Cough Remedies Research Articles

Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013.

After reports of increasing emergency department (ED) visits for unsupervised pediatric medication exposures in the 2000s, renewed efforts to improve safety packaging and education were initiated. National data on current trends can help further target interventions. We used nationally representative data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project (2004-2013) to assess trends in ED visits for unsupervised medication exposures in children aged <6 years. For 2010 through 2013, the dosage form and prescription status of implicated medications were identified. Based on 13,268 cases, there were an estimated 640,161 ED visits (95% confidence interval: 512,885 to 767,436) for unsupervised medication exposures from 2004 through 2013. From 2004 through 2010, ED visits for unsupervised exposures increased by an average of 5.7% annually, peaking at 75,842. After 2010, this trend reversed, and visits decreased by an average of 6.7% annually to 59,092 in 2013. From 2010 through 2013, 91.0% of unsupervised exposure visits involved 1 medication, most commonly an oral prescription solid (45.9%), oral over-the-counter (OTC) solid (22.3%), or oral OTC liquid (12.4%). More than 260 different prescription solids were implicated; opioids (13.8%) and benzodiazepines (12.7%) were the most common classes. Four medications were implicated in 91.2% of OTC liquid exposure visits: acetaminophen (32.9%), cough and cold remedies (27.5%), ibuprofen (15.7%), and diphenhydramine (15.6%). Targeting prevention efforts based on harm frequency and intervention feasibility can lead to continued reductions in ED visits for pediatric medication exposures.

Editorial: Brain cholinergic mechanisms.

Editorial: Brain cholinergic mechanisms.

Anti-Inflammatory Constituents of Alchornea cordifolia Leaves

Alchornea cordifolia (Schum and Thonn) Muell. Arg. (Euphorbiaceae) is a traditional medicinal plant widely distributed in West Africa including Nigeria.The plant has been used for ethnomedicinal purposes against wounds, ulcers, and sores. The decoction of the leaves has been reported to provide remedies for bronchial problems, rheumatic pain and cough. From the dichloromethane and ethyl acetate soluble parts of the Methanol leaf extract, two compounds namely Lup-20(29)-en-3c-ol (lupenol) and Methyl 3, 4,5-trihydroxy benzoate (Methyl gallate) were isolated and their structures elucidated. Anti-inflammatory and analgesic properties of the compounds on carrageenan-induced paw oedema and formalin-induced pain in rats showed that compound 2 significantly (P&lt;0.05) inhibit rat paw oedema compared to the standard drugs (Piroxicam and Morphine) used, while on formalin-induced pain in rats, the same trend was observed and were both comparable to Piroxicam and morphine, the standard anti-inflammatory and analgesic agents used, respectively. Compound 1 did not show any significant anti-inflammatory activity compared to control, likewise compound 2. Thus, compound 2, Methyl trihydroxy benzoate, might be responsible for the anti-inflammatory and analgesic properties of this plant.Keywords: Alchornea cordifolia, Anti-inflammatory, Analgesic, Methyl Trihydroxy Benzoate

English

Acute respiratory tract infections (ARI) are the leading cause of deaths among the under-five children in sub-Saharan Africa. The irrational self-medication of childhood ARIs at households in Uganda delays access to quality healthcare. Limited studies focus on strengthening household management of ARI. This study evaluated the household management of ARI among children under five years of age with ARIs in Kampala, Uganda. This study used a descriptive cross-sectional observational design. Households in Kampala were targeted in five divisions using the world health organization (WHO) 30 cluster method of sampling between June and July, 2011. Participants were invited to respond to a standardized questionnaire. The main outcome variable was management practices of ARI in children under-five years. Data were managed using Epidata V3.1 and exported to statistical package of social sciences (SPSS) v19 for quantitative analysis. Out of the 200 households interviewed, the majority 196 (98%) reported at least one episode of ARI in the last four weeks. The common cold with cough was the most common ARI syndrome 98 (49%; p< 0.001). 93 (46.5%; p = 0.322) cases of ARI were considered to be appropriately managed. The prescribing of antibiotics 86 (43%; p < 0.001), 25 (12.5%; p< 0.001) antimalarials and dexamethasone 10 (5%; p = < 0.001) was common. The appropriate management of the ARI at households was associated with frequency of the ARI, pneumonia symptoms, level of education of caretaker and source of the medicines. The prevalence of ARI among children under five years in Kampala is high. The management of ARIs among the under-fives in Kampala is suboptimal with misuse of antibiotics, antimalarials, dexamethasone, herbal medicines and cough remedies common. There is a need for household guidelines for management of ARI and related conditions. Community based programs are urgently required to empower parents of children in management of ARIs. Key words: Acute respiratory infections, household management, Kampala-Uganda.

Coumarins from Angelica decursiva Inhibit Lipopolysaccharide‐induced Nitric Oxide Production in RAW 264.7 Cells

Angelica decursiva has been used in Korean traditional medicine as an antitussive, analgesic, antipyretic, and cough remedy. In a recent study, the 90% methanol fraction of the dichloromethane fraction showed the most promising anti‐inflammatory activity; however, compounds responsible for the anti‐inflammatory activity were not identified. In this study, bioactivity‐guided isolation yielded 8 coumarins along with a new coumarin, 3′‐angeloyloxy‐4′‐hydroxy‐3′,4′‐dihydroxanthyletin (4). The anti‐inflammatory activity of compounds was evaluated via inhibition of nitric oxide (NO) and tumor necrosis factor‐α (TNF‐α), as well as inducible nitric oxide synthase (iNOS) and cyclooxygenase‐2 (COX‐2) expression in lipopolysaccharide (LPS)‐stimulated RAW 264.7 cells. Among the tested compounds, edulisin II (1) exhibited the highest NO inhibitory activity, followed by decursidin (2), Pd‐C‐III (3), 4, Pd‐C‐I (5), and Pd‐C‐II (6). Structure‐activity relationships revealed that esterification of the hydroxyl at C‐3′/C‐4′ with an angeloyl/senecioyl/acetyl is essential for NO inhibitory activity; the number and the position of angeloyl/or senecioyl groups greatly affect the potency of coumarins. Coumarins 1~6 inhibited TNF‐α production and iNOS expression while 1~4 inhibited COX‐2 expression. Thus, coumarins isolated from A. decursiva might be used as potential leads for the development of therapeutic agents for inflammation.

Drug News

In Brief Antacids may improve survival from oropharyngeal cancer...is aspirin appropriate for CVD prevention?...tell parents to avoid giving cough or cold remedies to children under age 2...many older adults are overtreated for diabetes...scant evidence supports opioid use for chronic pain

Inhibition of cough reflex sensitivity by diphenhydramine during acute viral respiratory tract infection.

Background: Currently available over-the-counter cough remedies historically have been criticized for lack of scientific evidence supporting their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors’ knowledge it has never been shown to inhibit cough reflex sensitivity in subjects with pathological cough. Objective: To evaluate the effect of diphenhydramine on cough reflex sensitivity. Setting: Montefiore Medical Center, an academic medical center in New York City. Methods: Twenty two subjects with acute viral upper respiratory tract infection (common cold) underwent cough reflex sensitivity measurement employing capsaicin challenge on 3 separate days, 2 h after ingesting single doses of study drug (to coincide with peak blood concentrations), administered in randomized, double-blind manner: a multicomponent syrup containing diphenhydramine (25 mg), phenylephrine (10 mg), in a natural cocoa formulation; dextromethorphan (30 mg) syrup; and, placebo syrup. The standard endpoint of cough challenge was used: concentration of capsaicin inducing ≥5 coughs (C5). Main outcome measure: Effect on cough reflex sensitivity (C5). Results: A significant difference (p = 0.0024) was established among groups, with pairwise analysis revealing a significant increase in mean log C5 (0.4 ± 0.55 (SD); p < 0.01) for the diphenhydramine-containing medication versus placebo, but not for dextromethorphan versus placebo. Conclusions: Our results provide the initial evidence of the ability of diphenhydramine to inhibit cough reflex sensitivity in subjects with acute pathological cough. Timing of cough reflex sensitivity measurement may not have allowed demonstration of maximal antitussive effect of dextromethorphan.

Isolation of Anticancer Bioactive and In Vitro Evaluation of Antioxidant and Anticancer Activity of Cynodon dactylon (L). Pers

Cynodon dactylon (L.) Pers. Graminae/Poaceae is called as Aruvam pillu in Tamil, Bermuda grass in English. A creeping herb rooting at the joints with smooth upward stem. It was distributed in all tropical and subtropical region of the world. The herb contains beta sitosterol, beta-carotene, vitamin C, palmitic acid, and triterpenoids. Alkaloids like ergonovine, ergonovivine, ferulic acid, syringic acid, vanillic acid. It is reported to have antiseptic, diuretic; It is a folk remedy for calculus, cancer, carbuncles, convulsions, cough, cramps, cystitis, and wounds. The aim of this research is to explore the antioxidant activity, leads to anticancer potential of this plant material. There were three different extracts used for the evaluation of this activity. In this, ethyl acetate and methanolic extracts showed sufficiently greater activity compared with the control in the study.

English

Aim: Honey and Garcinia kola have long been used separately by the traditional medical practitioners as remedies for cough and other ailments. Recently, a combination of both as a remedy for cough is common. This work was intended to see the effect of this synergy on the kidney. Methods: Twenty five Wistar albino rats weighing 180&plusmn;10g were grouped into 5 (A, B, C, D, E) of 5 rats each. They were fed twice daily for 14 days with a mixture of G. kola and honey: 0.16g/kg + 0.5ml, 0.20g/kg + 0.5ml, 0.24g/kg + 0.5ml, 0.28g/kg + 0.5ml and normal feeds respectively. The rats were sacrificed on the 15th day and blood and kidneys were taken for biochemistry and histology respectively. Results: Sodium, potassium, chloride, bicarbonate, urea, creatinine, as well as the histology of the kidney of the test rats were not significantly different from the control rats. Conclusion: Oral intake of one nut Garcinia kola along with about 5 ml honey&nbsp; twice daily for 14 days has no adverse effect on the kidney. Key words: Honey, Garcinia kola, Liver, Medicinal plant

Breeding of a New Japanese Apricot (Prunus mume Siebold et Zucc.) Cultivar ‘Okjoo’ with High Yields

매실(Prunus mume Siebold et Zucc.)은 장미과에 속하는 과수로 한국에서는 전통적으로 기침이나 소화불량의 민간 요법 과실로써 사랑받아 왔다. 1993년 국립원예특작과학원 배시험장에서 '옥영'과 '임주'를 교배하여 그 중 과실이 크고 과형이 좋으며 풍산성인 '옥주' 품종을 2006년에 선발, 육성하여 새로운 품종으로 등록하였다(등록번호: 4556호, 2013.6.18). '옥주' 품종의 만개기는 '옥영'보다 4일, '임주'보다 2일 빠르며 꽃잎색은 분홍색이고 꽃가루는 없다. PCR을 이용한 자가불화합인자 분석결과, 옥주의 자가불화합성 인자는 <TEX>$S_3S_6$</TEX>이었다. '옥주'의 성숙기는 6월 하순으로 과실은 원형이며 봉합선이 얕다. 평균과중 18.5g이며 가용성 고형물 함량은 <TEX>$7.66^{\circ}Brix$</TEX>, 산 함량은 4.81%, 과피색은 녹색이지만 햇빛을 많이 받는 쪽의 과실 일부가 적색을 띄기도 한다. 또한, 검은별무늬병과 세균성구멍병의 발생이 비교적 적고, 수량성이 높아 재배농가들이 새로운 품종을 선택할 수 있는 기회를 준다는 점에서 그 의의가 클 것으로 생각된다. Japanese apricot (Prunus mume Siebold and Zucc.) is a deciduous tree of the family Rosaceae, and it has long been used as a folk remedy for cough and dyspepsia. A new cultivar 'Okjoo' was developed from a cross between 'Gyokuei' and 'Rinsyu' carried out at the National Institute of Horticultural & Herbal Science in 1993. It w as s elected for good shape, large size and high yield capacity in 2006, and then it was granted official patent No. 4556 in 2013. It blooms 4 days and 2 days earlier than 'Gyokuei' and 'Rinsyu', respectively. Its flower petal color is pink, and the pollen amount is negligible. Its S-genotype, determined using Polymerase Chain Reaction with a S-RNase gene-specific primer pair, is <TEX>$S_3S_6$</TEX>. The average optimum harvest time of 'Okjoo' is late June. The fruit is round in shape and its suture is shallow. Average fruit weight is 18.5 g, and it contains total soluble solids <TEX>$7.66^{\circ}Brix$</TEX> and titratable acidity at 4.81%. Fruit skin color is green. Sometimes only the light side of the fruits seems to develop blush. The incidence levels of scab (Cladosporium carpophilum Thumen) and bacterial shot hole (Xanthomonas arboricola pv. Pruni) are quite low. Consequently, 'Okjoo' seems to be a promising new cultivar for Japanese apricot growers.

Influence of seasonal variation on Thymus longicaulis C. Presl chemical composition and its antioxidant and anti-inflammatory properties

Thymus longicaulis C. Presl. (Lamiaceae) is a small aromatic perennial herb typical of the Illyric-Mediterranean flora, traditionally used as remedy for cold, flu, cough, nephritis and abdominal pain. In order to carry out a thorough chemical and biological screening of the plant and to explore phenophases influence on its polyphenol content, samples of the plant were collected at different phases during its life cycle (July/October 2012 and January/April 2013). Each sample, previously extracted using a hydroalcoholic solution, was phytochemically analyzed for its metabolic constitution applying LC-DAD-ESI-MS/MS techniques. Although identified metabolites were differently concentrated at the various collection times, T. longicaulis leaf extracts were mainly constituted by low molecular weight phenols, and flavonoids. Rosmarinic acid was found as the main metabolite in Oct12 sample. Chemopreventive efficacy of the investigated extracts, by means of their anti-inflammatory, cytotoxic and antioxidant activities, was assessed. To this purpose, each extract underwent an extensive screening towards five human cell lines: CCRF-CEM (leukemia); U251 (glioblastoma); MDA-MB-231 (breast cancer); HCT-116 (colon cancer) and MRC-5 (lung fibroblasts) through XTT [2,3bis(2-metoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H tetrazolium hydroxide] test. The ability of the extracts to counteract cyclooxygenase-2 (COX-2) expression was also evaluated by COX-2 expression assay in human THP-1 monocyte-derived macrophages. COX-2 inhibition could represent a valuable anticancer strategy as it is associated with carcinogenesis and over-expressed in a variety of human malignancies. Oct12 extract, which was particularly rich in rosmarinic acid and methylapigenin, exhibited a strong antioxidant and anti-inflammatory effectiveness.

Cough in Children

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4–8weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Differentiating between Agathosma betulina and Agathosma crenulata – A quality control perspective

Agathosma betulina (Bergius) Pillans and Agathosma crenulata (L.) Pillans, ‘buchu’, have been used traditionally as an antispasmodic, antipyretic, cough remedy, diuretic and in the treatment of urinary tract infections. The two species are usually differentiated on the basis of their leaf shape as A. betulina has round leaves while A. crenulata has long oval leaves. This authentication method based on morphology has proven to be inadequate because of variable morphotypes. In this study, 63 leaf samples of A. betulina and A. crenulata were used to develop phytochemical fingerprints using high performance thin layer chromatography (HPTLC), liquid chromatography coupled to mass spectroscopy (LC–MS), near infrared spectroscopy (NIR) and mid infrared spectroscopy (MIR). The data were processed using Markerlynx® and SIMCA-P+® chemometric analysis software. Orthogonal projections to latent structure dicriminant analysis (OPLS-DA) revealed separation into two distinct clusters based on all the analytical methods investigated, one containing A. betulina samples and the other A. crenulata samples. Using HPTLC a visible difference between the species was determined to be the presence of a blue band at Rf 0.65 in A. crenulata only while LC–MS indicated the presence of quercetin-dimethyl ether-glucoside in A. betulina only. The vibrational spectroscopy results showed quantitative differences as the two species had similar peaks but with different intensities. The results showed that any of these methods can be used to distinguish between the two species.

The spatiotemporal association of non-prescription retail sales with cases during the 2009 influenza pandemic in Great Britain

ObjectiveTo assess whether retail sales of non-prescription products can be used for syndromic surveillance and whether it can detect influenza activity at different spatial scales. A secondary objective was to...

Tos en el niño

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Clinical assessment of the warming sensation accompanying flavor 316282 in a cold and cough syrup containing paracetamol, phenylephrine hydrochloride, and guaifenesin.

Objective:The primary objective was to assess the warming sensation caused by flavor 316282 in a cold and cough product in the target population.Methods:A single-cohort, single-treatment arm, open-label study. Subjects received one 30-mL dose of syrup containing flavor 316282, paracetamol, phenylephrine hydrochloride, and guaifenesin and recorded onset and disappearance of any warming sensation in the mouth/throat. Subjects’ assessment of strength and appeal of the sensation, taste, texture, and acceptability of the product as a cold and cough remedy was investigated using questionnaires.Results:A total of 51 subjects were included; 47 (92.1%) experienced a warming sensation. The median duration of the warming sensation was 100 s (95% confidence interval = 82 s, 112 s). The majority of subjects rated the syrup as excellent, good, or fair for treatment of cough and cold symptoms (96.1%), taste (80.4%), and texture (98.0%). There were no safety concerns, and the syrup was well tolerated. Most subjects liked the warming sensation.Conclusions:Flavor 316282 in a cold and cough syrup is associated with a warming sensation. The syrup is well tolerated, safe, and palatable.

Oseltamivir effectiveness in seasonal influenza patients taking symptomatic therapy: retrospective analysis of RCT data

The effectiveness of oseltamivir to improve seasonal influenza symptoms in clinical practice was analyzed using pooled data from patients who were also taking analgesics and other over-the-counter (OTC) medications. Data were pooled from 1,709 patients aged 13 - 64 years with confirmed seasonal influenza who enrolled in six randomized, placebo-controlled trials of oseltamivir (75 mg b.i.d. for 5 days) and took OTC analgesics (+/- other medications). Rates of improvement of seven symptoms, two functional measures (sleep quality and ability to undertake usual activities) and fever (body temperature) were calculated between Days 1 and 6 of illness. Time to reach defined tolerability thresholds was compared using Kaplan-Meier analysis. Two subgroup analyses were performed in patients taking cough and cold remedies (n = 635) and antibiotics (n = 175) in addition to analgesics. Six symptoms and both functional measures improved faster with oseltamivir than placebo, including nasal congestion (difference in rate, 19.3%), cough (34.1%), sleep quality (13.7%) and ability to perform usual activities (12.0%). Results in the Analgesics + cough/cold subgroup analysis were similar. In the Analgesics + antibiotics subgroup, three symptoms and both functional measures improved faster with oseltamivir. In all three analyses, median time to reach tolerability thresholds for all measures was faster in oseltamivir patients than placebo patients. Oseltamivir treatment of patients with seasonal influenza already receiving OTC medications produced a faster reduction in severity of most symptoms and a quicker return to ability to perform normal activities compared with patients who took OTC medications and placebo.

Effect of Taste Sensation on Cough Reflex Sensitivity

Cough is among the most common symptoms with which people present for medical attention, but evidence-based treatments remain limited. One issue compromising interpretation of clinical trials of cough preparations is that control formulations often are nearly as effective as those that contain active ingredients. This observation has caused some researchers to propose that one or more nominally inactive ingredients may have some physiological effects. For example, most liquid cough preparations are highly sweetened, and it has been suggested that sweet taste might modulate cough sensitivity. The fact that honey has been used for thousands of years as a cough remedy is consistent with this idea. However, empirical evidence for modulation of cough sensitivity by taste was lacking. Evidence is still sparse, but relevant experiments have now been published: rinsing the mouth with a sweet sucrose solution increased cough thresholds in a single-inhalation capsaicin challenge. Furthermore, rinsing the mouth with a bitter solution did not affect thresholds, an important demonstration of specificity. The underlying mechanisms of cough suppression by sweet taste are still unclear. However, extant data suggest that modulation of cough sensitivity by taste is a promising area for further investigation. Such work may lead to greater understanding of apparent placebo effects in clinical trials and provide empirical support for therapies based on stimulation of taste nerves.

Massive Esophageal Bleeding in an Immunocompetent Young Man

Question: A 21-year-old man presented with hematemesis and melena. On examination, vital signs were stable with temperature of 37.1°C, blood pressure of 120/80 mmHg, and pulse rate of 72 bpm. His past and family histories were nonspecific except for taking cough remedies on account of mild coughing for 2 months. Laboratory investigation revealed a white blood cell count of 6.7 × 103/mL, hemoglobin level of 12 g/dL, and normal blood chemistry. HIV screening test was negative. Emergent endoscopy revealed a longitudinal esophageal ulcer at 30 cm from the incisors.

Preliminary Phytochemical Screening and Antidiarrheal Properties of Manniophyton fulvum.

The genus Manniophytum Fulvum belongs to the family of Euphorbiaceae, which is geographically distributed widely in tropical Africa. It has been investigated for a number of properties, such as analgesia, anti-inflammation and as remedy for cough, dysentery, haemorrhoids and haemoptysis. Aims: This study investigates the phytochemical composition and antidiarrheal properties of the plant. Methodology: Aqueous and ethanol leaves extracts of Manniophyton fulvum was prepared and used for the experiment. During the entire period of study the animals were supplied with standard pellet diet and water ad libitum. The animal experimentation was carried out accordance to the guidelines of Institutional Animal Ethics Committee (IAEC). Results: Phytochemical studies carried out on aqueous and ethanol extract of Manniophyton fulvum leaves showed the presence of alkaloid, saponin, phenol, tannin, flavonoid, cardiac glycoside, steroid, phytosterol, triterpenoid and phlobatannin. The aqueous and ethanol leaves extracts of Manniophyton fulvum showed significant (p<0.05) antidiarrheal activity on gastrointestinal motility with barium sulfate milk and castor oil- induced diarrheal model in rats. Conclusion: These result obtained in this study, suggest that the leaves extract possess pharmacological activity against diarrhea and may find a place in the management of illness that present with diarrheal.