Postinfectious Cough Research Articles

Characteristics of pediatric patients with chronic cough: data from a pediatric immunology and allergy outpatient clinic

Aims: Chronic cough is a common complaint in childhood. A differential diagnosis is very important in children with a chronic cough. We aimed to investigate the etiology and underlying risk factors of chronic cough in children. Methods: Patients aged 1-18 years who were referred to Sincan Training and Research Hospital Pediatric Immunology and Allergy Outpatient Clinic were included. Demographic, clinical and laboratory features of patients were recorded. Results: The study included 403 children with a median age of 8 years (IQR 6-12) (53% males). 30% of patients had allergic rhinitis (AR), 4.7% of patients had atopic dermatitis (AD), and 2% patients had food allergy (FA) history. 78(19.3%) patients also complained of dyspnea and 9 (2.2%) patients had a diagnosis of cardiovascular disease. 245 (60.8%) asthma-wheezy infant, 107 (26.6%) post-infectious cough, 36 (9%) postnasal drip syndrome, 9 (2.2%) gastroesophageal reflux and 6 (1.5%) psychogenic cough were detected in the whole group. The number of patients with accompanying dyspnea 76 (28.5%) and familial history of atopy 113 (42.3%) were higher in the asthma-wheezy infant group than others group (p

Effects of intensive wearing face masks on patients with postinfectious cough: A randomized controlled trial.

Postinfectious cough was a common clinical symptom, which troubled patients and increased economic burden. The efficacy of pharmacotherapy for this symptom was unsatisfactory. This study aimed to explore the intervention effect of intensified mask-wearing on patients with post-upper respiratory tract infection cough and its role in reducing the economic burden of patients. As a randomized, controlled, single-blind trial, a total of 46 eligible patients with postinfectious cough were selected from local hospital, from November 2023 to February 2024. They were randomized into a control group (n = 21) and an experimental group (n = 25). Both groups received routine diagnosis and treatment, and the experimental group additionally received wearing medical surgical masks for >8 hours every day. All patients were followed up by on-site evaluation or telephone follow-up every 3 days for 3 weeks. We used a cough evaluation test to evaluate symptoms, recorded mask-wearing duration, and adjusted the treatment plan. There were no statistically significant differences in age, gender, course of disease, cough severity, and time of wearing face masks in the early stage between 2 groups (P > .05). Three people (12.0%) in the experimental group were excluded from the study because of substandard wearing face masks. The average daily mask-wearing time of the experimental and control groups were: 9.7 ± 0.9 versus 1.2 ± 2.2 hours (P < .001). There was a statistically significant difference in cough severity scores between 2 groups on the 9th day of follow-up, 6.6 ± 2.0 versus 8.0 ± 2.5 (P < .05), the markedly effective and total effective rates were: 86.4% versus 57.1% and 31.81% versus 38.09 % (P <.05). The treatment time for all patients in 2 groups to achieve effectiveness was: 10.1 ± 4.6 versus 13.0 ± 4.1 days (P < .05). The final medical expenditure of 2 groups were 289.4 (185.2, 782.2) CNY versus 717.5 (548.5, 1582.2) CNY (P < .05). The compliance of patients with intensive wearing face masks was high. The intensive wearing of face masks had a good intervention effect on the treatment of postinfectious cough, which could effectively reduce cough symptoms of patients, shorten the course of the disease, and reduce medical expenditure.

Efficacy and Safety of Zihua Wenfei Zhisou Granule in Treatment of Postinfectious Cough: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase II Clinical Trial.

To evaluate the efficacy and safety of Chinese medicine (CM) Zihua Wenfei Zhisou Granule (ZWZG) in postinfectious cough (PIC) patients with CM syndrome of wind-cold invading Fei (Lung, WCIF). This is a multicenter, randomized, double-blind, parallel-group, placebo-controlled phase II clinical trial. PIC patients with WCIF syndrome were recruited from the Respiratory Departments in 6 hospitals across China between March 2019 and December 2020. Eligible patients were randomly assigned to group A (ZWZG-matched placebo 15 g), group B (active ZWZG 15 g), and group C (active ZWZG 10 g plus ZWZG-matched placebo 5 g) in a 1:1:1 ratio. All medications were taken orally 3 times daily for 14 consecutive days. The primary outcomes were cough relief rate and cough disappearance rate. The secondary outcomes included time to cough relief, time to cough disappearance, and changes in cough symptom score (CSS), cough Visual Analog Scale (VAS) value, Cough-Specific Quality of Life Questionnaire (CQLQ) score, and CM syndrome score from baseline (day 0) to post-treatment (day 14). Adverse events (AEs) in each group were recorded. A total of 198 patients were included in the full analysis set (FAS) and safety analysis set (SS), while 183 were enrolled in the per-protocol analysis set (PPS). In the FAS population, the cough relief rate was 47.76%, 90.77% and 84.85% in groups A, B, and C, respectively; while the cough disappearance rate was 31.34%, 72.31% and 68.18%, respectively. The cough relief rates and cough disappearance rates in groups B and C were significantly higher than group A (P<0.0001). Both the median time to cough relief and cough disappearance in groups B and C were shorter than group A (P<0.0001). Compared with group A, groups B and C showed significantly greater improvements from baseline to post-treatment in CSS during daytime and nighttime as well as VAS (P<0.05). There were no significant differences in changes from baseline to post-treatment in CQLQ and CM syndrome scores among 3 groups (P>0.05). Results in the PPS population were consistent with those in the FAS population. Groups B and C showed lower incidence in AEs than group A (P<0.05), while there was no significant difference between groups B and C (P>0.05). No drug-related severe AEs were reported. ZWZG can increase cough disappearance rate and cough relief rate; and it is beneficial in shortening cough duration and reducing cough severity and frequency in patients suffering from PIC. It is safe and generally well tolerated. (Registration No. ChiCTR1900022078).

Real-Life Insights into Pertussis Diagnosis: High Yield of PCR Testing and Clinical Outcomes-An Emerging Old Enemy or Just a Sign of PCR Times?

Background/Objectives: Pertussis remains a significant public health concern despite effective vaccines due to diagnostic challenges and symptom overlap with other respiratory infections. This study assesses the prevalence of Bordetella pertussis using advanced polymerase chain reaction (PCR) testing and examines the clinical outcomes over a one-month follow-up. Methods: We conducted a cross-sectional study at the University Hospital of Larissa, Greece, from April to June 2024, collecting 532 nasopharyngeal swabs from patients with respiratory symptoms. Diagnostic testing utilized the BioFire® Respiratory 2.1 Plus Panel. Demographics, clinical presentations, vaccination histories, and clinical outcomes were systematically recorded and analyzed. Results: Of 532 patients, 47 (8.8%) were diagnosed with pertussis. The mean age was 61.87 ± 13.4 years; 57.4% were female. Only 12.8% had contact with known pertussis patients. Regarding vaccination history, 36.2% had received diphtheria, tetanus, and pertussis vaccines, with the last dose administered an average of 46 years prior to this study. The primary symptom was cough (100%), with additional symptoms including fever (36.2%) and paroxysmal cough (34%). Six patients (12.8%) required hospitalization due to pneumonia and severe respiratory failure. All patients received successful treatment; however, 23.4% reported persistent post-infectious cough at the one-month follow-up. Conclusions: PCR testing significantly improved the diagnosis of pertussis among adults presenting with respiratory symptoms. The findings highlight the need for updated vaccination strategies and improved diagnostic protocols to effectively manage pertussis and reduce its public health impact.

Prospects for dry cough therapy with Herbion®, Iceland moss syrup, during tripledemic: A review

Cough is a common reason for seeking medical care, regardless of the season, but especially during the increased prevalence of respiratory infections and other diseases often associated with prolonged cough. Cough is an essential physiological protective reflex that cleanses the airways of secretions and inhaled or aspirated substances; however, it significantly worsens the child's condition. A dry, unproductive, persistent cough especially affects the quality of life. The article addresses various aspects of using the medicinal product Herbion®, Iceland moss syrup, for treating dry, unproductive, persistent cough in various diseases, including post-infectious cough.

Acute respiratory viral infections: Consensus on rational therapy

There are diseases for which people turn to specific specialists, but there are also a number of ones that are treated by doctors of different specialties. Therapists, infectious disease specialists, otolaryngologists, and pulmonologists diagnose and treat acute respiratory viral infections. But the same specialists often have to deal with the outcomes of an acute process – postnasal drip and post-infectious cough, which decreases the quality of life and exhaust patients. However, in case when the correct diagnosis is made, there are treatment regimens that allow to achieve quick relieve subjective and objective symptoms, as well as clinical cure of the disease escaping the use of antibacterial therapy. The efficient therapy agreement of the otolaryngologist and pulmonologist is that for various causes of cough, herbal medicine is the best choice.

Kemin capsule ameliorates post-infectious cough by modulating the PI3K/AKT signaling pathway and TRPA1/TRPV1 channels

Ethnopharmacological relevanceKemin capsule (KMC), as an innovative traditional Chinese medicine (TCM), has shown excellent efficacy in treating PIC in China. The post-infectious cough (PIC) is a common condition in pediatrics, and the inflammatory responses to PIC are intricately linked to the immune mechanisms of the host. However, the precise mechanisms involved remain uncertain. Aim of studyThe objective of this research is to investigate the mechanisms by which KMC treats PIC using a combination of UPLC-MS, bioinformatics, network pharmacology, and molecular docking. The study's findings will be corroborated through in vitro and in vivo experiments. Materials and methodsThis study identified the main components of KMC using UPLC-MS. The mechanism by which these capsules treat PIC was explored through transcriptomics, network pharmacology, and molecular docking. PIC model in Balb/c mice was induced with respiratory syncytial virus (RSV) at a titer of 10^5.5 TCID50/mL. From day 14 post-infection, the mice were orally administered the capsules at doses of 0.3, 0.6, and 1.2 g/kg for two weeks. Cough was stimulated with capsaicin at 10^-4 mol/mL, and the effects on PIC mice were measured by cough frequency, latency, ELISA, and H&E staining. Expression levels of transient receptor potential (TRP) channel proteins and the PI3K/AKT signaling pathway were analyzed using RT-qPCR, immunohistochemistry (IHC), and western blot (WB). The effect of KMC on A549 cells proliferation in vitro was also assessed. ResultsThe therapeutic efficacy of KMC is potentially exerted through its inherent bioactive constituents, including deoxyandrographolide, quercetin, and chryseriol. These compounds are hypothesized to modulate the PI3K/AKT signaling pathway and influence the function of TRP channel proteins, consequently mitigating the pathological state associated with PIC. In vivo experiments have demonstrated that KMC significantly reduces the frequency of coughs and extends the cough latency period in mice with PIC. KMC mitigates airway inflammation by suppressing the production of pro-inflammatory cytokines, including TNF-α, IL-1β, and IL-6. The expression or phosphorylation levels of key regulators in the PI3K/AKT/TRP axis in mouse lung tissue, including PI3K, AKT, NF-κB p65, TLR4, STAT3, TRPV1, TRPA1 were significantly reduced. ConclusionKMC exerts its therapeutic effect on PIC by dampening the activation of the PI3K/AKT signaling pathway and the activity of TRPA1 and TRPV1 ion channels.

Effectiveness of Peripheral Antitussives in Patients with Dry Postinfectious Cough

Abstract Background: Postinfectious dry cough can significantly worsen the quality of life of patients, which forces them to seek medical help. To relieve this symptom, peripheral antitussive agents are most often used, since they have a high profile of effectiveness and safety. Subjects and Methods: The study used levodropropizine, which was prescribed to a study group consisting of 100 patients with dry postinfectious cough, at a dosage of 10 ml (60 mg) 3 times a day for 7 days. The comparison group consisted of 34 patients with dry postinfectious cough who refused to take levodropropizine or had contraindications to taking it. On the 1st, 4th, and 8th days of the study, complaints were collected, an objective examination, and an assessment of cough intensity using 6-point scales for evaluating day and night cough, as well as a Visual Analog Scale were conducted. In addition, undesirable side effects were assessed at each visit. Results: It was found that during 7 days of treatment with levodropropizine, the intensity of cough on the above-mentioned scales significantly decreased, and no side effects were observed in any patient. Conclusions: The resolution of the cough syndrome occurred faster when taking a peripheral antitussive drug (levodropropizine). Moreover, no side effects were reported in any of the subjects. Therefore, peripheral antitussives have a high efficacy and safety profile against dry postinfectious cough.

Integrating pharmacokinetics and network pharmacology to decipher the efficacy of Fufang Qinlan oral liquid on post infectious cough

Background and aimFufang Qinlan oral liquid (QLOL) is a traditional Chinese medicine formula used to treat fevers, sore throats and cough. This study was to evaluate QLOL's therapeutic effects on post infectious cough (PIC) and to investigate Q-markers and action mechanisms by integrating pharmacokinetics and network pharmacology. Materials and methodsPIC rats were measured for cough frequency, organ index, pathological section of lung and inflammatory factors to evaluate the effects of QLOL. Pharmacokinetic analyses were performed using HPLC-QQQ-MS/MS to explore the possible Q-markers of QLOL and the changes of them in vivo. Network pharmacology was used to obtain potential important targets and action mechanisms of treating PIC. The possible hub genes were evaluated using QPCR. ResultsThe symptoms of cough and lung injury were significantly alleviated and IL-6 and IL-1β were significantly decreased after treatment of QLOL. 6 compounds were considered as possible Q-makers and their pharmacokinetic parameters were analyzed. The compound-target network was constructed to identify 53 important targets. Among them, HSPA8, HSP90AA1, HSP90AB1, YWHAZ, EGFR, ESR1 and EP300 were selected as the core targets because of high degree value and direct connection with inflammation or microbial infection. All 6 compounds had potently binding activity to core targets in molecular docking. The QPCR results showed the up-regulation of core targets expression in QLOL group compared with PIC rats, which validated the effects of QLOL and the accuracy of Q-markers selection. ConclusionQLOL alleviated PIC symptoms through various targets and mechanisms. The potential Q-markers were baicalein, baicalin, oroxylin A-7-O-glucuronideloside, wogonoside, oroxylin A and forsythoside E. Taxonomy (classification by evise)the experimental approach.

Experience in optimizing pharmacotherapy for prolonged postinfectious cough

The paper describes the rationale for the method and the experience of optimizing pharmacotherapy for prolonged postinfectious cough using such drugs as budesonide, butamirate, levodropropizine, and animal fats.

Postinfectious cough in adults.

Postinfectious cough in adults.

Zhisou powder suppresses airway inflammation in LPS and CS-induced post-infectious cough model mice via TRPA1/TRPV1 channels

Ethnopharmacological relevanceZhisou Powder (ZSP), a traditional Chinese medicine (TCM) prescription, has been widely used in the clinic for the treatment of post-infectious cough (PIC). However, the exact mechanism is not clear. Aim of the studyThe aim of this study was to investigate the ameliorative effect of ZSP on PIC in mice. The possible mechanisms of action were screened based on network pharmacology, and the potential mechanisms were explored through molecular docking and in vivo experimental validation. Materials and methodsLipopolysaccharide (LPS) (80μg/50 μL) was used to induce PIC in mice, followed by daily exposure to cigarette smoke (CS) for 30 min for 30 d to establish PIC model. The effects of ZSP on PIC mice were observed by detecting the number of coughs and cough latency, peripheral blood and bronchoalveolar lavage fluid (BALF) inflammatory cell counts, enzyme-linked immunosorbent assay (ELISA), and histological analysis. The core targets and key pathways of ZSP on PIC were analyzed using network pharmacology, and TRPA1 and TRPV1 were validated using RT-qPCR and western blotting assays. ResultsZSP effectively reduced the number of coughs and prolonged the cough latency in PIC mice. Airway inflammation was alleviated by reducing the expression levels of the inflammatory mediators TNF-α and IL-1β. ZSP modulated the expression of Substance P, Calcitonin gene-related peptide (CGRP), and nerve growth factor (NGF) in BALF. Based on the results of network pharmacology, the mechanism of action of ZSP may exert anti-neurogenic airway-derived inflammation by regulating the expression of TRPA1 and TRPV1 through the natural active ingredients α-spinastero, shionone and didehydrotuberostemonine. ConclusionZSP exerts anti-airway inflammatory effects through inhibition of TRPA1/TRPV1 channels regulating neuropeptides to alleviate cough hypersensitivity and has a favorable therapeutic effect on PIC model mice. It provides theoretical evidence for the clinical application of ZSP.

Investigation into actions of Xiebai and Zengye decoction on cough sensitivity, airway inflammation and gut microbiota in the rat model of post-infectious cough

This work was undertaken to observe therapeutic effect of Xiebai and Zengye (XBZY) decoction on post-infectious cough (PIC) in rats, as well as its effect on gut microbiota and the exploration of the intestinal microecological mechanisms of XBZY decoction in the treatment of PIC. Using a random number table, the rats that were successfully modelled were assigned to the PIC, XBZY group (14.8 g/kg/d), and montelukast sodium treatment (MAS) group (1 mg/kg/d). The cough sensitivity of rats and changes in fecal water content were assessed, and serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) levels were determined by ELISA. The histopathological changes in the bronchus and colon tissues were observed under the microscope after hematoxylin-eosin staining. Short-chain fatty acids (SCFAs) in fecal samples were measured by gas chromatography, and changes in gut microbiota were observed using 16S rRNA sequencing. The PIC rats showed decreased fecal water content, increased cough sensitivity, elevated serum TNF-α and IL-8 levels, and higher bronchitis scores comparing to normal control group. The PIC rats showed reductions in SCFAs and significant changes in the structure of gut microbiota. XBZY decoction intervention led to increased fecal water content in rats, reduced cough sensitivity, decreased serum IL-8 and TNF-α levels, decreased bronchitis scores, and alleviated inflammatory cell infiltration was observed in the colonic mucosa. Additionally, elevated SCFAs levels were observed in the PIC rats. XBZY decoction intervention improved alpha-/beta-diversity, and corrected microbiota imbalance in PIC rats. SCFAs, TNF-α and IL-8, acetic acid was revealed to be positively associated with Allobaculum but inversely correlated with unclassified_f_Oscillospiraceae; propanoic acid was positively associated with Lactobacilli but negatively associated with Romboutsia; butanoic acid exhibited positive correlations with Akkermansia and Lactobacilli, but negative correlations with unclassified_f_Oscillospiraceae, Eubacterium_xylanophilum_group, and Lachnospiraceae_NK4A136_group; Additionally, TNF-α was inversely linked to Allobaculum, while IL-8 was positively related to Romboutsia and Turicibacter. In conclusion, XBZY decoction significantly reduced cough sensitivity and airway inflammation in PIC rats while ameliorating stool dryness and colonic inflammation. The protective effects of XBZY decoction could be linked to modulat gut microbiota in PIC rats, and regulat SCFAs contents in PIC rats, while the regulator mechanisms of XBZY decoction in gut microbiota still requires further in-depth investigation.

Phytotherapy of respiratory infections in children: Iceland moss syrup as a new treatment for dry cough. A review

Regardless of the season, cough is one of the most common reasons for visiting a doctor, especially during the period of a high incidence of acute respiratory infections and other diseases manifested by cough, including long-term cough (laryngitis, tracheitis, bronchitis, pneumonia, tuberculosis, asthma, and other diseases). Patients often seek medical advice at a pharmacy without first seeing a doctor. In most cases, the cough is a protective reflex that helps to clear the accumulated bronchial secretion; however, it can significantly worsen the patient's condition and quality of life in adults and children. It negatively impacts the quality of life when the cough is still dry and unproductive, or the sputum is very thick. The article addresses various aspects of using herbal medicinal products of the Herbion series for various cough types, including post-infectious cough. Evidence supports using herbal medicinal products for dry and productive cough and a novel product from the Herbion series, Iceland moss syrup, for treating dry cough, including in children from 1 year.

Xingbei antitussive granules ameliorate cough hypersensitivity in post-infectious cough guinea pigs by regulating tryptase/PAR2/TRPV1 pathway

Ethnopharmacological relevanceXingbei antitussive granules (XB) is a classic Chinese Medicine prescription for treating post-infectious cough(PIC), based on the Sanao Decoction from Formularies of the Bureau of People’s Welfare Pharmacies in the Song Dynasty and Jiegeng decoction from Essentials of the Golden Chamber in the Han Dynasty. However, the therapeutic effects and pharmacological mechanisms are still ambiguous. In the present study, we endeavored to elucidate these underlying mechanisms. Aims of the studyThis study aimed to explore the potential impact and mechanism of XB on PIC, and provide a scientific basis for its clinical application. Materials and methodsCigarette smoking (CS) combined with lipopolysaccharide (LPS) nasal drops were administered to induce the PIC guinea pig with cough hypersensitivity status. Subsequently, the model guinea pigs were treated with XB and the cough frequency was observed by the capsaicin cough provocation test. The pathological changes of lung tissue were assessed by HE staining, and the levels of inflammatory mediators, mast cell degranulating substances, and neuropeptides were detected. The protein and mRNA expression of transient receptor potential vanilloid type 1(TRPV1), proteinase-activated receptor2(PAR2), and protein kinase C (PKC) were measured by Immunohistochemical staining, Western blot, and RT-qPCR. Changes in the abundance and composition of respiratory bacterial microbiota were determined by 16S rRNA sequencing. ResultsAfter XB treatment, the model guinea pigs showed a dose-dependent decrease in cough frequency, along with a significant alleviation in inflammatory infiltration of lung tissue and a reduction in inflammatory mediators. In addition, XB high-dose treatment significantly decreased the levels of mast cell Tryptase as well as β-hexosaminidase (β-Hex) and downregulated the expression of TRPV1, PAR2, and p-PKC. Simultaneously, levels of neuropeptides like substance P (SP), calcitonin gene-related peptide (CGRP), neurokinin A (NKA), and nerve growth factor (NGF) were improved. Besides, XB also can modulate the structure of respiratory bacterial microbiota and restore homeostasis. ConclusionXB treatment alleviates cough hypersensitivity and inflammatory responses, inhibits the degranulation of mast cells, and ameliorates neurogenic inflammation in PIC guinea pigs whose mechanism may be associated with the inhibition of Tryptase/PAR2/PKC/TRPV1 and the recovery of respiratory bacterial microbiota.

Formulation and Evaluation of Herbal Remedy for Cough

The most frequent reason patients seek medical assistance is because of a persistent cough, despite the fact that coughing is both a crucial defensive reflex and a universal indication of health. According to an epidemiologic study, up to 40% of people report coughing. Upper respiratory tract infections (URTIs) and the common cold are the most frequent causes of cough, but other causes include post-infectious cough, undiagnosed chronic cough, and cough brought on by pulmonary diseases like asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, and lung cancer. The most common causes of cough in children are viral URTI, chronic bacterial bronchitis, and asthma. Whether acute or chronic, cough is linked to considerably reducing health-related quality of life. Patients with chronic cough commonly report sleep disturbance, nausea, chest pains, lethargy, social humiliation, urine incontinence, and low mood. Coughing may not be effective in certain circumstances (such as respiratory tract inflammation, neoplasia, eosinophilic bronchitis, airway irritation from various pollutants, airway hyperresponsiveness from infection, gastroesophageal reflux disease, and coughing without any known cause, also known as idiopathic cough). Opioidergic central cough suppressants, such as opioids, codeine, pholcodine, noscapine, and dextromethorphan, are useful when coughing is ineffective. Constipation, sedation, respiratory depression, dependence, drowsiness, addiction, and even mortality can result from prolonged use of these cough suppressants, which restricts their use in people. The proposed research project’s objective is to develop and assess herbal dosage forms that contain the widely used spice Piper longum L. (Piperaceae).

Effectiveness and safety of Xingbei Zhike granules in patients with postinfectious cough: A multicenter, randomized, double-blinded, placebo-controlled trial

BackgroundPostinfectious cough (PIC) is a common symptom following a respiratory tract infection. Xingbei Zhike (XBZK) granules, a Chinese patent medicine, has been widely used for PIC in clinics. However, there is a lack of evidence on the effectiveness. PurposeTo investigate whether treatment with XBZK granules is effective for PIC. Study designA multicenter, randomized, double-blinded, placebo-controlled trial. MethodsEligible participants from fourteen hospitals were randomly assigned in 3:1 ratio to receive either XBZK granules or placebo for 14 days. The primary outcome was the area under the curve (AUC) of a visual analogue scale (VAS) for cough symptoms. Secondary outcomes included cough symptom score (CSS), time and probability of recovery from cough, traditional Chinese medicine (TCM) syndrome score, relief rates of individual symptoms, Leicester Cough Questionnaire (LCQ) score, and the use of reliever drug. ResultsA total of 235 patients (176 in XBZK and 59 in placebo groups) were included in the analysis. The AUC for cough VAS scores was lower in the XBZK than placebo group (−8.10, 95 % CI -14.12 to −2.07, p = 0.009), indicating superiority. XBZK decreased CSS (−0.68 points, 95 % CI −1.13 to −0.22, p = 0.01), shortened time to cough recovery (−2 days, hazard ratio [HR] 1.48, 95 % CI 1.03 to 2.13, p = 0.02), enhanced the probability of cough recovery (risk ratio [RR] 1.66, 95 % CI 1.07 to 2.58, p = 0.03), lowered TCM syndrome score (−0.99 points, 95 % CI −1.58 to −0.40, p = 0.004), increased the rate of daytime (RR 1.84, 95 % CI 1.07 to 3.15, p = 0.02) and nighttime (RR 2.07, 95 % CI 1.29 to 3.35, p = 0.004) cough recovery, and reduced the viscosity of sputum (RR 2.92, 95 % CI 1.66 to 5.13, p < 0.001) compared to placebo. There were no significant differences in LCQ scores and taking reliever drugs between groups. No severe adverse events were reported in either group. ConclusionsXBZK granules are a promising therapy against PIC, effective in lowering the overall severity of cough, shortening the time to cough recovery, and reducing the viscosity of sputum.

Xiebai Zengye decoction improves respiratory function and attenuates inflammation in juvenile rats with postinfection cough via regulating ERK signaling pathway.

This study aimed to determine the effects of Xiebai Zengye decoction (XBZY)on airway inflammation and respiratory function in rats with postinfectious cough (PIC),and its regulatory effects on the extracellular signal-regulated kinase (ERK)signaling pathway. Compared with the normal group, the rats from thePIC group had significantly shortened expiratory time (TE)and enhanced pause (EEP),increased resistance (RT),and enhanced pause (Penh), along with increased levels of serum interleukin-4 (IL-4)and IL-6,and decreased levels of IL-10. The lung and colon tissues of rats from the PIC group showed histopathological changes, including inflammatory cell infiltration, damaged mucosal epithelium, and crypt structure, with significantly increased ERK mRNA and protein expression levels. Treatment with XBZY and montelukast sodium (MAS)improved the respiratory function and serum cytokine levels, reduced tissue inflammation, and decreased ERK mRNA and protein expression levels in the lung and colon tissues. In the lung tissues, XBZY treatment significantly decreased the expression of phosphorylated-ERK (p-ERK)protein, as well as p-MEK1/2, p-ERK1/2, and p-c-Fos proteins, while in the colon tissues, XBZY significantly decreased the expression of p-ERK1/2and p-c-Fos proteins. However, MAS treatment only showed significant improvement in the lung tissue inflammation score, and the expression level of p-ERK protein in the lung tissue was decreased. In conclusion, the present study suggests that XBZY has a potential therapeutic effect on PIC by improving respiratory function and attenuating inflammation, and this effect may be associated with the inhibition of the ERK signaling pathway. These findings could provide a new direction for the development of treatments for PIC. However, further research is needed to elucidate the underlying molecular mechanisms of XBZY and to confirm its safety and efficacy in clinical trials.

Addressing Postinfectious Cough: Insights into Treatment Strategies from a Literature Review

Addressing Postinfectious Cough: Insights into Treatment Strategies from a Literature Review

β-Hydroxybutyric acid upregulated by Suhuang antitussive capsule ameliorates cough variant asthma through GSK3β/AMPK-Nrf2 signal axis.

Cough variant asthma (CVA) is a chronic inflammatory disease characterized by cough as the main symptom. Suhuang antitussive capsule (Suhuang), one of traditional Chinese patent medicines, mainly treats CVA clinically. Previous studies have shown that Suhuang significantly improved CVA, post-infectious cough (PIC), sputum obstruction and airway remodeling. However, the effect of Suhuang on ovalbumin-induced (OVA-induced) metabolic abnormalities in CVA is unknown. This study aimed to identify potential metabolites associated with efficacy of Suhuang in the treatment of CVA, and determined how Suhuang regulates metabolites, and differential metabolites reduce inflammation and oxidative stress. Rats were given 1mg OVA/100mg aluminum hydroxide in the 1st and 7th days by intraperitoneal injection and challenged by atomizing inhalation of 1% OVA saline solution after two weeks to establish the CVA model. Rats were intragastrically (i.g.) administrated with Suhuang at 1.4g/kg and β-hydroxybutyric acid (β-HB) were given with different concentrations (87.5 and 175mg/kg/day) by intraperitoneal injection for 2 weeks. After 26 days, GC-MS-based metabolomic approach was applied to observe metabolic changes and search differential metabolites. The number of coughs, coughs latencies, enzyme-linked immunosorbent assay (ELISA), histological analysis and quantitative-polymerase chain reaction (Q-PCR) were used to investigate the effects of Suhuang. Then β-HB on CVA rats, NLRP3 inflammasome and GSK3β/AMPK/Nrf2 signalling pathway were detected by western blotting. The results showed that Suhuang treatment significantly enhanced the serum level of β-HB. Interestingly, exposure to exogenous β-HB was also protective against OVA-induced CVA. β-HB significantly reduced the number of coughs and lengthened coughs latencies, improved lung injury, reduced the secretion of various cytokines, and directly inhibited the NLRP3 inflammasome. In addition, β-HB increased the nuclear accumulation of Nrf2 by activating the GSK3β/AMPK signaling axis, and then inactivating the NF-κB signaling pathway, effectively protecting OVA-induced CVA from oxidative stress and inflammation. The results of this study shows that β-HB can reduce inflammation and oxidative stress, the increased production of β-HB in serum might be the crucial factor for Suhuang to exert its effect in the treatment of CVA.