA, however, prescription sources (either from qualified or unqualified sources) and use among children with fever or cough have not been explored. Thus the present study assessed antibiotic prescription sources and use among children <5y of age with fever and cough in SSA. We used Demographic and Health Survey data from 37 countries with a total of 18866 children <5y of age who had fever/cough. The surveys span from 2006 to 2021. The dependent variable was antibiotics taken for fever/cough based on prescriptions from qualified sources. The data were weighted using sampling weight, primary sampling unit and strata. A mixed-effects logistic regression model (both fixed and random effects) was fitted since the outcome variable was binary. Model comparison was made based on deviance (-2 log likelihood) and likelihood ratio tests were used for model comparison. Variables with p≤0.2 in the bivariable analysis were considered for the multivariable mixed-effects binary logistic regression model. In the final model, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p<0.05 in the multivariable model were used to declare a significant association with taking antibiotics for fever/cough prescribed from qualified sources. The percentage of unqualified antibiotic prescriptions among children <5y of age who had a fever/cough and took antibiotics was 67.19% (95% CI 66.51 to 67.85), ranging from 40.34% in Chad to 92.67% in Sao Tome. The odds of taking antibiotics prescribed from unqualified sources for fever/cough among children <5y of age living in rural areas were 1.23 times higher (AOR 1.23 [95% CI 1.13 to 1.33]) compared with urban children. The odds of taking antibiotics prescribed from qualified sources for fever/cough among children <5y of age whose mothers had primary, secondary and higher education decreased by 14% (AOR=0.86 [95% CI 0.79 to 0.93]), 21% (AOR 0.79 [95% CI 0.72 to 0.86]) and 21% (AOR 0.79 [95% CI 0.65 to 0.95]) compared with those whose mother had no formal education, respectively. The study showed that the majority of the children who received antibiotics obtained them from unqualified sources in the 37 SSA countries. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in children <5y of age.

A survey of UK respiratory specialists' opinion on the management of chronic cough.

Chronic cough is a common presentation to respiratory specialists. Here, we survey their opinion on diagnosis, investigation and management. Whilst investigations were appropriate, treatments were not guideline-based. Further education is needed. https://bit.ly/4a7W7Ay.

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome: a neurogenic cough prototype.

Chronic cough is a frequent disorder that is defined by cough of more than 8 weeks duration. Despite extensive investigation, some patients exhibit no aetiology and others do not respond to specific treatments directed against apparent causes of cough. Such patients are identified as having unexplained or refractory chronic cough. Recently, a high proportion of patients with chronic cough in the context of cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) was highlighted. CANVAS is a rare neurological disorder with a biallelic variation in the replication factor C subunit 1 (RFC1) gene corresponding mostly to an intronic AAGGG repeat expansion. Chronic cough in patients with CANVAS shares similar characteristics with cough hypersensitivity syndrome. The high prevalence of chronic cough in CANVAS gives the opportunity to better understand the neurogenic mechanism of chronic cough. In this review, we will describe the characteristics and mechanisms of CANVAS. We will also address the potential mechanisms responsible for chronic cough in CANVAS. Finally, we will address chronic cough management in the context of CANVAS.