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Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024; 166:171-186. [PMID: 38508333 DOI: 10.1016/j.chest.2024.03.026] [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: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
TOPIC IMPORTANCE Laryngeal dysfunction as a cause of chronic refractory cough and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. REVIEW FINDINGS The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. SUMMARY Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of chronic refractory cough and dyspnea. Recognition of laryngeal hypersensitivity in the patient with chronic refractory cough can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology-Head & Neck Surgery & Voice Disorders Center, University of Utah, Salt Lake City, UT
| | - Michael J Morris
- Pulmonary & Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
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Robin T, Robin E, Le Boedec K. A systematic review and meta-analysis of prevalence of complications after tracheal stenting in dogs. J Vet Intern Med 2024; 38:2034-2044. [PMID: 38822531 DOI: 10.1111/jvim.17117] [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: 10/20/2023] [Accepted: 05/07/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Stenting has become popular to treat tracheal collapse in dogs, but complications might arise and negatively affect treatment outcome. OBJECTIVES Determine the overall prevalence of complications of tracheal stenting in dogs. METHODS A bibliographic search was performed of publications from 2000 to 2020. Studies were assessed for quality of evidence and measured prevalence of the 8 most commonly reported complications after tracheal stenting in dogs (stent fracture, stent migration, relapsing collapse, granuloma formation, tracheobronchial infections, and early, late, and clinically relevant late cough). Random effects meta-analyses were used to estimate pooled complications prevalence. RESULTS Fifteen studies met inclusion criteria. Cough (early: 99%; 95% confidence interval [95% CI]: 95%-100%, late: 75%; 95% CI: 63%-85%, and clinically relevant: 52%; 95% CI: 42%-61%), tracheobronchial infections (24%; 95% CI: 14%-35%), and granulomas (20%; 95% CI: 11%-30%) were common after tracheal stenting. Stent fractures (12%; 95% CI: 5%-20%), relapsing collapse (10%; 95% CI: 5%-15%), and stent migration (5%; 95% CI: 1%-9%) were less frequent. Significant heterogeneity among studies was identified for the estimated prevalence of stent fracture, granulomas, infections, and late cough. CONCLUSIONS AND CLINICAL IMPORTANCE Tracheal stenting in dogs is associated with a high risk of coughing and a moderate risk of tracheobronchial infections and granuloma formation. Because most complications will impact a dog's quality of life, owners must be informed that tracheal stenting is a second-line procedure that does not necessarily alleviate the need for medical treatment and frequent follow-up visits. Additional studies are warranted to identify the risk factors of these complications.
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Affiliation(s)
- Thibaud Robin
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia France, Paris, France
| | - Elisabeth Robin
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia France, Paris, France
| | - Kevin Le Boedec
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia France, Paris, France
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Dallal-York J, Troche MS. Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1394110. [PMID: 38933659 PMCID: PMC11199739 DOI: 10.3389/fresc.2024.1394110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.
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Affiliation(s)
- Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
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Sundar KM, Stark AC, Dicpinigaitis P. Chronic Cough and Obstructive Sleep Apnea. Sleep Med Clin 2024; 19:239-251. [PMID: 38692749 DOI: 10.1016/j.jsmc.2024.02.004] [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] [Indexed: 05/03/2024]
Abstract
Chronic cough, defined as a cough lasting more than 8 weeks, is a common medical condition occurring in 5% to 10% of the population. Its overlap with another highly prevalent disorder, obstructive sleep apnea (OSA), is therefore not surprising. The relationship between chronic cough and OSA extends beyond this overlap with higher prevalence of OSA in patients with chronic cough than in the general population. The use of continuous positive airway pressure can result in improvement in chronic cough although further studies are needed to understand which patients will experience benefit in their cough from the treatment of comorbid OSA.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary & Critical Care Medicine, 30 N, Mario Capecchi Drive, 2nd floor North, University of Utah, Salt Lake City, UT 84112, USA.
| | - Amanda Carole Stark
- Voice Disorders Center, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84106, USA
| | - Peter Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 1825 Eastchester Road, Bronx, NY 10461, USA
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Dunne OM, Martin SL, Sergeant GP, McAuley DF, O'Kane CM, Button B, McGarvey LP, Lundy FT. TRPV2 modulates mechanically Induced ATP Release from Human bronchial epithelial cells. Respir Res 2024; 25:188. [PMID: 38678280 PMCID: PMC11056070 DOI: 10.1186/s12931-024-02807-0] [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: 11/04/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
Repetitive bouts of coughing expose the large airways to significant cycles of shear stress. This leads to the release of alarmins and the tussive agent adenosine triphosphate (ATP) which may be modulated by the activity of ion channels present in the human airway. This study aimed to investigate the role of the transient receptor potential subfamily vanilloid member 2 (TRPV2) channel in mechanically induced ATP release from primary bronchial epithelial cells (PBECs).PBECs were obtained from individuals undergoing bronchoscopy. They were cultured in vitro and exposed to mechanical stress in the form of compressive and fluid shear stress (CFSS) or fluid shear stress (FSS) alone at various intensities. ATP release was measured using a luciferin-luciferase assay. Functional TRPV2 protein expression in human PBECs was investigated by confocal calcium imaging. The role of TRPV2 inhibition on FSS-induced ATP release was investigated using the TRPV2 inhibitor tranilast or siRNA knockdown of TRPV2. TRPV2 protein expression in human lung tissue was also determined by immunohistochemistry.ATP release was significantly increased in PBECs subjected to CFSS compared with control (unstimulated) PBECs (N = 3, ***P < 0.001). PBECs expressed functional TRPV2 channels. TRPV2 protein was also detected in fixed human lung tissue. ATP release from FFS stimulated PBECs was decreased by the TRPV2 inhibitor tranilast (N = 3, **P < 0.01) (vehicle: 159 ± 17.49 nM, tranilast: 25.08 ± 5.1 nM) or by TRPV2 siRNA knockdown (N = 3, *P < 0.05) (vehicle: 197 ± 24.52 nM, siRNA: 119 ± 26.85 nM).In conclusion, TRPV2 is expressed in the human airway and modulates ATP release from mechanically stimulated PBECs.
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Affiliation(s)
- Orla M Dunne
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | | | - Gerard P Sergeant
- Smooth Muscle Research Centre, Dundalk Institute of Technology, Co. Louth, Dundalk, Ireland
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Cecilia M O'Kane
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Brian Button
- Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorcan P McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Zhang J, Wurzel DF, Perret JL, Lodge CJ, Walters EH, Dharmage SC. Chronic Bronchitis in Children and Adults: Definitions, Pathophysiology, Prevalence, Risk Factors, and Consequences. J Clin Med 2024; 13:2413. [PMID: 38673686 PMCID: PMC11051495 DOI: 10.3390/jcm13082413] [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: 03/05/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
The complex nature of chronic bronchitis (CB) and changing definitions have contributed to challenges in understanding its aetiology and burden. In children, CB is characterised by persistent airway inflammation often linked to bacterial infections and is therefore termed "protracted bacterial bronchitis" (PBB). Longitudinal studies suggest that CB in childhood persists into adulthood in a subgroup. It can also be associated with future chronic respiratory diseases including asthma, bronchiectasis, and chronic obstructive pulmonary disease (COPD). Adult CB is traditionally associated with smoking, occupational exposures, and lower socioeconomic status. The interplay between risk factors, childhood CB, adult CB, and other chronic respiratory diseases is intricate, requiring comprehensive longitudinal studies for a clearer understanding of the natural history of CB across the lifespan. Such longitudinal studies have been scarce to date given the logistic challenges of maintaining them over time. In this review, we summarise current evidence on the evolution of the definitions, pathophysiology, risk factors, and consequences of childhood and adulthood chronic bronchitis.
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Affiliation(s)
- Jingwen Zhang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
| | - Danielle F. Wurzel
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- Institute for Breathing and Sleep (IBAS), Melbourne, VIC 3084, Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
| | - E. Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
- School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053, Australia; (J.Z.); (D.F.W.); (J.L.P.); (C.J.L.); (E.H.W.)
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Cai W, Li M, Xu Y, Li M, Wang J, Zuo Y, Cao J. The effect of respiratory muscle training on children and adolescents with cystic fibrosis: a systematic review and meta-analysis. BMC Pediatr 2024; 24:252. [PMID: 38622583 PMCID: PMC11017573 DOI: 10.1186/s12887-024-04726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Cystic fibrosis is a chronic genetic disease that can affect the function of the respiratory system. Previous reviews of the effects of respiratory muscle training in people with cystic fibrosis are uncertain and do not consider the effect of age on disease progression. This systematic review aims to determine the effectiveness of respiratory muscle training in the clinical outcomes of children and adolescents with cystic fibrosis. METHODS Up to July 2023, electronic databases and clinical trial registries were searched. Controlled clinical trials comparing respiratory muscle training with sham intervention or no intervention in children and adolescents with cystic fibrosis. The primary outcomes were respiratory muscle strength, respiratory muscle endurance, lung function, and cough. Secondary outcomes included exercise capacity, quality of life and adverse events. Two review authors independently extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2. The certainty of the evidence was assessed according to the GRADE approach. Meta-analyses where possible; otherwise, take a qualitative approach. RESULTS Six studies with a total of 151 participants met the inclusion criteria for this review. Two of the six included studies were published in abstract form only, limiting the available information. Four studies were parallel studies and two were cross-over designs. There were significant differences in the methods and quality of the methodology included in the studies. The pooled data showed no difference in respiratory muscle strength, lung function, and exercise capacity between the treatment and control groups. However, subgroup analyses suggest that inspiratory muscle training is beneficial in increasing maximal inspiratory pressure, and qualitative analyses suggest that respiratory muscle training may benefit respiratory muscle endurance without any adverse effects. CONCLUSIONS This systematic review and meta-analysis indicate that although the level of evidence indicating the benefits of respiratory muscle training is low, its clinical significance suggests that we further study the methodological quality to determine the effectiveness of training. TRIAL REGISTRATION The protocol for this review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023441829.
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Affiliation(s)
- WenQian Cai
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Li
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - JiaNan Wang
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - YaHui Zuo
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - JinJin Cao
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Diab MS, Rodriguez-Villegas E. Feature evaluation of accelerometry signals for cough detection. Front Digit Health 2024; 6:1368574. [PMID: 38585283 PMCID: PMC10995234 DOI: 10.3389/fdgth.2024.1368574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Cough is a common symptom of multiple respiratory diseases, such as asthma and chronic obstructive pulmonary disorder. Various research works targeted cough detection as a means for continuous monitoring of these respiratory health conditions. This has been mainly achieved using sophisticated machine learning or deep learning algorithms fed with audio recordings. In this work, we explore the use of an alternative detection method, since audio can generate privacy and security concerns related to the use of always-on microphones. This study proposes the use of a non-contact tri-axial accelerometer for motion detection to differentiate between cough and non-cough events/movements. A total of 43 time-domain features were extracted from the acquired tri-axial accelerometry signals. These features were evaluated and ranked for their importance using six methods with adjustable conditions, resulting in a total of 11 feature rankings. The ranking methods included model-based feature importance algorithms, first principal component, leave-one-out, permutation, and recursive features elimination (RFE). The ranking results were further used in the feature selection of the top 10, 20, and 30 for use in cough detection. A total of 68 classification models using a simple logistic regression classifier are reported, using two approaches for data splitting: subject-record-split and leave-one-subject-out (LOSO). The best-performing model out of the 34 using subject-record-split obtained an accuracy of 92.20%, sensitivity of 90.87%, specificity of 93.52%, and F1 score of 92.09% using only 20 features selected by the RFE method. The best-performing model out of the 34 using LOSO obtained an accuracy of 89.57%, sensitivity of 85.71%, specificity of 93.43%, and F1 score of 88.72% using only 10 features selected by the RFE method. These results demonstrate the ability for future implementation of a motion-based wearable cough detector.
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Affiliation(s)
- Maha S. Diab
- Wearable Technologies Lab, Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
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Mir MJ, Childers JT, Wheeler-Hegland K. Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism. Mov Disord Clin Pract 2024; 11:265-275. [PMID: 38229245 DOI: 10.1002/mdc3.13965] [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: 03/07/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. OBJECTIVES We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. METHODS Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. RESULTS While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). CONCLUSIONS As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.
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Affiliation(s)
- Michela J Mir
- Breathing Research and Therapeutics Center, Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
- Brooks Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Justin T Childers
- College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, Florida, USA
- Upper Airway Dysfunction Lab, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
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McHenry KL. Airway Clearance Strategies and Secretion Management in Amyotrophic Lateral Sclerosis. Respir Care 2024; 69:227-237. [PMID: 37816542 PMCID: PMC10898456 DOI: 10.4187/respcare.11215] [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] [Indexed: 10/12/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare, neurodegenerative motor neuron disease that affects voluntary muscle movement. Often, difficulty in coughing, breathing, and swallowing are sequela associated with the condition, and the presence of bulbar muscle predominant weakness results in deleterious effects on airway clearance and secretion management. This narrative review will provide practical guidance for clinicians treating this population. Cough insufficiency in this population typically manifests as a prolonged, slow, weak cough effort that impedes the clearability of secretions and airway protection. Dystussia and dysphagia frequently occur simultaneously in bulbar dysfunction, subsequently impacting respiratory health. Measures of respiratory strength should be obtained and monitored every 3-6 months, preferably in a multidisciplinary clinic setting. Cough augmentation, whether manual or mechanical techniques, should be sought as early in the disease progression as possible to adequately control secretions in the proximal airways. This airway clearance strategy can aid in the prevention and treatment of respiratory tract infections (RTIs), which can pose a significant clinical hurdle to those with ALS. The use of mechanical insufflation-exsufflation may be complicated by severe bulbar dysfunction rendering this technique ineffective. Though peripheral airway clearance strategies, such as high-frequency chest-wall compression, have the advantage of being less impacted by bulbar dysfunction, it is only recommended this modality be used in conjunction with, versus in lieu of, proximal strategies. Salivary secretion management includes the use of anticholinergics, botulinum toxin, and radiation therapy depending on severity and desire for relief.
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Affiliation(s)
- Kristen L McHenry
- Boise State University, Department of Respiratory Care, Boise, Idaho.
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Kang J, Seo WJ, Kim JG, Moon JY, Kim DK, Kim JW, Jang SH, Kwon JW, Lee BJ, Koo HK. Sex-related disparities in cough-associated symptoms across different age groups. Ther Adv Respir Dis 2024; 18:17534666241252545. [PMID: 38780129 PMCID: PMC11119368 DOI: 10.1177/17534666241252545] [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: 10/03/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Sex-related disparities in the prevalence of chronic cough have been consistently reported globally, with varying male-to-female ratios. OBJECTIVES This study aimed to evaluate sex-related differences by comparing correlations between cough-related symptoms in males and females of different age groups. DESIGN Adult patients with chronic cough who completed the Leicester Cough Questionnaire (LCQ) were recruited from 16 respiratory centers. METHODS Correlation networks were constructed based on Spearman's correlation coefficients in males and females of various age groups. The distinct relationships of cough-related symptoms between subgroups were validated by an independent cohort. RESULTS A total of 255 patients were enrolled in this study (male-to-female ratio, 1:1.71). The following LCQ items were highly correlated: embarrassment and interference with daily work, anxiety, and interference with overall life enjoyment/feeling of being fed up, interference with daily work and overall life enjoyment, interference with overall life enjoyment and feeling of being fed up, and feeling of being fed up and annoyance to partner/family/friends. The patterns of these correlations between LCQ items varied in males and females of different ages. The strongest interrelationship was observed in male patients aged >50 years old, which was similar to those in the validation cohort. CONCLUSION The correlation patterns between cough-related symptoms vary significantly according to age and sex. Understanding the mechanisms underlying the development of cough-related symptoms may facilitate sex- and age-specific strategies for chronic cough.
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Affiliation(s)
- Jiyeon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Woo Jung Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jung Gon Kim
- Division of Rheumatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae-Woo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsanseo-gu, Goyang 10380, Republic of Korea
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Bali V, Schelfhout J, Sher MR, Tripathi Peters A, Patel GB, Mayorga M, Goss D, Romano C(D. Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis. Ther Adv Respir Dis 2024; 18:17534666241236025. [PMID: 38501735 PMCID: PMC10953008 DOI: 10.1177/17534666241236025] [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: 04/10/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals' lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies. OBJECTIVES The primary objectives of this study were to assess respondents' perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships. DESIGN Qualitative study. METHODS This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes. RESULTS A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0-24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents. CONCLUSION RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals' lived experiences may inform the development of RCC and UCC therapeutic strategies.
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Affiliation(s)
- Vishal Bali
- Center for Observational and Real-World Evidence, Merck & Co. Inc., 351 North Sumneytown Pike, North Wales, PA 19454, USA
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence, Merck & Co. Inc., Rahway, NJ, USA
| | | | | | - Gayatri B. Patel
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Diana Goss
- RTI Health Solutions, Research Triangle Park, NC, USA
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13
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Yu R, Okazaki T, Ren Y, Okuyama J, Ebihara S, Izumi SI. Effects of body postures on respiratory muscle force and coughing in healthy people. Respir Physiol Neurobiol 2024; 319:104181. [PMID: 37866524 DOI: 10.1016/j.resp.2023.104181] [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: 07/21/2023] [Revised: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
The respiratory muscle force determines the intensity of cough force. A greater cough force for cleaning the airways is essential for preventing and managing pneumonia. Body posture can affect the onset of aspiration pneumonia. However, the effects of body posture on the respiratory muscle and cough forces remain unclear. Thus, we aimed to explore the influence of the four body postures on respiratory muscle force, cough pressure, subjective ease of coughing, and pulmonary function in healthy individuals. Twenty healthy individuals were included in this study. Body postures were 0-degree supine, 30- and 60-degree semi-recumbent, and 90-degree sitting. The maximal inspiratory and expiratory pressures, maximal cough pressure, subjective ease of coughing, and pulmonary function, including peak expiratory flow, were evaluated. We set the measured values in the supine posture to 100% and showed the relative values. The 60-degree posture showed stronger inspiratory (125.1 ± 3.9%, mean ± standard error [SE]) and expiratory (116.4 ± 3.0%) muscle force, cough pressure, more subjective ease of coughing, and greater peak expiratory flow (113.4 ± 3.0%) than the supine posture. The sitting posture also showed greater inspiratory muscle force and peak expiratory flow than the supine posture. The correlation coefficient for the 60-degree posture showed that the maximal inspiratory pressure was moderately correlated with the maximal expiratory pressure (r = 0.512), cough pressure (r = 0.495), and peak expiratory flow (r = 0.558). The above findings suggest the advantage of keeping a 60-degree posture and avoiding the supine posture to generate a greater cough force in the prevention and management of pneumonia.
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Affiliation(s)
- Rui Yu
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuma Okazaki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Center for Dysphagia of Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Yuzhuo Ren
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Junko Okuyama
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Center for Dysphagia of Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shin-Ichi Izumi
- Center for Dysphagia of Tohoku University Hospital, Sendai, Miyagi, Japan; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Miyagi, Japan
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14
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Jakusova J, Brozmanova M. Methods of Cough Assessment and Objectivization. Physiol Res 2023; 72:687-700. [PMID: 38215057 PMCID: PMC10805254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/18/2023] [Indexed: 01/14/2024] Open
Abstract
Cough is one of the most important airway defensive reflexes aimed at removing foreign particles or endogenously produced materials from the airways and provides protection against aspiration. Generally considered, cough is a vital physiological defensive mechanism for lung health. However, in case of cough dysregulation this reflex can become pathological and leads to an adverse influence on daily life. Therefore, it is necessary to effectively evaluate the severity of cough for its diagnosis and treatment. There are subjective and objective methods for assessing cough. These methods should help describe the heterogeneity of cough phenotypes and may establish better treatment by monitoring response to nonpharmacological or pharmacological therapies. It is important to keep in mind that the clinical assessment of cough should include both tools that measure the amount and severity of the cough. The importance of a combined subjective and objective evaluation for a comprehensive assessment of cough has been advocated in the guidelines of the European Respiratory Society on cough evaluation. This review article provides an overview of subjective and objective methods for assessing and monitoring cough in children and adults comparing to animal models. Key words Cough frequency; Cough intensity; Cough reflex sensitivity; Cough monitors; Cough assessment.
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Affiliation(s)
- J Jakusova
- Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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15
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Xu W, He G, Shen D, Xu B, Jiang P, Liu F, Lou X, Guo L, Ma L. A noval pulmonary function evaluation method based on ResNet50 + SVR model and cough. Sci Rep 2023; 13:22065. [PMID: 38087014 PMCID: PMC10716123 DOI: 10.1038/s41598-023-49334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
Traditionally, the clinical evaluation of respiratory diseases was pulmonary function testing, which can be used for the detection of severity and prognosis through pulmonary function parameters. However, this method is limited by the complex process, which is impossible for patients to monitor daily. In order to evaluate pulmonary function parameters conveniently with less time and location restrictions, cough sound is the substitute parameter. In this paper, 371 cough sounds segments from 150 individuals were separated into 309 and 62 as the training and test samples. Short-time Fourier transform (STFT) was applied to transform cough sound into spectrogram, and ResNet50 model was used to extract 2048-dimensional features. Through support vector regression (SVR) model with biological attributes, the data were regressed with pulmonary function parameters, FEV1, FEV1%, FEV1/FVC, FVC, FVC%, and the performance of this models was evaluated with fivefold cross-validation. Combines with deep learning and machine learning technologies, the better results in the case of small samples were achieved. Using the coefficient of determination (R2), the ResNet50 + SVR model shows best performance in five basic pulmonary function parameters evaluation as FEV1(0.94), FEV1%(0.84), FEV1/FVC(0.68), FVC(0.92), and FVC%(0.72). This ResNet50 + SVR hybrid model shows excellent evaluation of pulmonary function parameters during coughing, making it possible to realize a simple and rapid evaluation for pneumonia patients. The technology implemented in this paper is beneficial in judge the patient's condition, realize early screening of respiratory diseases, evaluate postoperative disease changes and detect respiratory infectious diseases without time and location restrictions.
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Affiliation(s)
- Wenlong Xu
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | - Guoqiang He
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | - Dan Shen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bingqiao Xu
- College of Information Engineering, China Jiliang University, Hangzhou, China
| | | | - Feng Liu
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Xiaomin Lou
- Hangzhou Chest Hospital Affiliated, Zhejiang University Medical College, Hangzhou, China
| | - Lingling Guo
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, China.
| | - Li Ma
- Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
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16
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Aguilera LG, Gallart L, Ramos I, Duran X, Escolano F. Effects of midline laparotomy on cough strength: a prospective study measuring cough pressure. Minerva Anestesiol 2023; 89:1092-1098. [PMID: 38019173 DOI: 10.23736/s0375-9393.23.17519-5] [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] [Indexed: 11/30/2023]
Abstract
BACKGROUND Laparotomy is assumed to decrease cough strength due to three factors: abdominal muscle trauma, postoperative pain, and diaphragmatic dysfunction. However, the effect of trauma from laparotomy itself on strength (net of the other two factors) has not been measured to our knowledge. The aim of this study was to measure the effect of laparotomy on cough strength after first measuring the effect of epidural analgesia. METHODS In 11 patients scheduled for open midline laparotomy, cough pressure (PCOUGH), a proxy for strength, was measured with a rectal balloon at three moments: before the procedure, at baseline; before surgery, under epidural bupivacaine to T6; and postoperatively, under epidural bupivacaine to the same analgesic level (T6). Continuous variables were compared using the Wilcoxon signed-rank test. The repeatability of PCOUGH measurements was confirmed with the intraclass correlation coefficient (ICC). Pain on coughing, hand grip strength, and the Ramsay and modified Bromage scores were also recorded. RESULTS Median (interquartile range) PCOUGH decreased from a baseline of 103 (89-137) to 71 (56-116) cmH2O under presurgical epidural bupivacaine (P=0.003). Postoperative PCOUGH remained unchanged at 76 (46-85) cmH2O under epidural analgesia (P=0.131). The ICCs indicated excellent repeatability of the PCOUGH measurements (P<0.001). Pain on coughing was 0 to 1 in all subjects. Hand grip strength and the Ramsay and Bromage scores were unchanged. CONCLUSIONS Although thoracic epidural bupivacaine reduces cough strength as measured by PCOUGH, midline laparotomy does not further reduce strength in the presence of adequate epidural analgesia.
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Affiliation(s)
- Lluís G Aguilera
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain -
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònome de Barcelona, Bellaterra, Spain
| | - Isabel Ramos
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
| | - Xavier Duran
- Service of Methodological and Biostatistical Advisory, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Fernando Escolano
- Department of Anesthesiology, Parc de Salut MAR, Barcelona, Spain
- Perioperative Medicine and Pain Research Group, Neurosciences Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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17
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Asakawa T, Ogino M, Tominaga N, Ozaki N, Kubo J, Kakuda W. Effects of Rehabilitative Intervention for Augmenting Cough Function in Patients with Multiple System Atrophy. Prog Rehabil Med 2023; 8:20230035. [PMID: 37790746 PMCID: PMC10542584 DOI: 10.2490/prm.20230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Objectives One of the causes of death in patients with multiple system atrophy (MSA) is aspiration pneumonia caused by cough dysfunction. This study aimed to identify an effective approach to improve coughing and to explore the establishment of criteria for the use of gastrostomy based on cough and respiratory dysfunctions. Methods Eighteen probable MSA patients participated in the study. They were categorized into air stacking and non-air stacking groups. First, we investigated how the inspiration volume changes by applying maximum insufflation capacity (MIC). Second, peak cough flow (PCF) was measured by different cough augmentation methods: 1) spontaneous coughing (SpC); 2) SpC with MIC (SpC + MIC); 3) SpC with manually assisted cough (MAC) (SpC + MAC); and 4) SpC with MIC and MAC (SpC + MIC + MAC). Among these four conditions, PCF values were compared to determine the most effective approach for cough augmentation. Receiver operating characteristic analysis was performed on percent forced vital capacity (%FVC) to determine an index for discriminating PCF below160 L/min, which indicates a high risk of suffocation, involving SpC and SpC + MIC. Results Inspiration volume increased significantly with MIC in both groups (P < 0.05), and PCF increased significantly with MIC in the air stacking group (P < 0.01). PCF could not be maintained at 160 L/min when %FVC fell below 59%, even when MIC was applied. Conclusions PCF increases with MIC in patients with MSA. It may be meaningful to consider the timing of gastrostomy introduction based on the severity of cough and respiratory dysfunction.
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Affiliation(s)
- Takashi Asakawa
- Department of Clinical Medical Sciences, Rehabilitation
Medicine, International University of Health and Welfare Graduate School of Medicine,
Narita, Japan
- Department of Rehabilitation Division of Physiotherapy,
International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Mieko Ogino
- Department of Neurology and Intractable Neurological Disease
Center, International University of Health and Welfare Ichikawa Hospital, Ichikawa,
Japan
| | - Naomi Tominaga
- Department of Neurology and Intractable Neurological Disease
Center, International University of Health and Welfare Ichikawa Hospital, Ichikawa,
Japan
| | - Naoto Ozaki
- Department of Rehabilitation Medicine, Jikei University
School of Medicine, Tokyo, Japan
| | - Jin Kubo
- Department of Rehabilitation Medicine, International
University of Health and Welfare School of Medicine, Narita, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, International
University of Health and Welfare School of Medicine, Narita, Japan
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18
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Asakawa T, Ogino M, Tominaga N, Ozaki N, Kubo J, Kakuda W. Deterioration of Cough, Respiratory, and Vocal Cord Functions in Patients with Multiple System Atrophy. Neurol Int 2023; 15:1227-1237. [PMID: 37873834 PMCID: PMC10594415 DOI: 10.3390/neurolint15040077] [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: 09/09/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
The purpose of this study was to clarify changes in cough function in patients with multiple system atrophy (MSA). Seventeen probable patients with MSA were studied. Peak cough flow (PCF), respiratory function (percentage of vital capacity, percentage of forced vital capacity, and percentage of predicted forced expiratory volume in one second), respiratory muscle strength (percentage of maximal inspiratory mouth pressure and percentage of maximal expiratory mouth pressure), and maximum phonation time (MPT) were assessed. Walking ability, disease duration, possibility of air stacking, Unified MSA Rating Scale (UMSARS), and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III were also assessed. Data were separately analyzed for ambulatory and non-ambulatory groups categorized by Functional Ambulation Categories. PCF, respiratory function, respiratory muscle strength, and MPT were significantly lower in the non-ambulatory group than in the ambulatory group. On the other hand, no correlation between PCF and disease duration was observed. A significant number of patients in the non-ambulatory group were unable to hold their breath. The UMSARS and MDS-UPDRS Part III in the non-ambulatory group were significantly higher than in the ambulatory group. It was concluded that ambulatory dysfunction is associated with the decline of cough function and respiratory-related function in patients with MSA.
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Affiliation(s)
- Takashi Asakawa
- Department of Clinical Medical Sciences, Rehabilitation Medicine, Graduate School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan;
- Department of Rehabilitation, Division of Physiotherapy, International University of Health and Welfare, Ichikawa Hospital, Ichikawa 272-0827, Japan
| | - Mieko Ogino
- Department of Neurology, Intractable Neurological Disease Center, International University of Health and Welfare, Ichikawa Hospital, Ichikawa 272-0827, Japan; (M.O.); (N.T.)
| | - Naomi Tominaga
- Department of Neurology, Intractable Neurological Disease Center, International University of Health and Welfare, Ichikawa Hospital, Ichikawa 272-0827, Japan; (M.O.); (N.T.)
| | - Naoto Ozaki
- Department of Rehabilitation Medicine, School of Medicine, The Jikei University, Minato-ku 105-8471, Japan;
| | - Jin Kubo
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan;
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan;
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19
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de Brito SAF, Scianni AA, Silveira BMF, de Oliveira ERM, Mateus ME, Faria CDCDM. Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial. PLoS One 2023; 18:e0291051. [PMID: 37682839 PMCID: PMC10490961 DOI: 10.1371/journal.pone.0291051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION NCT05608941. Registered on November 8, 2022.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Mara Franco Silveira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Eduarda Mateus
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Kraman SS, Pasterkamp H, Wodicka GR. Smart Devices Are Poised to Revolutionize the Usefulness of Respiratory Sounds. Chest 2023; 163:1519-1528. [PMID: 36706908 PMCID: PMC10925548 DOI: 10.1016/j.chest.2023.01.024] [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: 11/04/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The association between breathing sounds and respiratory health or disease has been exceptionally useful in the practice of medicine since the advent of the stethoscope. Remote patient monitoring technology and artificial intelligence offer the potential to develop practical means of assessing respiratory function or dysfunction through continuous assessment of breathing sounds when patients are at home, at work, or even asleep. Automated reports such as cough counts or the percentage of the breathing cycles containing wheezes can be delivered to a practitioner via secure electronic means or returned to the clinical office at the first opportunity. This has not previously been possible. The four respiratory sounds that most lend themselves to this technology are wheezes, to detect breakthrough asthma at night and even occupational asthma when a patient is at work; snoring as an indicator of OSA or adequacy of CPAP settings; cough in which long-term recording can objectively assess treatment adequacy; and crackles, which, although subtle and often overlooked, can contain important clinical information when appearing in a home recording. In recent years, a flurry of publications in the engineering literature described construction, usage, and testing outcomes of such devices. Little of this has appeared in the medical literature. The potential value of this technology for pulmonary medicine is compelling. We expect that these tiny, smart devices soon will allow us to address clinical questions that occur away from the clinic.
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Affiliation(s)
- Steve S Kraman
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY.
| | - Hans Pasterkamp
- University of Manitoba, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - George R Wodicka
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
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21
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Brindle K, Morice A, Carter N, Sykes D, Zhang M, Hilton A. The "vicious circle" of chronic cough: the patient experience - qualitative synthesis. ERJ Open Res 2023; 9:00094-2023. [PMID: 37228274 PMCID: PMC10204820 DOI: 10.1183/23120541.00094-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
Aim The aim of this study was to systematically search and synthesise findings from peer-reviewed qualitative studies describing the experiences of those living with chronic cough. Methods A systematic search was conducted to identify all studies that used qualitative methodology to report on the experiences of adults living with chronic cough. A thematic synthesis of the first-hand narratives was undertaken. Key themes in relation to personal perspectives and experiences of living with chronic cough were identified and grouped into analytical themes. Results Six studies met the inclusion criteria. The thematic synthesis generated three analytical themes: 1) "It's just a cough"; 2) "Constant cough and constant worry"; and 3) "No light at the end of the tunnel", highlighting the biopsychosocial nature of chronic cough. The synthesis highlights chronic cough as a heterogeneous experience that may appear idiosyncratic, completely consuming the lives of those living with it. Conclusion This is to our knowledge the first qualitative synthesis reporting on the perceptions and experiences of adults living with chronic cough. Our review draws attention to the paucity of literature that utilises qualitative methodology to explore the experience of living with chronic cough. We highlight the missing voice of people living with chronic cough in the contemporary literature. There is now a requirement for research exploring the narratives of those living with chronic cough, to gain an understanding of the condition beyond simple quantification.
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Affiliation(s)
- Kayleigh Brindle
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Alyn Morice
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Natalie Carter
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
| | - Dominic Sykes
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Mengru Zhang
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Andrea Hilton
- University of Hull, Faculty of Health Sciences, Hull, UK
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22
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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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Xu W, He G, Pan C, Shen D, Zhang N, Jiang P, Liu F, Chen J. A forced cough sound based pulmonary function assessment method by using machine learning. Front Public Health 2022; 10:1015876. [PMID: 36388361 PMCID: PMC9640833 DOI: 10.3389/fpubh.2022.1015876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
Pulmonary function testing (PFT) has important clinical value for the early detection of lung diseases, assessment of the disease severity, causes identification of dyspnea, and monitoring of critical patients. However, traditional PFT can only be carried out in a hospital environment, and it is challenging to meet the needs for daily and frequent evaluation of chronic respiratory diseases. In this study, we propose a novel method for accurately assessing pulmonary function by analyzing recorded forced cough sounds by mobile device without time and location restrictions. In the experiment, 309 clips of cough sound segments were separated from 133 patients who underwent PFT by using Audacity software. There are 247 clips of training samples and 62 clips of testing samples. Totally 52 features were extracted from the dataset, and principal component analysis (PCA) was used for feature reduction. Combined with biological attributes, the normalized features were regressed by using machine learning models with pulmonary function parameters (i.e., FEV1, FVC, FEV1/FVC, FEV1%, and FVC%). And a 5-fold cross-validation was applied to evaluate the performance of the regression models. As described in the experimental result, the result of coefficient of determination (R2) indicates that the support vector regression (SVR) model performed best in assessing FVC (0.84), FEV1% (0.61), and FVC% (0.62) among these models. The gradient boosting regression (GBR) model performs best in evaluating FEV1 (0.86) and FEV1/FVC (0.54). The result confirmed that the proposed method was capable of accurately assessing pulmonary function with forced cough sound. Besides, the cough sound sampling by a smartphone made it possible to conduct sampling and assess pulmonary function frequently in the home environment.
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Affiliation(s)
- Wenlong Xu
- College of Information Engineering, China Jiliang University, Hangzhou, Zhejiang, China,Wenlong Xu
| | - Guoqiang He
- College of Information Engineering, China Jiliang University, Hangzhou, Zhejiang, China
| | - Chen Pan
- College of Information Engineering, China Jiliang University, Hangzhou, Zhejiang, China
| | - Dan Shen
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ning Zhang
- Lishui People's Hospital, Lishui, Zhejiang, China
| | | | - Feng Liu
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, QL, Australia
| | - Jingjing Chen
- Department of Digital Urban Governance and School of Computer and Computing Science, Zhejiang University City College, Hangzhou, China,*Correspondence: Jingjing Chen
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24
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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: 81] [Impact Index Per Article: 40.5] [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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Ren Z, Chang Y, Bartl-Pokorny KD, Pokorny FB, Schuller BW. The Acoustic Dissection of Cough: Diving Into Machine Listening-based COVID-19 Analysis and Detection. J Voice 2022:S0892-1997(22)00166-7. [PMID: 35835648 PMCID: PMC9197794 DOI: 10.1016/j.jvoice.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) has caused a crisis worldwide. Amounts of efforts have been made to prevent and control COVID-19's transmission, from early screenings to vaccinations and treatments. Recently, due to the spring up of many automatic disease recognition applications based on machine listening techniques, it would be fast and cheap to detect COVID-19 from recordings of cough, a key symptom of COVID-19. To date, knowledge of the acoustic characteristics of COVID-19 cough sounds is limited but would be essential for structuring effective and robust machine learning models. The present study aims to explore acoustic features for distinguishing COVID-19 positive individuals from COVID-19 negative ones based on their cough sounds. METHODS By applying conventional inferential statistics, we analyze the acoustic correlates of COVID-19 cough sounds based on the ComParE feature set, i.e., a standardized set of 6,373 acoustic higher-level features. Furthermore, we train automatic COVID-19 detection models with machine learning methods and explore the latent features by evaluating the contribution of all features to the COVID-19 status predictions. RESULTS The experimental results demonstrate that a set of acoustic parameters of cough sounds, e.g., statistical functionals of the root mean square energy and Mel-frequency cepstral coefficients, bear essential acoustic information in terms of effect sizes for the differentiation between COVID-19 positive and COVID-19 negative cough samples. Our general automatic COVID-19 detection model performs significantly above chance level, i.e., at an unweighted average recall (UAR) of 0.632, on a data set consisting of 1,411 cough samples (COVID-19 positive/negative: 210/1,201). CONCLUSIONS Based on the acoustic correlates analysis on the ComParE feature set and the feature analysis in the effective COVID-19 detection approach, we find that several acoustic features that show higher effects in conventional group difference testing are also higher weighted in the machine learning models.
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Affiliation(s)
- Zhao Ren
- EIHW - Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany; L3S Research Center, Hannover, Germany.
| | - Yi Chang
- GLAM - Group on Language, Audio, & Music, Imperial College London, London, United Kingdom
| | - Katrin D Bartl-Pokorny
- EIHW - Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany; Division of Phoniatrics, Medical University of Graz, Graz, Austria; Division of Physiology, Medical University of Graz, Graz, Austria.
| | - Florian B Pokorny
- EIHW - Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany; Division of Phoniatrics, Medical University of Graz, Graz, Austria; Division of Physiology, Medical University of Graz, Graz, Austria
| | - Björn W Schuller
- EIHW - Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany; GLAM - Group on Language, Audio, & Music, Imperial College London, London, United Kingdom
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26
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Dallal-York J, Segalewitz T, Croft K, Colsky J, DiBiase L, Anderson A, Vasilopoulos T, Pelaez A, Shahmohammadi A, Pipkin M, Machuca TN, Plowman EK. Incidence, Risk Factors and Sequelae of Dysphagia Mediated Aspiration Following Lung Transplantation. J Heart Lung Transplant 2022; 41:1095-1103. [DOI: 10.1016/j.healun.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022] Open
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27
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Satia I, Mayhew AJ, Sohel N, Kurmi O, Killian KJ, O'Byrne PM, Raina P. Impact of mental health and personality traits on the incidence of chronic cough in the Canadian Longitudinal Study on Aging. ERJ Open Res 2022; 8:00119-2022. [PMID: 35651367 PMCID: PMC9149388 DOI: 10.1183/23120541.00119-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundChronic cough is a common troublesome condition, but risk factors for developing chronic cough are poorly understood. The aim of this study was to understand the relationship between mental health disorders, personality traits and chronic cough.MethodsThe Canadian Longitudinal Study on Aging is a prospective, nationally generalisable, random sample of adults aged 45–85 years at baseline recruited between 2011 and 2015, and followed-up 3 years later. Chronic cough was defined as a daily cough over the last 12 months. Incident chronic cough was defined as those participants who reported new-onset chronic cough between baseline and follow-up 1. Current depressive symptoms and psychological distress were assessed using the Center for Epidemiologic Study Short Depression Scale (CESD-10) and Kessler Psychological Distress Scale (K-10), respectively. The “Big Five” personality traits were assessed using the Ten-Item Personality Inventory. Relative risks are reported using a multivariate mutually adjusted model.ResultsAt follow-up 1, 2506 participants (11.1%) reported new-onset chronic cough during the ∼3-year interval. Depressive symptoms (CESD-10 ≥10: relative risk 1.22 (95% CI 1.03–1.44)) and psychological distress (K-10 ≥22: relative risk 1.20 (95% CI 1.07–1.36)) at baseline were both independent predictors of a higher risk of incident chronic cough. Prevalent and incident chronic cough were also independently associated with an increased risk of developing depressive symptoms and psychological distress. Personality traits did not influence the development of chronic cough but did increase the risk of depressive symptoms and psychological distress.ConclusionsThis study shows that there is a bidirectional relationship between chronic cough, and depressive symptoms and psychological distress, and personality traits do not independently influence the development of chronic cough.
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Liang H, Ye W, Wang Z, Liang J, Yi F, Jiang M, Lai K. Prevalence of chronic cough in China: a systematic review and meta-analysis. BMC Pulm Med 2022; 22:62. [PMID: 35151307 PMCID: PMC8840780 DOI: 10.1186/s12890-022-01847-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background Individual studies have indicated variable prevalence for chronic cough, but thus far, there has been no systematic report on the prevalence of this condition. Methods In this study, we performed a systematic review and meta-analysis by searching databases including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese biomedical literature service system, Wanfang Database, and VIP database, for studies on chronic cough in China published before December 28, 2020. A random effects model was used to calculate pooled prevalence estimates with 95% confidence interval [95%CI], weighted by study size. Results Fifteen studies with 141,114 community-based adults were included in the study, showing a prevalence of 6.22% (95% CI 5.03–7.41%). And 21 studies with 164,280 community-based children were included, presenting a prevalence of 7.67% (95% CI 6.24–9.11%). In subgroup meta-analyses, the prevalence in adults was 4.38% (95% CI 2.74–6.02%) in southern China and 8.70% (95% CI 6.52–10.88%) in northern China. In the children population, the prevalence in northern China was also higher than in southern China (northern vs. southern: 7.45% with a 95% CI of 5.50–9.41%, vs. 7.86% with a 95% CI of 5.56–10.16%). Conclusions Our population-based study provides relatively reliable data on the prevalence of chronic cough in China and may help the development of global strategies for chronic cough management. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01847-w.
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Kaneko H, Suzuki A, Horie J. Effects of Cough Training and Inspiratory Muscle Training on Cough Strength in Older Adults: A Randomized Controlled Trial. Lung 2022; 200:49-57. [PMID: 35050397 DOI: 10.1007/s00408-022-00509-2] [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: 09/23/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE While the need for preventive strategies to reduce the incidence of aspiration pneumonia has been indicated, it is also important to investigate effective training methods to improve cough function, which is associated with the development of aspiration pneumonia. This study aimed to investigate whether a 4-week home-based unsupervised cough training (CT) or inspiratory muscle training (IMT) program was effective in improving cough strength in older adults. METHODS Fifty-three ambulatory older adults without airflow limitations were randomly assigned to one of three groups: a CT group (n = 18), an IMT group (n = 18), or a control group (n = 17). The CT and IMT groups performed home-based unsupervised training with a device for 4 weeks. Cough strength (cough peak flow), forced vital capacity, and respiratory muscle strength were assessed at the 4-week and 16-week follow-up. Intention-to-treat analyses were performed to investigate differences between the three groups using linear mixed models. RESULTS At the 4-week follow-up, the CT group showed significant increases in cough peak flow and forced vital capacity compared with the control group, while the IMT group showed significant increases in inspiratory muscle strength compared with the cough training and control groups. At the 16-week follow-up, the CT group showed a significant increase in cough peak flow compared with the IMT group. CONCLUSION These preliminary results suggest that a 4-week home-based CT program may have short-term effectiveness in improving cough peak flow in ambulatory older adults. TRIAL REGISTRATION This trial was registered on UMIN-CTR on 01/05/2018 (UMIN000031656).
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Affiliation(s)
- Hideo Kaneko
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-shi, Fukuoka, 831-8501, Japan.
| | - Akari Suzuki
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-shi, Fukuoka, 831-8501, Japan
| | - Jun Horie
- Department of Physical Therapy, School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
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30
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Eccles R. Placebo and Side Effects Confound Clinical Trials on New Antitussives. Lung 2021; 199:319-326. [PMID: 34279718 PMCID: PMC8416890 DOI: 10.1007/s00408-021-00458-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
This review discusses how the placebo effect related to treatment side effects may confound clinical trials on antitussives and specifically looks at the implications for trials on ATP antagonists. These new antitussives have distinctive side effects on the sensation of taste, and investigators have expressed concerns that this may unblind the clinical trials. Blinding is an essential component of trial design, but the degree of blinding in trials is rarely assessed. The assumptions of additivity and balance in clinical trials are discussed as important factors that allow assessment of the pharmacological activity of an antitussive. How side effects unbalance a clinical trial by amplifying the placebo effect of active treatments is discussed. The point is made that unblinding of trials invalidates any assessment of efficacy but that there is little interest or discussion about this fundamental aspect of trials. Proposals are discussed which may improve the blinding of trials and control placebo effects by changes to participant information, trial design, patient selection and use of active placebos. The issue of unblinding of clinical trials is not a new issue, but if real progress is to be made in developing new antitussives, then it is an issue that needs to be urgently addressed.
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Affiliation(s)
- Ronald Eccles
- Cardiff School of Biosciences, Cardiff University, Museum Avenue, Cardiff, CF10 3AX, UK.
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Baddini-Martinez J, Chinarelli T, Orlandini CB, de Oliveira MR, Bricoleri I, Cardamoni V, Rodrigues-Junior AL. The Multidimensional Cough Index: A Practical Scale to Measure Cough and Sputum. Am J Med Sci 2021; 362:396-402. [PMID: 33991501 DOI: 10.1016/j.amjms.2021.05.003] [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: 10/26/2020] [Revised: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There currently is a lack of easy-to-use instruments with which to assess cough. The aim of the present study was to develop a scale for measuring the characteristics of cough and sputum. METHODS The authors developed a scale for assessing cough, including aspects such as intensity, frequency, physical impact, psychosocial impacts and sputum characteristics. The first four components were scored using a Cough Index, with a range of 0 to 20. Sputum information included volume, appearance, and hemoptysis. The scale was administered to 105 patients and re-administered to 51 about two weeks later. The patients also reported cough frequency and intensity using a 100-mm visual analogue scale (VAS) and answered the Leicester Cough Questionnaire (LCQ). Additionally, 12 patients with acute exacerbation (AE) of chronic airways disease were interviewed upon admission to and discharge from the hospital. RESULTS Analysis identified only one factor for the Cough Index, and Cronbach's alpha value was 0.819. Cough Index was significantly correlated with VASfrequency (r = 0.651, p < 0.0001), VASintensity (r = 0.543, p<0.0001), and LCQ (r = -0.824, p < 0.0001). The intraclass correlation coefficient of test-retest scores was 0.779. The median Cough Index significantly decreased after AE treatment, as did the number of patients reporting increased sputum production and greenish and dark sputum. A Cough Index ≥ 4 distinguished respiratory patients from healthy subjects, with a sensitivity of 80% and a specificity of 85%. CONCLUSION The Multidimensional Cough Index condenses complex aspects related to cough and sputum production into a single instrument, with satisfactory validation.
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Affiliation(s)
- José Baddini-Martinez
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil; Present Institution, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
| | - Tamiris Chinarelli
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Caisa Brunelli Orlandini
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Mariane Rocha de Oliveira
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Isabela Bricoleri
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Victor Cardamoni
- Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Abstract
Sensitive skin can be considered a neuropathic disorder. Sensory disorders and the decrease in intra-epidermal nerve ending density are strong arguments for small-fiber neuropathies. Sensitive skin is frequently associated with irritable bowel syndrome or sensitive eyes, which are also considered neuropathic disorders. Consequently, in vitro co-cultures of skin and neurons are adequate models for sensitive skin.
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