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Woo SC, Lyu YR, Lee SW, Kwon OJ, Choi YE, Yang C, Park YC. Efficacy, Safety and Economic Evaluation of Wolbigachul-Tang for Chronic Cough Due to Upper Airway Cough Syndrome (UACS): A Study Protocol for Randomized, Double-Blind, Active-Comparator Controlled, Parallel, Exploratory Clinical Trial. Healthcare (Basel) 2023; 11:2733. [PMID: 37893807 PMCID: PMC10606134 DOI: 10.3390/healthcare11202733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough.
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Affiliation(s)
- Seong-Cheon Woo
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
| | - Yee Ran Lyu
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
| | - O-Jin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Young-Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
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Irwin RS, Madison JM. Gefapixant for Refractory or Unexplained Chronic Cough? JAMA 2023; 330:1335-1336. [PMID: 37694857 DOI: 10.1001/jama.2023.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
| | - J Mark Madison
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester
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Husain SA, Larik MO, Urooj M, Javed MA, John JM. Comparative Efficacy of Anti-asthma Therapy in Non-asthmatic Cough: A Cross-Sectional Study in Dubai, United Arab Emirates. Cureus 2023; 15:e47377. [PMID: 38021559 PMCID: PMC10657502 DOI: 10.7759/cureus.47377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cough is one of the most common presenting complaints for physicians across the world, with the potential to result in a significant influence on one's daily life. It is typically categorized into acute cough (<3 weeks), subacute cough (three to eight weeks), and chronic cough (>8 weeks). The lack of specific treatment guidelines and evidence-based recommendations for resolving cough creates reasonable controversy in the medical field. This retrospective study aims to identify the clinical features of cough and evaluate the comparative efficacy between different anti-asthmatic treatment modalities in the urban city of Dubai, United Arab Emirates. Methods A retrospective cross-sectional study was performed on patients presenting to pulmonology or respiratory outpatient clinics with complaints of cough in the absence of any known history of chronic respiratory illness (e.g., asthma). Analysis was conducted via chi-squared and analysis of variance (ANOVA) testing. Results A total of 308 patients were eligible for inclusion, with 273 patients presenting for follow-up. Overall, patients with acute, subacute, and chronic coughs had similar clinical presentations, with no statistically significant differences noted. However, patients with pets were more likely to develop an acute cough (p = 0.04). Moreover, the follow-up outcomes of acute, subacute, and chronic cough were similar, with no significant statistical difference noted. Furthermore, patients receiving dual therapy using budesonide and montelukast, and patients receiving triple therapy using budesonide, montelukast, and tiotropium/ipratropium were most likely to gain complete relief of their symptoms, although triple therapy treatment was also associated with the highest rate of null improvement (p = 0.012). Additionally, chronic cough patients were more likely to be subject to higher C-reactive protein (CRP) levels in comparison to other cohorts (p = 0.26). Conclusion The comparative superiority of dual therapy using budesonide and montelukast, and triple therapy using budesonide, montelukast, and tiotropium/ipratropium were highlighted in this study. In the sparseness of specific treatment guidelines and evidence-based recommendations for cough, the use of anti-asthmatic therapy for cough patients has shown favorable results. Moreover, the lack of clinical differences between acute, subacute, and chronic cough may result in difficulties with the treatment of cough patients. To arrive at a valid conclusion, further comprehensive studies with larger and more diversified sample populations are encouraged.
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Affiliation(s)
| | | | - Maryam Urooj
- Department of Medicine, Dow International Medical College, Karachi, PAK
| | | | - Jean Mary John
- Department of Pulmonology, King's College Hospital London, Dubai, ARE
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Jo EJ, Lee JH, Won HK, Kang N, Kang SY, Lee SE, Lee JH, Kim MY, Shim JS, An J, Yoo Y, Park SY, Kim BK, Moon JY, Park HK, Kim MH, Kwon HS, Kim SH, Kim SH, Chang YS, Kim SH, Birring SS, Lee BJ, Song WJ. Baseline Cohort Profile of the Korean Chronic Cough Registry: A Multicenter, Prospective, Observational Study. Lung 2023; 201:477-488. [PMID: 37658853 DOI: 10.1007/s00408-023-00644-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The Korean Chronic Cough Registry study was initiated to characterize patients with chronic cough (CC) and investigate their outcomes in real-world clinical practice. This report aims to describe the baseline cohort profile and study protocols. METHODS This multicenter, prospective observational cohort study included newly referred CC patients and those already being treated for refractory or unexplained chronic cough (RUCC). Cough status was assessed using a visual analog scale, the Leicester Cough Questionnaire (LCQ), and the Cough Hypersensitivity Questionnaire (CHQ). RESULTS A total of 610 patients (66.9% women; median age 59.0 years) were recruited from 18 centers, with 176 being RUCC patients (28.9%). The median age at CC onset was 50.1 years, and 94.4% had adult-onset CC (≥ 19 years). The median cough duration was 4 years. Compared to newly referred CC patients, RUCC patients had a longer cough duration (6.0 years vs. 3.0 years) but had fewer symptoms and signs suggesting asthma, rhinosinusitis, or gastroesophageal acid reflux disease. Subjects with RUCC had lower LCQ scores (10.3 ± 3.3 vs. 11.6 ± 3.6; P < 0.001) and higher CHQ scores (9.1 ± 3.9 vs. 8.4 ± 4.1; P = 0.024). There were no marked differences in the characteristics of cough between refractory chronic cough and unexplained chronic cough. CONCLUSIONS Chronic cough typically develops in adulthood, lasting for years. Cough severity and quality of life impairment indicate the presence of unmet clinical needs and insufficient cough control in real-world clinical practice. Longitudinal follow-up is warranted to investigate the natural history and treatment outcomes.
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Affiliation(s)
- Eun-Jung Jo
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Youngsang Yoo
- Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - So-Young Park
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung-Keun Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Han-Ki Park
- Department of Allergy and Clinical Immunology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Kim
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Yang S, Huang S, Hincapie-Castillo JM, Ke X, Ding H, Schelfhout J, Sher MR, Jones B, Wilson DL, Lo-Ciganic WH. Patterns of Cough Medication Prescribing among Patients with Chronic Cough in Florida: 2012-2021. J Clin Med 2023; 12:6286. [PMID: 37834931 PMCID: PMC10573590 DOI: 10.3390/jcm12196286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Among patients with chronic cough (CC) in the 2012-2021 statewide OneFlorida Clinical Research Consortium database, we examined trends in cough medication (CM) prescribing prevalence over time in repeated cross-sectional analyses and identified distinct CM utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Among eligible adults (≥18 years) without cancer/benign respiratory tumor diagnoses, we identified CC patients and non-CC patients with any cough-related diagnosis. In the GBTM analysis, we calculated the number of monthly prescriptions for any CMs (excluding gabapentinoids) during the 12 months from the first qualifying cough event to identify distinct utilization trajectories. From 2012 to 2021, benzonatate (9.6% to 26.1%), dextromethorphan (5.2% to 8.6%), and gabapentinoid (5.3% to 14.4%) use increased among CC patients, while opioid antitussive use increased from 2012 to 2015 and decreased thereafter (8.4% in 2012, 14.7% in 2015, 6.7% in 2021; all p < 0.001). Of 15,566 CC patients and 655,250 non-CC patients identified in the GBTM analysis, CC patients had substantial burdens of respiratory/non-respiratory comorbidities and healthcare service and concomitant medication use compared to non-CC patients. Among CC patients, GBTM identified three distinct CM utilization trajectories: (1) no CM use (n = 11,222; 72.1%); (2) declining CM use (n = 4105; 26.4%); and (3) chronic CM use (n = 239; 1.5%). CC patients in Florida had limited CM use with increasing trends in use of benzonatate, dextromethorphan, and gabapentinoids and a decreasing trend in opioid antitussive use. CC patients, particularly with chronic prescription CM use, experienced substantial disease burden.
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Shu Huang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Juan M. Hincapie-Castillo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Xuehua Ke
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | - Helen Ding
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | | | - Bobby Jones
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Suresh S, Perret JL, Walters EH, Abramson MJ, Bowatte G, Lodge C, Lowe A, Erbas B, Thomas P, Hamilton GS, Chang AB, Dharmage SC, Bui DS. Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults. Pulmonology 2023:S2531-0437(23)00154-X. [PMID: 37743172 DOI: 10.1016/j.pulmoe.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. METHODS Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into "explained cough" if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or "unexplained cough" if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. RESULTS The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being "unexplained". Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. CONCLUSIONS Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.
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Affiliation(s)
- S Suresh
- University of Melbourne Medical School, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - J L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E H Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - M J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - C Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - A Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - B Erbas
- School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - P Thomas
- Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - G S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia
| | - A B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; NHMRC-CRE Centre for Air pollution, Energy and Health Research, Australia
| | - D S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Moon JY, Lee H, Kim MH, Song WJ, Lee SM, Kim SH, Kim SH, Lee BJ, Yoon HJ, Kim SH. Bacterial Etiology in Subacute Cough. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:673-681. [PMID: 37153983 PMCID: PMC10570775 DOI: 10.4168/aair.2023.15.5.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 10/14/2023]
Abstract
Although postinfectious etiology is the most common cause of subacute cough, there are insufficient data on the epidemiology of associated bacterial infections. We aimed to identify the etiology of bacterial detection in subjects with subacute cough. A multicenter prospective observational study of 142 patients with postinfectious subacute cough was performed between August 2016 and December 2017 in Korea. We obtained 2 nasal swabs from each patient and used a multiplex bacterial polymerase chain reaction (PCR) kit that simultaneously detects Bordetella pertussis, Chlamydophila pneumoniae, Haemophilus influenzae, Legionella pneumophilia, Mycoplasma pneumoniae, and Streptococcus pneumoniae. About 29% (n = 41) of patients with subacute cough were positive for bacterial PCR in nasal swabs. The most common bacteria detected by bacterial PCR was H. influenzae (n = 19, 13.4%), followed by S. pneumoniae (n = 18, 12.7%), B. pertussis (n = 7, 4.9%), M. pneumoniae (n = 3, 2.1%), L. pneumophilia (n = 2, 1.4%), and C. pneumoniae (n = 1, 0.7%). Nine patients had dual positivity for the PCR. In conclusion, bacterial PCR was positive in the nasal swabs of about 29% of subjects with subacute cough, including 5% of positive PCR results for B. pertussis.
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Affiliation(s)
- Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Nowon Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.
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Lee JH, Oh JY, Kwon HS, Kim TB, Cho YS, Song WJ. Effects of bepotastine, a nonsedating H1-antihistamine, for the treatment of persistent cough and allergic rhinitis: a randomised, double-blind, placebo-controlled trial. ERJ Open Res 2023; 9:00448-2023. [PMID: 37868148 PMCID: PMC10588790 DOI: 10.1183/23120541.00448-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023] Open
Abstract
Background Empirical therapy with oral histamine-1 receptor antagonists (H1RAs) is often used for patients with suspected upper airway cough syndrome. No placebo-controlled trials with nonsedating H1RAs (nsH1RAs) have evaluated validated cough outcomes. The objective of the present study was to assess the effect of an nsH1RA, bepotastine, on cough outcomes in patients with allergic rhinitis and persistent cough. Methods A randomised, double-blind, placebo-controlled trial was conducted. Adult patients with persistent cough (>3 weeks in duration) and symptomatic allergic rhinitis were recruited and randomly assigned to receive either bepotastine or placebo at a 1:1 ratio. The primary outcome was cough-specific quality of life assessed using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included cough severity visual analogue scale (VAS), throat VAS, Cough Hypersensitivity Questionnaire, Sinonasal Outcome Test-22 score and drug adverse events. Results Between October 2021 and September 2022, 50 participants (43 females; mean age 46.28 years; median cough duration 3 months) were assigned to either the bepotastine 10 mg twice daily or placebo group in a 1:1 ratio. After 2 weeks of treatment, both bepotastine and placebo groups showed significant improvements in the LCQ scores, but there was no significant difference in the magnitude of change between the groups (3.45±2.10 versus 3.04±2.94, p=0.576). Secondary outcomes were also comparable. Conclusions Despite the relatively small sample size, our study clearly demonstrated that a 2-week treatment with bepotastine did not provide therapeutic benefits for cough outcomes. These findings suggest against the use of nsH1RAs with the intention of improving cough outcomes, even in patients with persistent cough and allergic rhinitis.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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59
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Zhang M, Morice AH. Unravelling vagal hypersensitivity in chronic cough: A distinct disease. J Physiol 2023. [PMID: 37642341 DOI: 10.1113/jp284641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Chronic cough (CC) is a common but poorly understood disease that has a negative impact on quality of life. For years, clinicians have been trying to find the underlying diagnosis and using existing disease models to describe the patients' illness. This presents a confusing picture of CC. Most patients with CC present with hypersensitivity of the cough reflex, which is characterised by laryngeal paraesthesia and an increased response to the tussive stimuli or an innocuous stimulus that would not trigger coughing in healthy people. Recently, it has been proposed that CC is a unique disease characterised by vagal hypersensitivity that projects to the central nervous system altering responsiveness. The evidence supports the hypothesis that CC is primarily a neurological disorder, consisting of different phenotypes.
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Affiliation(s)
- Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Alyn H Morice
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
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60
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Terada S, Matsumoto H, Nishi K, Kogo M, Nomura N, Tashima N, Morimoto C, Sunadome H, Nagasaki T, Oguma T, Nakatsuka Y, Murase K, Kawaguchi T, Tabara Y, Sonomura K, Matsuda F, Chin K, Hirai T. Association of lower plasma citric acid with prolonged cough: the Nagahama study. Sci Rep 2023; 13:13921. [PMID: 37626075 PMCID: PMC10457296 DOI: 10.1038/s41598-023-40878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Little is known about the association of prolonged cough, a common and troublesome symptom, with metabolic pathways. We aimed to clarify this association using data from the Nagahama cohort, a prospective study of participants from the general population. Self-report questionnaires on prolonged cough were collected at baseline and 5-year follow-up assessments. Blood tests at follow-up were used for gas chromatography-mass spectrometry-based metabolomics. The association between metabolites and prolonged cough was examined using the partial least squares discriminant analysis and multiple regression analysis. Among the 7432 participants, 632 had newly developed prolonged cough at follow-up, which was defined as "new-onset prolonged cough". Low plasma citric acid was significantly associated with new-onset prolonged cough, even after the adjustment of confounding factors including the presence of asthma, upper airway cough syndrome (UACS), and gastroesophageal reflux disease (GERD). A similar association was observed for isocitric acid, 3-hydroxybutyric acid, and 3-hydroxyisobutyric acid. The analysis of these four metabolites revealed that citric acid had the strongest association with new-onset prolonged cough. This significant association remained even when the analysis was confined to participants with UACS or GERD at baseline or follow-up, and these associations were also observed in participants (n = 976) who had prolonged cough at follow-up regardless of baseline status. In conclusion, low blood citric acid may be associated with prolonged cough.
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Affiliation(s)
- Satoru Terada
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
- Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama City, Osaka, Japan.
| | - Kenta Nishi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Natsuko Nomura
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriyuki Tashima
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chie Morimoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hironobu Sunadome
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Nagasaki
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Kazuhiro Sonomura
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Technology Research Laboratory, Life Science Research Center, Shimadzu Corporation, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Drake MG, McGarvey LP, Morice AH. From bench to bedside: The role of cough hypersensitivity in chronic cough. Clin Transl Med 2023; 13:e1343. [PMID: 37501282 PMCID: PMC10374883 DOI: 10.1002/ctm2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Chronic cough is a burdensome condition characterized by persistent cough lasting longer than 8 weeks. Chronic cough can significantly affect quality of life, physical function and productivity, with many people troubled with a cough that lasts for months or even years. People with chronic cough commonly report a persistent urge to cough with frequent bouts of coughing triggered by innocuous stimuli, which has led to the concept of cough hypersensitivity. MAIN BODY Both central and peripheral neural pathways regulate cough, and although mechanisms driving development of cough hypersensitivity are not fully known, sensitization of these neural pathways contributes to excessive cough triggering in cough hypersensitivity. Effective therapies that control chronic cough are currently lacking. Recent therapeutic development has focused on several ion channels and receptors involved in peripheral activation of cough (e.g., transient receptor potential channels, P2 × 3 receptors and voltage-gated sodium channels) or central cough processing (e.g., neurokinin-1 [NK-1] receptors and nicotinic acetylcholine receptors). CONCLUSION These targeted therapies provide novel insights into mechanisms underlying cough hypersensitivity and may offer new treatment options for people with chronic cough. In this review, we explore preclinical and clinical studies that have improved our understanding of the mechanisms responsible for chronic cough and discuss the most promising targeted approaches to date, including trials of P2 × 3-receptor antagonists and NK-1-receptor antagonists.
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Affiliation(s)
- Matthew G. Drake
- Division of Pulmonary and Critical Care Medicine, Department of MedicineOregon Health and Science UniversityPortlandOregonUSA
| | - Lorcan P. McGarvey
- Wellcome‐Wolfson Institute for Experimental Medicine, School of MedicineDentistry & Biomedical Science, Queen's University BelfastBelfastUnited Kingdom of Great Britain and Northern Ireland
| | - Alyn H. Morice
- Respiratory Research GroupHull York Medical SchoolUniversity of HullCottinghamUK
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Chawla A, Largajolli A, Hussain A, Kleijn H, Ait‐Oudhia S, Anton J, Krishna Ananthula H, Nussbaum J, La Rosa C, Gheyas F. Population pharmacokinetic analysis of the P2X3-receptor antagonist gefapixant. CPT Pharmacometrics Syst Pharmacol 2023; 12:1107-1118. [PMID: 37147897 PMCID: PMC10431053 DOI: 10.1002/psp4.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023] Open
Abstract
Gefapixant, a P2X3-receptor antagonist, demonstrated objective and subjective efficacy in individuals with refractory or unexplained chronic cough. We report a population pharmacokinetic (PopPK) analysis that characterizes gefapixant pharmacokinetics (PKs), quantifies between- and within-participant variability, and evaluates the impact of intrinsic and extrinsic factors on gefapixant exposure. The PopPK model was initially developed using PK data from six phase I studies. Stepwise covariate method was utilized to identify covariates impacting PK parameters; the model was re-estimated and covariate effects were re-assessed after integrating PK data from three phase II and III studies. Simulations were conducted to evaluate the magnitude of covariate effects on gefapixant exposure. Of 1677 participants included in this data set, 1618 had evaluable PK records. Age, body weight, and sex had statistically significant, but not clinically relevant, effects on exposure. Degree of renal impairment (RI) had statistically significant and clinically relevant effects on exposure; exposure was 17% to 89% higher in those with versus without RI. Simulation results indicated that gefapixant 45 mg administered once daily to patients with severe RI has similar exposure to gefapixant 45 mg administered twice daily to patients with normal renal function. There were no significant effects of proton pump inhibitors or food. Of evaluated intrinsic and extrinsic factors, only RI had a clinically relevant effect on gefapixant exposure. Patients with mild or moderate RI do not require dosage adjustments; however, for patients with severe RI who are not on dialysis, gefapixant 45 mg once daily is recommended.
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Affiliation(s)
| | | | | | - Huub Kleijn
- Certara Strategic ConsultingPrincetonNew JerseyUSA
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63
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Chang AB, Irwin RS, O’Farrell HE, Dicpinigaitis PV, Goel S, Kantar A, Marchant JM. Cough Hypersensitivity Syndrome: Why Its Use Is Inappropriate in Children. J Clin Med 2023; 12:4879. [PMID: 37568280 PMCID: PMC10419757 DOI: 10.3390/jcm12154879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
In children and adults, chronic cough is a common symptom presenting to health professionals worldwide. It is internationally accepted that children with chronic cough should be managed with pediatric specific management guidelines. The newly proposed clinical entity of 'cough hypersensitivity syndrome' has gained significant attention in adult literature. Given the significant differences between childhood and adult chronic cough, including in respiratory physiology and anatomy, and cough sensitivity, we address the suitability of the use of cough hypersensitivity syndrome in children. We explore these differences between childhood and adult chronic cough, explain what cough hypersensitivity is and highlight why the term cough hypersensitivity syndrome should not be used in children.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Richard S. Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA 01605, USA
| | - Hannah E. O’Farrell
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Peter V. Dicpinigaitis
- Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA
| | - Suhani Goel
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Somerville House, South Brisbane, QLD 4101, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, via Forlanini 15, Ponte San Pietro-Bergamo, 24036 Bergamo, Italy
| | - Julie M. Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
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Chuang MH, Chen IW, Chen JY, Kang FC, Ho CN, Wu SC, Yew M, Lan KM, Hung KC. Efficacy and safety of gefapixant for chronic cough: a meta-analysis of randomised controlled trials. Eur Respir Rev 2023; 32:32/168/220219. [PMID: 37197770 DOI: 10.1183/16000617.0219-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND The efficacy and safety of gefapixant in adults with chronic cough remain unclear. Our objective was to assess the efficacy and safety of gefapixant using updated evidence. METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched from inception through September 2022. Subgroup analysis based on dose of gefapixant (i.e. ≤20, 45-50 and ≥100 mg twice daily for low, moderate and high doses, respectively) was performed to explore a potential dose-dependent effect. RESULTS Five studies involving seven trials showed the efficacy of moderate- or high-dose gefapixant for reducing objective 24-h cough frequency (estimated relative reduction 30.9% and 58.5%, respectively) (i.e. primary outcome) and awake cough frequency (estimated relative reduction 47.3% and 62.8%, respectively). Night-time cough frequency was only reduced with high-dose gefapixant. Consistently, the use of moderate- or high-dose gefapixant significantly alleviated cough severity and improved cough-related quality of life, but increased the risk of all-cause adverse events (AEs), treatment-related AEs and ageusia/dysgeusia/hypogeusia. Subgroup analysis showed dose dependency in both efficacy and AEs with a cut-off dose being ≥45 mg twice daily. CONCLUSIONS This meta-analysis revealed dose-dependent efficacy and adverse effects of gefapixant against chronic cough. Further studies are required to investigate the feasibility of moderate-dose (i.e. 45-50 mg twice daily) gefapixant in clinical practice.
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Affiliation(s)
- Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
- Both authors contributed equally
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
- Both authors contributed equally
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Fu-Chi Kang
- Department of Anesthesiology, Chi Mei Medical Center, Chiali, Tainan City, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Mao Lan
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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65
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Mäki-Heikkilä R, Koskela H, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. Cross-country skiers often experience respiratory symptoms during and after exercise but have a low prevalence of prolonged cough. BMJ Open Sport Exerc Med 2023; 9:e001502. [PMID: 37342789 PMCID: PMC10277524 DOI: 10.1136/bmjsem-2022-001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Background Cross-country skiers train and compete during the winter for long periods of time in subfreezing conditions, which strains the airways and provokes respiratory symptoms. This study aimed to compare the prevalence of exercise-related symptoms and prolonged cough in competitive cross-country skiers versus the general population and to investigate the association between these symptoms and asthma. Methods A questionnaire was sent to Finnish cross-country skiers (n=1282) and a random sample of the general population (n=1754), with response rates of 26.9% and 19.0%, respectively. Results Both groups were mostly asymptomatic at rest, but symptoms were increased in both groups during and after exercise. Cough was more prevalent after exercise in skiers and phlegm production was more common during and after exercise in skiers. Asthma did not provoke specific symptoms, but symptom prevalence was higher in asthmatic individuals. Skiers had a higher prevalence of cough after exercise (60.6% vs 22.8%, p<0.001) compared with controls, but controls had a higher prevalence of prolonged cough (4.1% vs 9.6%, p=0.004). In participants without asthma, cold air triggered symptoms more often in skiers than controls, while strong odours triggered symptoms more often in asthmatic controls than skiers. Chronic cough lasting more than 8 weeks was rare, reported by 4.8% of controls and 2.0% of skiers. Conclusion Cross-country skiers, especially those with asthma, experience a higher burden of exercise-related respiratory symptoms compared with controls. However, repeated exposure to cold air does not appear to result in long-term hypersensitivity of the cough reflex arc.
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Affiliation(s)
| | - Heikki Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
- Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland School of Medicine, Kuopio, Pohjois-Savo, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Pirkanmaa, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Pirkanmaa, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
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66
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Guilleminault L, Demoulin-Alexikova S, de Gabory L, Varannes SBD, Brouquières D, Balaguer M, Chapron A, Grassin-Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. Guidelines for the management of chronic cough in adults. Endorsed by the French speaking society of respiratory diseases (Société de Pneumologie de Langue Française, SPLF), the Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou (SFORL), the Société Française de Phoniatrie et de Laryngologie (SFPL), the Société Nationale Française de Gastro-entérologie (SNFGE). Respir Med Res 2023; 83:101011. [PMID: 37087905 DOI: 10.1016/j.resmer.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
Patients with chronic cough experience a high alteration of quality of life. Moreover, chronic cough is a complex entity with numerous etiologies and treatments. In order to help clinicians involved in the management of patients with chronic cough, guidelines on chronic cough have been established by a group of French experts. These guidelines address the definitions of chronic cough and the initial management of patients with chronic cough. We present herein second-line tests that might be considered in patients with cough persistence despite initial management. Experts also propose a definition of unexplained or refractory chronic cough (URCC) in order to better identify patients whose cough persists despite optimal management. Finally, these guidelines address the pharmacological and non-pharmacological interventions useful in URCC. Thus, amitryptilline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are a mainstay of treatment strategies in URCC. Other treatment options, such as P2 × 3 antagonists, are being developed.
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Affiliation(s)
- Laurent Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, 31000, Toulouse, France.
| | - Silvia Demoulin-Alexikova
- CHU de Lille, Lille, France Univ. Lille, CNRS, Inserm, CHU Lille - Service des Explorations Fonctionnelles Respiratoires, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, 59000, Lille, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, Univ. Bordeaux, 33000, France
| | - Stanislas Bruley Des Varannes
- Gastroenterology Department, CHU de Nantes, Institut des Maladies de l'Appareil Digestif, IMAD CIC 1413, Université de Nantes, 44000, Nantes, France
| | - Danielle Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | - Mathieu Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Anthony Chapron
- Université de Rennes 1, CHU Rennes, Département de Médecine Générale, 35000, Rennes, France
| | - Stanislas Grassin-Delyle
- Respiratory Diseases Department, Foch Hospital, 92150, Suresnes, France; Infection and Inflammation, Health Biotechnology Department, Paris-Saclay University, UVSQ, INSERM, 78180, Montigny le Bretonneux, France
| | - Mathias Poussel
- CHRU-Nancy, Exploration Fonctionnelle Respiratoire-Centre Universitaire de Médecine du Sport et Activités Physiques Adaptées, F54000, Nancy, France; DevAH, Université de Lorraine, F54000, Nancy, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, Centre Hospitalo-Universitaire de Toulouse, 24 chemin de pouvourville, 31059, Toulouse, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, 49000, Angers, France
| | - Virginie Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - Sabine Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
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Saari E, Mononen M, Hasala H, Lätti A, Kaulamo J, Nurmi H, Kaarteenaho R, Purokivi M, Koskela HO. Characteristics of idiopathic pulmonary fibrosis -associated cough. a case-control study. BMC Pulm Med 2023; 23:179. [PMID: 37221535 DOI: 10.1186/s12890-023-02476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Most patients with idiopathic pulmonary fibrosis (IPF) complain of cough. IPF-associated cough is widely characterized as dry or non-productive. The aim of this study was to compare chronic cough in early stage IPF patients to cough in subjects with chronic cough from a community-based sample and, especially, to investigate whether cough in IPF is less productive than chronic cough in a community-based sample. METHODS The IPF cough population consisted of 46 biopsy-confirmed patients who complained of chronic cough. Control population consisted of subjects with chronic cough, gathered by a community-based email survey sent to public service employees and the Finnish Pensioners' Federation. A case-control setting was applied by having four age, gender, and smoking-status matched subjects from the community sample for each IPF cough patient. A cough specific quality of life questionnaire (Leicester Cough Questionnaire (LCQ)) was filled in by all subjects. The LCQ questionnaire contains 19 questions, each question is scored from 1 to 7 and total score from 3 to 21 with a smaller value indicating more severe impairment. RESULTS The sputum production frequency, as assessed by LCQ question 2, was 5.0 (3.0-6.0) in the IPF chronic cough population and 5.0 (3.0-6.0) in the community-based chronic cough population (median and interquartile range p= 0.72). The LCQ total score was 14.8 (11.5-18.1) in the IPF chronic cough population and 15.4 (13.0-17.5) in the community-based chronic cough population (p=0.76). The domain impact scores were physical, 4.9 (3.9-6.1) vs. 5.1 (4.5-5.6) (p=0.80); psychological, 4.6 (3.7-5.9) vs. 4.7 (3.9-5.7) (p=0.90); and social, 5.5 (3.7-6.5) vs. 5.5 (4.5-6.3) (p=0.84), respectively. Furthermore, cough response to paint or fumes, cough disturbing sleep, and cough frequency per day did not differ between the groups. CONCLUSION Cough in early stage IPF patients was not distinguishable from chronic cough in the community-based population by LCQ. Especially, there was no difference in the self-reported frequency of cough-associated sputum production.
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Affiliation(s)
- Eeva Saari
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland.
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, PO 100, 70029, Kuopio, Finland.
| | - Minna Mononen
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland
| | - Hannele Hasala
- Department of Respiratory Medicine, Tampere University Hospital, PO 2000, 33521, Tampere, Finland
| | - Anne Lätti
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, PO 100, 70029, Kuopio, Finland
| | - Johanna Kaulamo
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland
- Health Care Services for Prisoners, Mehiläinen Terveyspalvelut Oy, Kauppakatu 39A, 70110, Kuopio, Finland
| | - Hanna Nurmi
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, PO 100, 70029, Kuopio, Finland
| | - Riitta Kaarteenaho
- Research Unit of Internal Medicine, University of Oulu, PO 500, 90400, Oulu, Finland
- Center of Internal Medicine and Respiratory Medicine and Medical Research Center (MRC) Oulu, Oulu University Hospital, PO 20, 90029, Oulu, Finland
| | - Minna Purokivi
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, PO 100, 70029, Kuopio, Finland
| | - Heikki O Koskela
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 1627, 70211, Kuopio, PO, Finland
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, PO 100, 70029, Kuopio, Finland
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68
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Guilleminault L, Demoulin-Alexikova S, de Gabory L, Bruley des Varannes S, Brouquières D, Balaguer M, Chapron A, Grassin Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S. [Guidelines for the management of chronic cough in adults]. Rev Mal Respir 2023; 40:432-452. [PMID: 37080877 DOI: 10.1016/j.rmr.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 04/22/2023]
Abstract
Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.
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Affiliation(s)
- L Guilleminault
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, université de Toulouse III, Toulouse, France.
| | - S Demoulin-Alexikova
- CHU de Lille, Lille, France; Inserm, CNRS, U1019-UMR9017, service des explorations fonctionnelles respiratoires, centre d'infection et d'immunité de Lille (CIIL), Institut Pasteur de Lille, university Lille, CHU Lille, Lille, France
| | - L de Gabory
- Department of otorhinolaryngology - head and neck surgery, university hospital of Bordeaux, Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - S Bruley des Varannes
- IMAD CIC 1413, gastroenterology department, Institut des maladies de l'appareil digestif, université de Nantes, CHU de Nantes, Nantes, France
| | - D Brouquières
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - M Balaguer
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - A Chapron
- Département de médecine générale, université de Rennes 1, CHU Rennes, Rennes, France
| | - S Grassin Delyle
- Respiratory diseases department, Foch hospital, Suresnes, France; Inserm, UVSQ, infection and inflammation, health biotechnology department, Paris-Saclay university, Montigny-le-Bretonneux, France
| | - M Poussel
- Exploration fonctionnelle respiratoire, centre universitaire de médecine du sport et activités physiques adaptées, CHRU de Nancy, 54000 Nancy, France; DevAH, université de Lorraine, 54000 Nancy, France
| | - N Guibert
- Pôle des voies respiratoires, service de pneumo-allergologie, centre hospitalo-universitaire de Toulouse, Toulouse, France
| | - G Reychler
- Université catholique de Louvain, Louvain, Belgique
| | - W Trzepizur
- Department of respiratory and sleep medicine, Angers university hospital, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, équipe CarME, SFR ICAT, university of Angers, 49000 Angers, France
| | - V Woisard
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - S Crestani
- Unité de voie et déglutition, hôpital Larrey, CHU de Toulouse, Toulouse, France
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Kang N, Won HK, Lee JH, Shim JS, Kang SY, Park HK, Jo EJ, Lee SE, Kim MH, Kim SH, Kim SH, Chang YS, Lee BJ, Song WJ, Jo MW. Health-Related Quality of Life and Its Determinants in Chronic Cough: The Korean Chronic Cough Registry Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:348-360. [PMID: 37075795 DOI: 10.4168/aair.2023.15.3.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/22/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE Chronic cough (CC) is associated with health-related quality of life (HRQoL) impairment. However, the determinants of HRQoL are under-investigated. METHODS Patients aged 19-80 years with CC were prospectively recruited from 10 referral clinics. Comparisons were made with age- and sex-matched controls (1:4 ratio) selected from a Korean general population survey database; 1) a group without current cough (non-cough controls) and 2) another group without major chronic illnesses (healthy controls). HRQoL was assessed using the EuroQoL 5-dimension (EQ-5D) index. In CC patients, cough-specific patient-reported outcomes (PROs) were additionally measured. Cross-sectional analyses were performed to evaluate demographic and clinical parameters associated with the EQ-5D index of CC patients. RESULTS A total of 200 CC patients (137 newly referred with CC and 63 refractory or unexplained CC [RUCC] patients), 800 non-cough controls, and 799 healthy controls were analyzed. The EQ-5D index of CC patients was significantly lower than that of non-cough controls or healthy controls (0.82 ± 0.14 vs 0.92 ± 0.14/0.96 ± 0.08; P < 0.001, respectively). The index was also associated with older age (≥ 60 years), female sex, and comorbidities such as asthma or depression. Among the patients with CC, the index was significantly lower in patients with RUCC than in those with newly referred CC, being treated with codeine or cough neuromodulators, or with cough-related fatigue. In Spearman analyses, the EQ-5D index correlated with cough-specific quality of life and cough severity scores, not with throat sensation or cough trigger scores. CONCLUSIONS The HRQoL impairment of CC patients was associated with older age, female sex, and comorbidities but it was also affected by cough severity, complications, treatments, and treatment responses. Longitudinal studies are warranted to further understand and improve the HRQoL of CC patients.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha-Kyeong Won
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sung-Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Han-Ki Park
- Department of Allergy and Clinical Immunology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
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70
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Oh JY, Kang YR, An J, Choo E, Lee JH, Kwon HS, Lee JS, Lee SW, Kim TB, Oh YM, Cho YS, Lee SD, Song WJ. Codeine prescription pattern and treatment responses in patients with chronic cough: a routinely collected institutional database analysis. J Thorac Dis 2023; 15:2344-2354. [PMID: 37197516 PMCID: PMC10183498 DOI: 10.21037/jtd-22-1857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
Background Codeine has been long used as an antitussive drug in several countries. However, a prescription pattern of codeine, such as dose or treatment duration, has not been reported in detail. Furthermore, there is few scientific evidence on the efficacy and safety. We aimed to examine codeine prescription pattern and explore treatment response in patients with chronic cough in real-world practice. Methods This was a retrospective cohort analysis of patients with chronic cough who were newly referred to tertiary allergy and asthma clinics between July 2017 and July 2018. Routinely collected electronic healthcare records (EHRs), including medical notes, prescriptions, and outpatient visits, were analyzed. Codeine prescription records were examined for duration, mean daily dose, and 1-year cumulative dose. Codeine responses were evaluated by manual EHR reviews. Results Among a total of 1,233 newly referred patients with chronic cough, 666 were prescribed codeine for a median [interquartile range (IQR)] of 27.5 days (IQR 14-60 days); the median daily dose was 30 mg/year (IQR 21.6-30 mg/year), and the 1-year cumulative dose was 720 mg/year (IQR 420-1,800 mg/year). About 14.0% of patients were prescribed codeine for >8 weeks; they were older and had a longer cough duration, throat abnormal sensation and less dyspnea than patients prescribed codeine for ≤8 weeks or who did not receive codeine. Codeine prescription and duration was positively associated with the number of other cough-related medications, diagnostic tests, or outpatient visits. Cough status change was noted in 61.3% of codeine-prescribed patients (as 'improved' in 40.1% and 'not improved' in 21.2%), but not documented in 38.7%. Side effects were described in 7.8%. Conclusions Codeine prescription may be frequent and chronic in real-world practice of patients with chronic cough, despite the lack of robust clinical evidence on the efficacy. High prescription rates suggest unmet clinical needs. Prospective studies are warranted to identify codeine treatment responses and safety, and to build up clinical evidence to guide appropriate use of narcotic antitussives.
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Affiliation(s)
- Ji-Yoon Oh
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Ri Kang
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin An
- Department of Pulmonary, Allergy and Critical Care Medicine, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Eugene Choo
- Division of Allergy and Immunology, Mount Sinai School of Medicine, New York, NY, USA
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Seung Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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71
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Yang BE, Moss J. Cough, Cough: How Much of the Symptom Resides in Your Genes? Chest 2023; 163:746-748. [PMID: 37031980 DOI: 10.1016/j.chest.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 04/11/2023] Open
Affiliation(s)
- Bennett E Yang
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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72
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Schellenberg M, Herth FJF. [Chronic cough]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:288-294. [PMID: 36703081 DOI: 10.1007/s00108-022-01467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
Coughing is an important protective reflex of the respiratory tract and primarily serves clearance of the bronchial system. It is also an exceptionally common symptom in outpatient care that can be an expression of a variety of diseases. Coughing duration of longer than 8 weeks is referred to as chronic cough. A structured, often interdisciplinary diagnostic process is essential. The aim here is to identify causal treatment options, avoiding overdiagnosis and simultaneously not overlooking severe illness. This article discusses current diagnostic procedures, important differential diagnoses and possible treatment options.
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Affiliation(s)
- M Schellenberg
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Universität Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland.
| | - F J F Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Universität Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
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73
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Lavorini F, Bernacchi G, Fumagalli C, Noale M, Maggi S, Mutolo D, Cinelli E, Fontana GA. Somatically evoked cough responses help to identify patients with difficult-to-treat chronic cough: a six-month observational cohort study. EClinicalMedicine 2023; 57:101869. [PMID: 36874394 PMCID: PMC9975680 DOI: 10.1016/j.eclinm.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Recently we identified in patients with chronic cough a sensory dysregulation via which the urge-to-cough (UTC) or coughing are evoked mechanically from "somatic points for cough" (SPCs) in the neck and upper trunk. We investigated the prevalence and the clinical relevance of SPCs in an unselected population of patients with chronic cough. METHODS From 2018 to 2021, symptoms of 317 consecutive patients with chronic cough (233 females) were collected on four visits (V1-V4) 2 months apart at the Cough Clinic of the University Hospital in Florence (I). Participants rated the disturbance caused by the cough (0-9 modified Borg Scale). We attempted to evoke coughing and/or UTC using mechanical actions in all participants who were subsequently categorised as responsive (somatic point for cough positive, SPC+) or unresponsive (SPC-) to these actions. An association was established between chronic cough and its commonest causes; treatments were administered accordingly. FINDINGS 169 patients were SPC+ and had a higher baseline cough score (p < 0.01). In most of the patients, the treatments reduced (p < 0.01) cough-associated symptoms. All patients reported a decrease (p < 0.01) in cough score at V2 (from 5.70 ± 1.4 to 3.43 ± 1.9 and from 5.01 ± 1.5 to 2.74 ± 1.7 for SPC+ and SPC- patients respectively). However, whilst in SPC- patients the cough score continued to decrease indicating virtually complete cough disappearance at V4 (0.97 ± 0.8), in SPC+ patients this variable remained close to V2 values during the entire follow-up. INTERPRETATION Our study suggests that the assessment of SPCs may identify patients whose cough is unresponsive and are eligible for specific treatments. FUNDING This work was funded by an unrestricted grant from Merck (Italy).
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Corresponding author. Department of Experimental and Clinical Medicine, Largo Brambilla 3, Florence 50134, Italy.
| | - Guja Bernacchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marianna Noale
- Italian National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefania Maggi
- Italian National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
| | - Donatella Mutolo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Eliana Cinelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni A. Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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74
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Yardstick for managing cough, part 1: In adults and adolescent patients older than 14 years of age. Ann Allergy Asthma Immunol 2023; 130:379-391. [PMID: 36526233 DOI: 10.1016/j.anai.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Nationwide statistics in the United States and Australia reveal that cough of undifferentiated duration is the most common complaint for which patients of all ages seek medical care in the ambulatory setting. Management of chronic cough is one of the most common reasons for new patient visits to pulmonologists. Because symptomatic cough is such a common problem and so much has been learned about how to diagnose and treat cough of all durations but especially chronic cough, this 2-part yardstick has been written to review in a practical way the latest evidence-based guidelines most of which have been developed from recent high quality systematic reviews on how best to manage cough of all durations in adults, adolescents, and children. In this manuscript, part 1 of the 2-part series, we provide evidence-based, and expert opinion recommendations on the management of chronic cough in adult and adolescent patients (>14 years of age).
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75
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The Relationship Between Chronic Cough and Laryngopharyngeal Reflux. J Voice 2023; 37:245-250. [PMID: 33262000 DOI: 10.1016/j.jvoice.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
Chronic cough is multifactorial in origin, may affect quality of life adversely, and often poses a diagnostic challenge for physicians. Laryngopharyngeal reflux (LPR) is one common contributing factor for chronic cough, but the mechanism by which reflux causes cough remains unclear. Research investigating the relationship between chronic cough and LPR has focused largely on reflux from the perspective of gastroenterology, rather than otolaryngology. OBJECTIVE The purpose of our study was to investigate the relationship between chronic cough and LPR by using the objective results of 24-hour pH impedance studies. METHODS We conducted a retrospective chart review of all patients who presented to the voice center of the senior author (RTS) with a chief complaint of chronic cough and no previous diagnosis of reflux. Patient demographics, past medical history, laboratory data, and exam findings during the initial visit from 2015 to 2020 and at follow-up were analyzed. RESULTS We identified 28 patients who presented with a chief complaint of chronic cough and who had not been diagnosed with or treated for reflux previously. Twenty-three had additional risk factors for chronic cough (asthma, chronic sinusitis, and bronchial schwannoma). All 28 had findings consistent with LPR upon exam. Treatment with reflux medications and lifestyle modification decreased the reflux finding score significantly from 11.39 to 9.21 (P= 0.005). Of all, 60.7% of patients reported subjective improvement in cough symptoms. The cough had improved in 50.0% and had resolved completely in 10.7%. Patients with VF paresis were less likely to report improvement in their cough. Further workup was performed for the 11 patients who had cough that did not resolve completely after reflux treatment. Detectable levels of antimycoplasma antibodies were found in nine patients, and antipertussis antibodies were found in two patients. Six patients followed up after a course of clarithromycin, three of whom had experienced improvement in their cough. CONCLUSIONS Our findings suggest that LPR may be a prevalent contributing or etiologic factor for chronic cough. The expected improvement after initiating reflux treatment is 60% at 3 months. Cough resolved completely in 10% of patients at 4 months. Nonresponders may have other contributing causes of cough, including esophageal dysmotility, mycoplasma, pertussis, and other contributors. Further studies are needed to confirm or refute these findings.
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76
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Truba O, Dabrowska M, Grabczak EM, Bialek-Gosk K, Rybka-Fraczek A, Klimowicz K, Zukowska M, Krenke R. Diagnostic yield of chest radiograph in management of adults with difficult-to-treat chronic cough-retrospective study. J Thorac Dis 2023; 15:928-939. [PMID: 36910068 PMCID: PMC9992608 DOI: 10.21037/jtd-22-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 12/02/2022] [Indexed: 02/10/2023]
Abstract
Background Chest radiograph (CXR) is a routine imaging test in adults with chronic cough (CC), while value of thoracic computed tomography (CT) in these patients is still a matter of discussion. The aims of the study were to assess the diagnostic yield of CXR and to evaluate the impact of thoracic CT on management of patients with difficult-to-treat CC referred to our cough clinic. Methods The retrospective analysis of paired CXR and CT results was performed in 189 consecutive adults treated due to CC between 2015-2019 in our cough clinic. CC was defined as cough >8 weeks being the main or isolated ailment. The sensitivity, specificity, negative/positive predictive value (NPV, PPV) and diagnostic accuracy of CXR were calculated based on chest CT scan as the "gold standard". Only those CT scans which revealed abnormalities potentially related to CC and were associated with the changes in further diagnostic or therapeutic approach were construed as relevant CT findings during final analysis. Results The median age of patients (male/female ratio 53/136) was 58 years (IQR 44-67), only 6 subjects (3.0%) were active smokers, median CC duration was 48 months (IQR 24-120). CXR revealed abnormal findings in 23/189 (12.2%) patients. Normal CXR was confirmed by CT in 141 subjects (141/166; 84.9%). In 25/166 (15.1%) patients, CT showed abnormalities that could explain the cause of CC and changed either the diagnostic protocol or therapy. In patients with abnormal CXR, CT confirmed abnormal findings in 8 cases (8/23, 34.8%). The sensitivity, specificity, PPV, NPV, diagnostic accuracy were 24.2%, 90.4%, 34.8%, 84.9% and 78.8%, respectively. Conclusions CXR shows a limited diagnostic yield in adults with difficult-to-treat CC referred to cough clinic. Chest CT scan may add significant data impacting the diagnostic and therapeutic approach in these patients.
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Affiliation(s)
- Olga Truba
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Dabrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Elzbieta M. Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Bialek-Gosk
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Rybka-Fraczek
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Klimowicz
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Zukowska
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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Weiner M, Weaver J, Gowan T, Baird SA, Huffman M, Dexter P, Bali V, Schelfhout J, Griffith A, Pell J, Doshi I, Talib T. Health-related experiences of adults with chronic cough: Empirical research mixed methods. Nurs Open 2023; 10:4055-4063. [PMID: 36815576 PMCID: PMC10170930 DOI: 10.1002/nop2.1665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023] Open
Abstract
AIM To describe adults' health-related experiences with chronic cough. DESIGN Survey and interviews. METHODS Participants completed questionnaires and interviews, to explore chronic cough's impact and management. DATA SOURCES Patients aged 18-85 years with at least three cough-related encounters within 56-120 days. RESULTS Forty-one patients were surveyed. Mean cough severity was 4.5 (scale 0-9). Chronic cough-related problems included embarrassment (66%), fatigue (56%), and anxiety or depression (49%). Testing was judged insufficient by 44%. Only 28% were satisfied with treatment; 20% reported abandoning treatment due to ineffectiveness. Interview themes (N = 30) included frustration with diagnostic uncertainty, and feelings of therapeutic futility. Some reported psychological distress. Work and socializing were commonly disrupted. CONCLUSION Diagnostic uncertainty, perceived limitations of testing, and treatment failures suggest needs for better approaches to evaluating and treating chronic cough. Special attention to identifying and addressing mental health issues appears warranted.
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Affiliation(s)
- Michael Weiner
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | | | - Tayler Gowan
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sean A Baird
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Paul Dexter
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA.,Eskenazi Health, Indianapolis, IN, USA
| | | | | | | | - Jacob Pell
- Indiana University, Indianapolis, IN, USA
| | | | - Tasneem Talib
- Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University, Indianapolis, IN, USA
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Kaulamo JT, Lätti AM, Koskela HO. Healthcare-Seeking Behaviour Due to Cough in Finnish Elderly: Too Much and Too Little. Lung 2023; 201:37-46. [PMID: 36700959 PMCID: PMC9879231 DOI: 10.1007/s00408-023-00595-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Cough-related healthcare-seeking has not been studied specifically in the elderly, although chronic cough is most prevalent among them. We studied the frequencies and predictors of any (≥ 1) and repeated (≥ 3) doctor's visits due to any cough episode during the past year, and due to the current cough episode. METHODS This was a cross-sectional email survey among a Finnish community-based elderly population. Participants with current cough and age ≥ 64 years were included in the analyses (n = 1109). RESULTS The proportions of participants with ≥ 1 and ≥ 3 cough-related doctor's visits during the past year were 25.9% and 7.1%, respectively. Repeated visitors accounted for 55.9% of the visits during the past year. These visits first increased with cough duration but decreased after 5 years. In the multivariate analysis, bronchiectasis [aOR 3.22 (CI95% 1.08-9.58)], asthma [2.62 (1.56-4.40)], chronic sputum production [1.61 (0.94-2.76)], low self-assessed health status [1.40 (1.04-1.88)] and Leicester Cough Questionnaire total score [1.34 per tertile (1.10-1.62)] predicted repeated cough-related doctor's visits during the past year. The proportions of ≥ 1 and ≥ 3 doctor's visits due to current cough were 31.8% and 15.5%, respectively. Among participants with current chronic cough, 60.1% had not visited a doctor. CONCLUSION A minority of participants accounted for most of the cough-related doctor's visits during the past year, whereas most participants with chronic cough had never sought medical help for it. The heavy healthcare users were not those with the longest cough episodes. Repeated visitors due to cough were characterised by chronic phlegmy respiratory conditions, and quality-of-life impairment.
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Affiliation(s)
- Johanna Tuulikki Kaulamo
- School of Medicine, Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland. .,Mehiläinen Terveyspalvelut Oy, Healthcare Services for Prisoners, Kuopio, Finland.
| | - Anne Marika Lätti
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Olavi Koskela
- School of Medicine, Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.,Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
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Donaldson AM. Upper Airway Cough Syndrome. Otolaryngol Clin North Am 2023; 56:147-155. [DOI: 10.1016/j.otc.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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80
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Canadian Health Care Professionals' Familiarity with Chronic Cough Guidelines and Experiences with Diagnosis and Management: A Cross-Sectional Survey. Lung 2023; 201:47-55. [PMID: 36808540 DOI: 10.1007/s00408-023-00604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/01/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Educational programs on chronic cough may improve patient care, but little is known about how Canadian physicians manage this common debilitating condition. We aimed to investigate Canadian physicians' perceptions, attitudes, and knowledge of chronic cough. METHODS We administered a 10-min anonymous, online, cross-sectional survey to 3321 Canadian physicians in the Leger Opinion Panel who managed adult patients with chronic cough and had been in practice for > 2 years. RESULTS Between July 30 and September 22, 2021, 179 physicians (101 general practitioners [GPs] and 78 specialists [25 allergists, 28 respirologists, and 25 ear/nose/throat specialists]) completed the survey (response rate: 5.4%). In a month, GPs saw a mean of 27 patients with chronic cough, whereas specialists saw 46. About one-third of physicians appropriately identified a duration of > 8 weeks as the definition for chronic cough. Many physicians reported not using international chronic cough management guidelines. Patient referrals and care pathways varied considerably, and patients frequently experienced lost to follow-up. While physicians endorsed nasal and inhaled corticosteroids as common treatments for chronic cough, they rarely used other guideline-recommended treatments. Both GPs and specialists expressed high interest in education on chronic cough. CONCLUSION This survey of Canadian physicians demonstrates low uptake of recent advances in chronic cough diagnosis, disease categorization, and pharmacologic management. Canadian physicians also report unfamiliarity with guideline-recommended therapies, including centrally acting neuromodulators for refractory or unexplained chronic cough. This data highlights the need for educational programs and collaborative care models on chronic cough in primary and specialist care.
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Paladino FV, Accorsi TAD, Gueuvoghlanian-Silva BY, de Almeida MA, Barbosa JC, de Oliveira MA, Pedrotti CHS, Amicis KD, Lottenberg CL, Cordioli E. Mobile application-based oximetry: a potential toolfor appropriate referral of patients with respiratory symptoms examined via telemedicine. EINSTEIN-SAO PAULO 2023; 21:eAO0025. [PMID: 36629679 PMCID: PMC9785575 DOI: 10.31744/einstein_journal/2023ao0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To calculate the positive likelihood ratio to determine whether telemedicine is able to optimize referral to the emergency department. METHODS Unicenter study with 182 consecutive patients admitted to Hospital Israelita Albert Einstein due to respiratory symptoms. All patients were submitted to oxygen saturation measurement using the standard method Welch Allyn finger device vital sign monitor and a 2-minute evaluation (Binah.ai mobile application). The reproducibility of oxygen saturation measurements made with both methods was investigated using interclass correlation coefficients and analysis of dispersion. Bland-Altman plots were constructed and kappa concordance coefficients used to examine data normality. Accuracy was also estimated. RESULTS Oxygen saturation measurement differences between methods were ≤2% in more than 85% of cases. The mean difference (bias) between methods was near zero (0.835; Bland-Altman analysis). Oxygen saturation measurements made using the Binah.ai mobile application had an average ability to detect patients with altered oxygen saturation levels compared to the conventional method (ROC analysis). The positive likelihood ratio of the mobile application was 6.23. CONCLUSION Mobile applications for oxygen saturation measurement are accessible user-friendly tools with moderate impact on clinical telemedicine evaluation of patients with respiratory symptoms, and may optimize referral to the emergency department.
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Affiliation(s)
- Fernanda Vieira Paladino
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Marcia Aparecida de Almeida
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - João Carlos Barbosa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Miguel Almeida de Oliveira
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Claudio Luiz Lottenberg
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Dicpinigaitis PV, Birring SS, Blaiss M, McGarvey LP, Morice AH, Pavord ID, Satia I, Smith JA, La Rosa C, Li Q, Nguyen AM, Schelfhout J, Tzontcheva A, Muccino D. Demographic, clinical, and patient-reported outcome data from 2 global, phase 3 trials of chronic cough. Ann Allergy Asthma Immunol 2023; 130:60-66. [PMID: 35569802 DOI: 10.1016/j.anai.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The current characterization of patients with refractory or unexplained chronic cough (RCC and UCC, respectively) primarily stems from relatively small clinical studies. OBJECTIVE To report the baseline medical history and clinical characteristics of individuals with RCC or UCC who were enrolled in COUGH-1 and COUGH-2, 2 large, global, phase 3 trials of gefapixant, a P2 × 3-receptor antagonist. METHODS Adults with a chronic cough lasting for more than 1 year, diagnosis of RCC or UCC, and score greater than 40 mm on a 100-mm cough severity visual analog scale at both screening and baseline were eligible for enrollment. Demographics, medical history, and cough characteristics were collected at baseline. Cough-related measures included objective cough frequency, cough severity visual analog scale, Leicester Cough Questionnaire, and Hull Airway Reflux Questionnaire. The data were summarized using descriptive statistics. RESULTS Of 2044 participants, 75% were women; mean age was 58 years, and mean cough duration was approximately 11 years. Among all participants, 73% were previously diagnosed with asthma, gastroesophageal reflux disease, or upper airway cough syndrome. The mean Leicester Cough Questionnaire total score was 10.4, with domain scores reflecting impaired cough-specific quality of life across physical, psychological, and social domains. The mean Hull Airway Reflux Questionnaire score was 39.6, with some of the most burdensome reported items being consistent with features of cough-reflex hypersensitivity. Participant characteristics and cough burden were comparable across geographic regions. CONCLUSION Participants with RCC or UCC had characteristics consistent with published demographics associated with chronic cough. These data reflect a global population with burdensome cough of long duration and substantial impairment to quality of life. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers: COUGH-1, NCT03449134 (https://www. CLINICALTRIALS gov/ct2/show/NCT03449134); COUGH-2, NCT03449147 (https://clinicaltrials.gov/ct2/show/NCT03449147).
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Affiliation(s)
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Michael Blaiss
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lorcan P McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland
| | - Alyn H Morice
- Hull York Medical School, Cottingham, United Kingdom
| | - Ian D Pavord
- Oxford National Institute for Health Research (NIHR) Respiratory Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jaclyn A Smith
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester & Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | | | - Qing Li
- Merck & Co, Inc, Kenilworth, New Jersey
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Chronic cough comes of age. Ann Allergy Asthma Immunol 2023; 130:4-5. [PMID: 36596612 DOI: 10.1016/j.anai.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 01/03/2023]
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Zou M, Zhang W, Xu Y, Zhu Y. Relationship Between COPD and GERD: A Bibliometrics Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:3045-3059. [PMID: 36510485 PMCID: PMC9738194 DOI: 10.2147/copd.s391878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose A growing body of evidence links chronic obstructive pulmonary disease (COPD) to gastroesophageal reflux disease (GERD). In spite of the lack of understanding of the specific cause-effect relationship between COPD and GERD, GERD has been shown to be a significant predictor of acute exacerbations of COPD. In this study, we examined the evolution of the relationship between COPD and GERD over the past decades and provided valuable insights into this topic. Methods The Web of Science Core Collection (WoSCC) was searched since its inception until 19 August 2022 to obtain publications related to COPD and GERD. The data was analyzed in Microsoft Excel (version 2021), HisCite (version 2.1), Scimago Graphica (version 1.0.23), VOSviewer (1.6.17), and CiteSpace (version 5.8.R3). Results We extracted 545 documents from the WoSCC database. Since 2002, there have been rapid increases in publications. Among countries and institutions, the United States and the University of Manchester were most prolific. The most cited journal was Chest, while Respiratory Medicine had the most publications. Among 2870 related authors, Hasenfuss, Gerd, Lange, Peter, and Martinez, Gerd were the top 3 contributing authors in this field. Aside from "gastroesophageal reflux disease" and "chronic obstructive pulmonary disease", the terms "quality of life", "cough", and "inflammation" were frequently occurred in the title and abstract of articles. Keywords co-occurrence overlay visualization indicated that "refractory chronic cough" was hot topics in recent years. Conclusion Research on COPD and GERD has flourished, and its content topics have become more in-depth over time. In the future, this hot topic deserves more attention.
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Affiliation(s)
- Menglong Zou
- Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Wei Zhang
- Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Yin Xu
- Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Ying Zhu
- Department of Gastroenterology, The First Hospital of Hunan University of Chinese Medicine, Changsha, People’s Republic of China,Correspondence: Ying Zhu; Yin Xu, The First Hospital of Hunan University of Chinese Medicine, No. 95, Shaoshan Middle Road, Changsha, Hunan, People’s Republic of China, Tel +86-731-85600700, Email ;
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85
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Schelfhout J, Nguyen AM, Birring SS, Bacci ED, Vernon M, Muccino DR, La Rosa C, Smith JA. Validation and Meaningful Change Thresholds for an Objective Cough Frequency Measurement in Chronic Cough. Lung 2022; 200:717-724. [PMID: 36348054 PMCID: PMC9675653 DOI: 10.1007/s00408-022-00587-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Objective cough frequency is used to assess efficacy of chronic cough (CC) treatments. The objective of this study was to explore the relationship between objective cough frequency and cough-specific patient-reported outcomes (PROs) and estimate a clinically meaningful change threshold (MCT) for objective cough frequency. METHODS Data collected in a phase 2b study in participants with refractory or unexplained CC were used to investigate the relationship between 24-h cough frequency (measured using an ambulatory cough monitor) and cough-specific PROs (i.e., cough severity visual analog scale, cough severity diary, Leicester Cough Questionnaire). Convergent validity was assessed using Spearman ρ. An MCT for 24-h cough frequency was estimated using the patient global impression of change (PGIC) scale as an anchor. RESULTS Correlations between 24-h cough frequency and cough-specific PROs at baseline, Week 4, and Week 12 were significant (P < 0.0001) but low to moderate in strength (ρ = 0.30-0.58). Participants categorized as very much improved/much improved (i.e., PGIC of 1 or 2) or minimally improved (i.e., PGIC of 3) had mean 24-h cough frequency reductions of 55% and 30%, respectively. Receiver operating characteristic curve analysis suggested that a 24-h cough frequency reduction of 38% optimizes sensitivity and specificity for predicting a PGIC score of 1-3. CONCLUSION Objective 24-h cough frequency is significantly associated with cough-specific PROs, but cough frequency and PROs most likely capture distinct aspects of CC. A ≥ 30% reduction in 24-h cough frequency is a reasonable MCT to define treatment response in CC clinical trials.
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Affiliation(s)
| | | | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | | | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, 2nd Floor Education and Research Centre, University of Manchester and Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
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86
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Diab N, Patel M, O'Byrne P, Satia I. Narrative Review of the Mechanisms and Treatment of Cough in Asthma, Cough Variant Asthma, and Non-asthmatic Eosinophilic Bronchitis. Lung 2022; 200:707-716. [PMID: 36227349 DOI: 10.1007/s00408-022-00575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022]
Abstract
Chronic cough is a debilitating condition affecting 10-12% of the general population and is one of the leading causes for referral to secondary care. Many conditions have been associated with chronic cough, including asthma, gastro-esophageal reflux disease and upper airways cough syndrome. Inflammatory airway conditions including cough variant asthma (CVA) and non-asthmatic eosinophilic bronchitis (NAEB) contribute to a significant proportion of presentations with chronic cough, with differing diagnostic criteria and different responses to commonly used asthma therapy for their respective diagnoses. Mechanistic studies in both animal models and humans have identified increased neuronal sensitivity and subsequent central sensitization. These mechanisms include inflammatory-mediated nociceptor sensitization and alterations of afferent nerve terminal excitability, phenotypic changes in the vagal afferent neurons over time, and central neuroplasticity resulting from increased synaptic signalling from peripheral afferents. The aim of this review is to discuss the mechanisms, neurophysiology, and management approaches currently available for patients presenting with chronic cough with underlying asthma, CVA, and NAEB and to shed a light on areas of further research required to elucidate the mechanisms of cough in this patient population.
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Affiliation(s)
- Nermin Diab
- Department of Medicine, McMaster University, Hamilton, ON, Canada. .,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada. .,Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Matthew Patel
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul O'Byrne
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Imran Satia
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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87
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Satia I, Mayhew AJ, Sohel N, Kurmi O, Killian KJ, O’Byrne PM, Raina P. Impact of productive and dry chronic cough on mortality in the Canadian Longitudinal Study on Aging (CLSA). J Thorac Dis 2022; 14:5087-5096. [PMID: 36647475 PMCID: PMC9840029 DOI: 10.21037/jtd-22-1306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Background Chronic cough is a common troublesome condition and accounts for a high burden on quality of life. Previous data investigating the mortality associated with chronic cough has been derived in patients with chronic bronchitis. No data exists on chronic dry cough. Therefore, we investigated if chronic dry and productive cough is independently associated with increased mortality. Methods The Canadian Longitudinal Study on Ageing (CLSA) is a prospective, nationally generalizable, stratified random sample of adults aged 45-85 years at baseline recruited between 2011-2015 and followed up three years later. Chronic cough was identified based on a self-reported daily cough in the last 12 months. Deaths were confirmed by the Ministry of Health and/or completion of descendent questionnaire by a family member. Models were investigated for dry and productive chronic cough and was adjusted for age, sex, smoking, body mass index (BMI), and respiratory diseases. Results Of the 30,016 participants, 4,783 (15.9%) reported chronic cough at baseline; 2,724 (57%) had a dry cough, and 2,059 (43%) had productive chronic cough. There was a total of 561 deaths between baseline and follow-up-1 (3 years later). There was a 49% higher risk of death in participants with chronic productive cough {adjusted odds ratio (aOR) 1.49 [95% confidence intervals (CI): 1.08-2.07]}, but not dry chronic cough [aOR 0.85 (0.60-1.20)]. The effects of chronic productive cough on mortality were persistent in those with no airflow obstruction [chronic productive cough aOR 1.90 (1.09-3.31)]. Conclusions Chronic productive cough is associated with a higher risk of death, while chronic dry cough has no impact on mortality risk of death in middle-aged and older adults. This highlights the importance of careful evaluation of patients with chronic cough.
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Affiliation(s)
- Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra J. Mayhew
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada
| | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada
| | - Om Kurmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Kieran J. Killian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul M. O’Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
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Pan Y, Li J, Wang X, Zhang J, Zhang C, Liu Z. Prognosis of patients with laryngeal contact granuloma: Development and validation of RCGSG score. Laryngoscope Investig Otolaryngol 2022; 7:1973-1978. [PMID: 36544923 PMCID: PMC9764766 DOI: 10.1002/lio2.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Objective This study aimed to develop an objective and simple score for predicting the prognosis of patients with laryngeal contact granuloma (LCG) treated with local glucocorticoid injection combined with oral proton pump inhibitor (GI + PPI). Methods Cox regression analysis was used to analyze the effect of baseline variables on the prognosis of 507 patients with LCG treated with GI + PPI. An easy-to-apply RCGSG (Reflus, Cough, Gender, and Surgery in GI + PPI therapy) score was developed based on the independent risk factors selected by univariate and multivariate Cox regression analyses. The score was internally validated by receiver-operating characteristic curve, calibration curve, and decision curve analysis. Results After univariate and multivariate analyses, male gender (hazard ratio [HR] 0.546, p < .001), laryngopharyngeal reflux (HR 0.702, p = .001), chronic cough (HR 0.709, p = .001), and history of surgical resection (HR 0.433, p < .001) were found to be the independent risk factors affecting the prognosis of LCG. According to the score, the median cure time was 3 months (95% confidence interval [CI] 2.81-3.19) in the low-risk group, 4 months (95% CI 3.74-4.26) in the moderate-risk group, and 5 months (95% CI 4.76-5.24) in the high-risk group. The bootstrap method was used to plot calibration curves for internal validation. Conclusion The RCGSG score, developed based on laryngopharyngeal reflux, chronic cough, gender, and surgical resection history, has been internally verified to be a good predictor of the prognosis of patients with LCG receiving GI + PPI treatment. Level of evidence Level 4.
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Affiliation(s)
- Yufei Pan
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Jinrang Li
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Xiaoyu Wang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Jinhong Zhang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Chun Zhang
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
| | - Zhi Liu
- Department of Otolaryngology – Head and Neck SurgeryThe Sixth Medical Center of PLA General Hospital of BeijingBeijingChina
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Arai Y, Okuyama K, Onishi Y, Schelfhout J, Tokita S, Kubo T. Clinical characteristics and drug utilisation patterns in patients with chronic cough: a retrospective cohort study using a Japanese claims database. BMC Pulm Med 2022; 22:429. [PMID: 36411418 PMCID: PMC9677640 DOI: 10.1186/s12890-022-02180-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although unmet medical needs for better care of patients with chronic cough exist in Japan, epidemiological information about these patients and their treatments is very limited. OBJECTIVES To describe patient characteristics, underlying cough-related diseases and drug utilisation patterns in patients with chronic cough, and their changes over time. METHODS This large retrospective claims database study enrolled subjects with chronic cough, identified either by a specific diagnostic cough code for chronic cough (Population 1) or by multiple cough-related diagnostic codes spanning > 8 weeks (Population 2). Within Population 2, patients with each of the three most frequent diagnostic cough codes were analysed as subgroups. Patient characteristics, underlying cough-related diseases and utilisation patterns for drugs used for cough were documented at the index date, during the 6-month pre-index period and during the 12-month post-index period. RESULTS 6,038 subjects were enrolled in the cohort (Population 1: N = 3,500; Population 2: N = 2,538). The mean age was 43.7 ± 12.2 years and 61.8% were women. The largest cough diagnosis subgroups in Population 2 were 'other coughs' (N = 1,444), 'cough-variant asthma' (N = 1,026) and 'atopic/allergic cough' (N = 105). At the index date, the most frequent underlying cough-related diseases were allergic rhinitis/nasal inflammation (N = 3,132; 51.9%), asthma (N = 2,517; 41.7%) and gastro-esophageal reflux disease (N = 829; 13.7%). At the index date, 4,860 participants (80.5%) were prescribed at least one cough-related treatment. 194 participants (4.0% of medication users) were prescribed central antitussives alone, principally in Population 1, and 2,331 (48.0%) were prescribed expectorants. Other frequently prescribed medications were antiallergic drugs (N = 2,588; 53.3%), antimicrobials (N = 1,627; 34.4%) and inhaled corticosteroids with long-acting beta-agonists (N = 1,404; 28.9%). Over time, cough diagnoses tended to be lost, with only 470 participants in Population 1 retaining a diagnostic code for chronic cough one year later. The frequency of underlying cough-related diseases was stable over time. CONCLUSIONS Patients in this cohort with chronic cough are most frequently identified by a diagnostic cough code for chronic cough, followed by codes for other coughs, cough-variant asthma and atopic cough. Chronic cough frequently presents with an underlying cough-related disease, most frequently allergic rhinitis/nasal inflammation, asthma or GERD. Medication prescription for the underlying cough-related diseases was generally appropriate.
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Affiliation(s)
- Yoko Arai
- grid.473495.80000 0004 1763 6400MSD K.K, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667 Japan
| | - Kotoba Okuyama
- grid.473495.80000 0004 1763 6400MSD K.K, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667 Japan
| | | | | | - Shigeru Tokita
- grid.473495.80000 0004 1763 6400MSD K.K, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667 Japan
| | - Takekazu Kubo
- grid.473495.80000 0004 1763 6400MSD K.K, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667 Japan
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Guilleminault L, Chazelas P, Melloni B, Magdelaine C, Villeneuve T, Brouquières D, Lia AS, Magy L. Repeat Expansions of RFC1 in Refractory Chronic Cough: A Missing Piece of the Puzzle? Chest 2022; 163:911-915. [PMID: 36403641 DOI: 10.1016/j.chest.2022.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Laurent Guilleminault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, Toulouse, France; Department of Respiratory Medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France.
| | - Pauline Chazelas
- Service de Biochimie et Génétique Moléculaire, CHU Limoges, Limoges, France; NeurIT-UR20218, Université de Limoges, Limoges, France
| | - Boris Melloni
- Department of Respiratory Diseases, CHU Limoges, Dupuytren 2, Limoges, France
| | | | - Thomas Villeneuve
- Department of Respiratory Medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Danielle Brouquières
- Department of Respiratory Medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France
| | - Anne-Sophie Lia
- Service de Biochimie et Génétique Moléculaire, CHU Limoges, Limoges, France; NeurIT-UR20218, Université de Limoges, Limoges, France; Service de Bioinformatique-CHU Limoges, Limoges, France
| | - Laurent Magy
- Service de Biochimie et Génétique Moléculaire, CHU Limoges, Limoges, France; NeurIT-UR20218, Université de Limoges, Limoges, France; Service et Laboratoire de Neurologie, Centre de Référence Neuropathies Périphériques Rares, NNerf, CHU Limoges, Limoges, France
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91
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Volkmann ER, Kreuter M, Hoffmann-Vold AM, Wijsenbeek M, Smith V, Khanna D, Denton CP, Wuyts W, Miede C, Alves M, Sambevski S, Allanore Y. Dyspnoea and cough in patients with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial. Rheumatology (Oxford) 2022; 61:4397-4408. [PMID: 35150246 PMCID: PMC9629379 DOI: 10.1093/rheumatology/keac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of these analyses was to investigate the rate of decline in forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (SSc-ILD) with and without cough or dyspnoea in the SENSCIS trial. METHODS Patients in the SENSCIS trial were randomized to receive nintedanib or placebo. Subgroups with and without cough or dyspnoea at baseline were defined by responses to the St George's Respiratory Questionnaire. RESULTS At baseline, 114/575 patients (19.8%) did not have cough and 172/574 patients (30.0%) did not have dyspnoea. In the placebo group, the rate of FVC decline over 52 weeks was similar in patients with and without cough (-95.6 and -83.4 mL/year, respectively) or dyspnoea (-95.8 and -87.7 mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough [difference: 74.4 (95% CI -11.1, 159.8) vs 31.5 (-11.1, 74.1)] and without than with dyspnoea [79.8 (9.8, 149.7) vs 25.7 (-19.9, 71.3)], but interaction P-values did not indicate heterogeneity in the treatment effect between these subgroups (P = 0.38 and P = 0.20, respectively). CONCLUSION In the placebo group of the SENSCIS trial, the rate of FVC decline was similar irrespective of the presence of cough or dyspnoea at baseline. The effect of nintedanib on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough or dyspnoea at baseline, but no statistically significant heterogeneity was observed between the subgroups. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02597933.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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92
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Yu CJ, Song WJ, Kang SH. The disease burden and quality of life of chronic cough patients in South Korea and Taiwan. World Allergy Organ J 2022; 15:100681. [PMID: 36119656 PMCID: PMC9463600 DOI: 10.1016/j.waojou.2022.100681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Chronic cough (CC) is a common condition, but the burden of CC in general populations remains largely unknown. This study aims to investigate the disease prevalence and burden among community-based CC patients in South Korea and Taiwan, using structured tools. Methods A population-based cross-sectional study uses data from the 2020 South Korea and Taiwan National Health and Wellness Survey (NHWS) as well as a CC survey conducted between January–February 2020 and March–April 2020, respectively. Health outcome measures included health-related quality of life (HRQoL), health state utilities, work productivity and activity impairment (WPAI), and measurement of depression, anxiety, and insomnia among CC patients. Results The weighted lifetime and 12-month prevalence of CC was 6.20% and 4.34% in South Korea, and 8.27% and 5.55% in Taiwan. Compared to matched non-CC controls, CC patients reported poorer HRQoL (SF-12v2) in terms of physical component summary (PCS) score (South Korea: 47.69 ± 7.68 vs. 50.08 ± 7.29; Taiwan: 48.58 ± 7.15 vs. 50.50 ± 7.30) and mental component summary (MCS) score (44.15 ± 8.85 vs. 46.28 ± 8.50; 42.44 ± 7.78 vs. 44.60 ± 8.08), health state utilities EQ-5D index (0.73 ± 0.23 vs. 0.82 ± 0.16; 0.82 ± 0.13 vs. 0.86 ± 0.14), and more visits to healthcare professionals (7.80 vs. 4.61; 6.09 vs. 4.20) (p < 0.05). In terms of WPAI, CC patients reported higher impairments in presenteeism (32.8% vs. 21.0%; 25.9% vs. 19.4%), total work productivity (36.2% vs. 22.3%; 27.7% vs. 20.6%), and total activity (34.2% vs. 23.2%; 27.7% vs. 20.3%) than non-CC controls (p < 0.001). CC patients in South Korea and Taiwan experienced anxiety, depression, and insomnia more than non-CC controls. Poorer health outcomes were associated with the severity of CC. Patients with severe CC (visual analogue scale [VAS]>4) in both nations reported lower PCS score (45.80 vs. 49.48; 47.41 vs. 49.22) and higher absenteeism (8.5% vs. 3.6%; 5.5% vs. 1.8%) than patients with mild CC (VAS≤4) (p < 0.05). Conclusions The findings revealed that the disease burden of CC in general populations of South Korea and Taiwan is considerable with a negative impact on the overall quality of life, social and work life, and psychological comorbidities and is significantly associated with increased severity of the CC. There is an unmet need for further treatment interventions for CC patients to relieve the burden of CC in both nations.
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Affiliation(s)
- Chong-Jen Yu
- Department of Internal Medicine, and Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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93
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A 65-Year-Old Woman With Intractable Cough. Chest 2022; 162:e123-e126. [DOI: 10.1016/j.chest.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
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94
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Prenner B, Topp R, Beltyukova S, Fox C. Referrals, Etiology, Prevalence, Symptoms and Treatments of Chronic Cough: A Survey of Allergy Specialists. Ann Allergy Asthma Immunol 2022; 129:731-736. [PMID: 36041686 DOI: 10.1016/j.anai.2022.08.993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Chronic cough (CC) affects 11% of the U.S. adult population and these patients experience persistent symptoms despite adherence to recommended treatment protocols. Further research is needed to identify effective therapies to treat CC. OBJECTIVE The purpose of this study was to describe the referral sources, etiology, prevalence, symptoms, and treatments for patients diagnosed with CC who present to allergy specialists (AS). METHODS An online survey was administered to 177 allergy specialists (AS). The survey queried each AS experiences with CC patients, including the prevalence of chronic cough, source of referrals for chronic cough patients, as well as perceived efficacy of treatments. RESULTS 103 (58%) AS reported that the CC patients they treated were primarily female (58.26%), and Caucasian (65.69%). Family physicians, nurse practitioners, physician assistants and primary care internists were the most common source of referrals of CC patients to AS. 20% of the respondents reported a complete resolution of the symptoms for more than 75% of their CC patients. The top four "very common complaints" reported by CC patients were social embarrassment, loss of sleep, decreased quality of life, and sleep disruption. The top four most frequent treatments prescribed for CC were anti-reflux treatments, inhaled corticosteroids (ICS) alone or in combination with long acting beta-agonist (LABA), short acting bronchodilators, and first generation antihistamines. None of the therapies were rated "very effective" in greater than 50% of the CC patients. CONCLUSION The available treatments for CC do not effectively resolve the symptoms of this condition and additional treatments need to be developed.
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Affiliation(s)
- Bruce Prenner
- Division of Allergy, Immunology and Rheumatology, University of California San Diego School of Medicine, La Jolla, California
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95
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Smith JA, Kitt MM, Bell A, Noulin N, Tzontcheva A, Seng MM, Lu S. Treatment with the P2X3-Receptor Antagonist Gefapixant for Acute Cough in Induced Viral Upper Respiratory Tract Infection: A Phase 2a, Randomized, Placebo-Controlled Trial. Pulm Ther 2022; 8:297-310. [PMID: 35969360 PMCID: PMC9458823 DOI: 10.1007/s41030-022-00193-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Available therapies for acute cough, a condition frequently caused by a viral upper respiratory tract infection (URTI), have shown limited evidence of efficacy. Gefapixant, a P2X3-receptor antagonist, has demonstrated efficacy and safety in studies of the treatment of refractory or unexplained chronic cough, but its efficacy for treating acute cough has not been previously studied. METHODS This was a phase 2a, randomized, double-blind, placebo-controlled, parallel-group, pilot study. Healthy volunteers were randomized 1:1 to receive twice-daily gefapixant 45 mg or placebo and inoculated with human rhinovirus 16 to induce URTI and cough. Participants were observed while quarantined for 7 days after the start of treatment. The primary endpoint was awake cough frequency on day 3, which was objectively measured with a cough-recording device. Secondary endpoints included change from baseline to day 3 in subjective cough severity measures (cough severity visual analog scale, Cough Severity Diary) and cough-specific quality of life (Leicester Cough Questionnaire-acute). RESULTS Of the 46 participants who met inclusion criteria [mean (standard deviation, SD) age, 24.6 (6.5) years; females, n = 8], 40 completed the study (gefapixant, n = 21; placebo, n = 19). There was no significant difference in awake cough frequency on day 3 between the gefapixant and placebo groups [least squares means, 2.4 versus 2.7 coughs per hour, respectively; mean difference (95% confidence interval, CI), -0.3 (-2.3, 1.7); P = 0.75]. There were no significant between-group differences for any of the secondary endpoints. Peak cough frequency was low and occurred later in the study than expected (days 4-5). The safety profile was consistent with that of previous studies of gefapixant. CONCLUSION Compared with placebo, gefapixant did not reduce the frequency or severity of acute cough secondary to induced URTI. Induced viral URTI produced mild symptoms, including lower cough frequency than observed in previous studies of patients selected for acute cough associated with naturally occurring URTI. TRIAL REGISTRATION ClinicalTrials.gov, NCT03569033; EudraCT, 2017-000472-28; protocol number, MK-7264-013.
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Affiliation(s)
- Jaclyn A Smith
- Division of Infection, Immunity & Respiratory Medicine, 2nd Floor Education & Research Centre, University of Manchester, Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, M23 9LT, Manchester, UK.
| | | | - Alan Bell
- hVIVO, a subsidiary of Open Orphan Plc, London, UK
| | | | | | | | - Susan Lu
- Merck & Co., Inc., Rahway, NJ, USA
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96
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Holzinger F, Gehrke-Beck S, Krüger K. [Acute and chronic cough - differential diagnosis and treatment]. Dtsch Med Wochenschr 2022; 147:989-1001. [PMID: 35915885 DOI: 10.1055/a-1716-8101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Cough is a frequent reason for consultation in the general practitioner's office. Most of the time, the symptom is harmless and self-limiting, as in the case of a banal cold cough, for example - however, serious diseases such as malignancies can also be the cause. Evaluation is therefore not always easy. This article presents a targeted and appropriate approach and discusses which treatments are recommended and effective.Acute and chronic cough are differentiated according to the duration of symptoms (up to 8 weeks/longer than 8 weeks). The most common cause of acute cough is a self-limiting viral infection of the upper respiratory tract; the most important differential diagnosis is community-acquired pneumonia. If there are no defined warning signs (red flags), the history and clinical examination are sufficient to establish the diagnosis in the case of an acute cough; medication is not necessary. In the case of a chronic cough, a chest X-ray is usually ordered and then further investigations are carried out in accordance with the most probable suspected diagnosis; probationary therapies are an important part of the workup. Coughs that are refractory to treatment or unexplained require individualised treatment (pharmacological, including off-label, non-pharmacological) and regular re-evaluation.
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97
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Wright ML, Fujiki RB, Lunga T, Thibeault SL. Patient-Reported Qualitative Analysis of Chronic Refractory Cough. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1719-1725. [PMID: 35512298 DOI: 10.1044/2022_ajslp-21-00364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Chronic cough has been shown to be associated with adverse effects on quality of life. There is a paucity of research characterizing quality-of-life factors associated with chronic refractory cough (CRC), a cough persisting > 8 weeks despite evaluation and treatment of possible etiologies. The purpose of this study was to elucidate the features of CRC from the patient's perspective, including presenting symptoms, past treatment methods, and quality-of-life factors. METHOD Prospective semistructured interviews were conducted, recorded, and transcribed for 20 patients diagnosed with CRC. Exclusion criteria included lung disease, smoking history, laryngeal cancer, and neurological disease. Grounded theory analysis was completed on transcribed interviews. RESULTS Eighteen participants were women. Mean participant age was 53.5 years (SD = 1.41), and average cough duration was 52 months (SD = 71.6 months). Responses to 30 open-ended questions revealed four dominant themes with 24 subthemes. CONCLUSIONS CRC affects patient quality of life. Understanding patient perspective on CRC diagnosis and treatment helps providers better understand the physical and emotional toll CRC takes on patients. Findings suggest that providers should spend more time counseling patients regarding their treatment and diagnosis, as patients with CRC do not always fully understand their diagnosis and resort to self-blame.
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Affiliation(s)
- Miranda L Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Robert Brinton Fujiki
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
| | - Tadeas Lunga
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
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98
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Cough Presentation and Cough-Related Healthcare Utilization in Tertiary Care: Analysis of Routinely Collected Academic Institutional Database. Lung 2022; 200:431-439. [PMID: 35810219 DOI: 10.1007/s00408-022-00555-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Routinely collected data (RCD) from electronic health records (EHR) are useful for studying disease epidemiology in the real world. We examined cough presentation and cough-related healthcare utilization using an academic institutional EHR database in Korea. METHODS In this retrospective cohort study, patients with subacute (3-8 weeks) or chronic cough (> 8 weeks in duration) referred to allergy and asthma clinics were studied. Cases were identified using the search term "cough" or "coughing," which is the chief complaint, in the data fields. Structured data, including demographics, medical history, symptoms, and diagnostic tests, were analyzed. Healthcare utilization was assessed for drug prescriptions, additional tests, or outpatient visits for 1 year. RESULTS Cough was the chief complaint in 13,223 cases (46.7%) among 28,312 new referrals for 8 years. A total of 3810 subacute and 7150 chronic cough patients were analyzed. The common demographic profile was middle-aged woman (mean age 52.1 years), reported in 63% of the cases. Cough was frequently accompanied by anterior nasal (about 50%), lower airway (30%), or acid reflux disease symptoms (20%), and by test abnormalities in chest X-rays (14%), spirometry (23%), or T2 inflammation markers (40%). Chronic cough patients frequently required additional tests (chest CT scan: 24%), drug prescriptions (codeine: 21.5% and oral steroids: 9.9%), and long-term healthcare utilization (16.0%) for 1 year. CONCLUSIONS Cough is a common chief complaint at allergy and asthma clinics, but the clinical presentation may be heterogeneous. Further studies are needed to understand long-term outcomes and reduce the disease burden.
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99
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Chung KF, McGarvey L, Song WJ, Chang AB, Lai K, Canning BJ, Birring SS, Smith JA, Mazzone SB. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers 2022; 8:45. [PMID: 35773287 PMCID: PMC9244241 DOI: 10.1038/s41572-022-00370-w] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, London, UK
| | - Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland's University of Technology and Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Division of Child Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, University of Melbourne, Victoria, Australia.
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100
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Yang S, Hincapie-Castillo JM, Ke X, Schelfhout J, Ding H, Sher MR, Zhou L, Chang CY, Wilson DL, Lo-Ciganic WH. Evaluation of Cough Medication Use Patterns in Ambulatory Care Settings in the United States: 2003-2018. J Clin Med 2022; 11:jcm11133671. [PMID: 35806956 PMCID: PMC9267927 DOI: 10.3390/jcm11133671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Using 2003−2018 National Ambulatory Medical Care Survey data for office-based visits and 2003−2018 National Hospital Ambulatory Medical Care Survey data for emergency department (ED) visits, we conducted cross-sectional analyses to examine cough medication (CM) use trends in the United States (US) ambulatory care settings. We included adult (≥18 years) patient visits with respiratory-infection-related or non-infection-related cough as reason-for-visit or diagnosis without malignant cancer or benign respiratory tumor diagnoses. Using multivariable logistic regressions, we examined opioid antitussive, benzonatate, dextromethorphan-containing antitussive, and gabapentinoid use trends. From 2003−2005 to 2015−2018, opioid antitussive use decreased in office-based visits (8.8% to 6.4%, Ptrend = 0.03) but remained stable in ED visits (6.3% to 5.9%, Ptrend = 0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. Benzonatate use more than tripled (office-based:1.6% to 4.8%; ED:1.5% to 8.0%; both Ptrend < 0.001). Dextromethorphan-containing antitussive use increased in ED visits (1.8% to 2.6%, Ptrend = 0.003) but stayed unchanged in office-based visits (3.8% to 2.7%; Ptrend = 0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006−2008 to 2.4% in 2015−2018, Ptrend < 0.001) but was negligible in ED visits. In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan-containing antitussive and gabapentinoid use remained low (<3%).
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Juan M. Hincapie-Castillo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Xuehua Ke
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | - Helen Ding
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | | | - Lili Zhou
- Global Patient Safety, BeiGene USA, Inc., San Mateo, CA 94403, USA;
| | - Ching-Yuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-6255
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