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Clark G, Fitzgerald DA, Rubin BK. Cough medicines for children- time for a reality check. Paediatr Respir Rev 2023; 48:30-38. [PMID: 37718235 DOI: 10.1016/j.prrv.2023.08.003] [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: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023]
Abstract
Cough medicines have been in use for over a century to treat the common and troublesome, but often helpful, symptoms of cough in children. They contain various combinations of "anti-tussive" drugs including opioids, antihistamines, herbal preparations, mucolytics, decongestants and expectorants. Whilst theoretically attractive for symptom relief when children are suffering, as time has passed these popular over the counter medicines have been shown to lack efficacy, delay more serious underlying diagnoses, and can cause complications and sometimes death. This has resulted in clinician concerns, a citizen petition to the American Food and Drug Association in 2007, some self-regulation from manufacturers and escalating restrictions on their use from regulatory agencies across the world over the last twenty years. This article will review the protective role of cough, juxtapose the conflicting treatment goals of suppressing a dry cough and promoting expectoration for a wet cough, consider the evidence basis for prescribing cough medicines in comparison to other more specific treatments such as for asthma [beta agonists] or infection [antibiotics], regulatory interventions, and conclude with the view that over counter cough medicines should not be used in children, especially young children.
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Affiliation(s)
- Gene Clark
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, NSW, Australia
| | - Bruce K Rubin
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA; The Children's Hospital of Richmond at VCU, Richmond, VA, USA.
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Nakajima Y, Tsujimura T, Tsutsui Y, Chotirungsan T, Kawada S, Dewa N, Magara J, Inoue M. Atropine facilitates water-evoked swallows via central muscarinic receptors in anesthetized rats. Am J Physiol Gastrointest Liver Physiol 2023; 325:G109-G121. [PMID: 37219016 DOI: 10.1152/ajpgi.00039.2023] [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: 02/26/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Anticholinergic medication causes impaired swallowing with hyposalivation. However, the underlying mechanisms by which these drugs modulate the swallowing reflex remain unclear. This study investigated the effects of the muscarinic acetylcholine receptor (mAChR) nonspecific antagonist atropine on the initiation of swallowing. Experiments were performed on 124 urethane-anesthetized rats. A swallow was evoked by either topical laryngeal application of a small amount of distilled water (DW), saline, citric acid, or capsaicin; upper airway distention with a continuous airflow; electrical stimulation of the superior laryngeal nerve (SLN); or focal microinjection of N-methyl-d-aspartate (NMDA) into the lateral region of the nucleus of the solitary tract (L-nTS). Swallows were identified by electromyographic bursts of the digastric and thyrohyoid muscles. Either atropine, the peripheral mAChR antagonist methylatropine, or antagonists of mAChR subtypes M1-M5 were intravenously delivered. Atropine at a dose of 1 mg/kg increased the number of DW-evoked swallows compared with baseline and did not affect the number of swallows evoked by saline, citric acid, capsaicin, or upper airway distention. Methylatropine and M1-M5 antagonists did not significantly change the number of DW-evoked swallows. Bilateral SLN transection completely abolished DW-evoked swallows, and atropine decreased the swallowing threshold of SLN electrical stimulation. Finally, microinjection of NMDA receptor antagonist AP-5 into the L-nTS inhibited DW-evoked swallows, and atropine facilitated the initiation of swallowing evoked by NMDA microinjection into this region. These results suggest that atropine facilitates DW-evoked swallows via central mAChR actions.NEW & NOTEWORTHY Atropine facilitated the distilled water (DW)-evoked swallows in anesthetized rats. Atropine decreased the swallowing threshold evoked by electrical stimulation of the superior laryngeal nerve, which is a primary sensory nerve for the initiation of DW-evoked swallows. Atropine facilitated the swallows evoked by N-methyl-d-aspartate microinjection into the lateral region of the nucleus of the solitary tract, which is involved in the DW-evoked swallows. We speculate that atropine facilitates the DW-evoked swallows via central muscarinic receptor actions.
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Affiliation(s)
- Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Titi Chotirungsan
- Department of Oral Diagnosis, Faculty of Dentistry, Naresuan University, Muang, Phitsanulok, Thailand
| | - Satomi Kawada
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nozomi Dewa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Basin S, Valentin S, Demoulin-Alexikova S, Demoulin B, Foucaud L, Gérard D, Pouget C, Allado E, Chenuel B, Poussel M. Impact of Inhaled Corticosteroids on the Modulation of Respiratory Defensive Reflexes During Artificial Limb Exercise in Ovalbumin-Sensitized Rabbits. Front Physiol 2022; 12:804577. [PMID: 35145425 PMCID: PMC8821955 DOI: 10.3389/fphys.2021.804577] [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: 10/29/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Cough is a major lower airway defense mechanism that can be triggered by exercise in asthma patients. Studies on cough reflex in experimental animal models revealed a decrease of cough reflex sensitivity during exercise in healthy animals, but a lack of desensitization in ovalbumin-sensitized rabbits. The aim of our study is to evaluate the impact of inhaled corticosteroids on cough reflex during artificial limb exercise in an animal model of eosinophilic airway inflammation. Materials and Methods Sixteen adult ovalbumin-sensitized rabbits were randomly divided into two groups. The “OVA-Corticoid” group (n = 8) received inhaled corticosteroids (budesonide; 1 mg/day during 2 consecutive days) while the “OVA-Control” (n = 8) group was exposed to saline nebulization. The sensitivity of defensive reflexes induced by direct mechanical stimulation of the trachea was studied in anesthetized animals, at rest and during artificial limb exercise. Cell count was performed on bronchoalveolar lavage fluid and middle lobe tissue sections to assess the level of eosinophilic inflammation. Results All rabbits were significantly sensitized but there was no difference in eosinophilic inflammation on bronchoalveolar lavage or tissue sections between the two groups. Artificial limb exercise resulted in a significant (p = 0.002) increase in minute ventilation by 30% (+ 209 mL.min–1, ± 102 mL/min–1), with no difference between the two groups. 322 mechanical tracheal stimulations were performed, 131 during exercise (40.7%) and 191 at rest (59.3%). Cough reflex was the main response encountered (46.9%), with a significant increase in cough reflex threshold during artificial limb exercise in the “OVA-Corticoid” group (p = 0.039). Cough reflex threshold remained unchanged in the “OVA-Control” group (p = 0.109). Conclusion Inhaled corticosteroids are able to restore desensitization of the cough reflex during artificial limb exercise in an animal model of airway eosinophilic inflammation. Airway inflammation thus appears to be involved in the physiopathology of exercise-induced cough in this ovalbumin sensitized rabbit model. Inhaled anti-inflammatory treatments could have potential benefit for the management of exercise-induced cough in asthma patients.
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Affiliation(s)
- Sarah Basin
- Department of Pneumology, CHRU Nancy, Nancy, France
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- *Correspondence: Sarah Basin,
| | - Simon Valentin
- Department of Pneumology, CHRU Nancy, Nancy, France
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Department of Pediatric Respiratory Function Testing, CHRU Nancy, Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Laurent Foucaud
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | | | - Celso Pouget
- Department of Pathology CHRU Nancy, Nancy, France
| | - Edem Allado
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Bruno Chenuel
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Mathias Poussel
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
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Furuya WI, Bassi M, Menani JV, Colombari E, Zoccal DB, Colombari DSA. Modulation of hypercapnic respiratory response by cholinergic transmission in the commissural nucleus of the solitary tract. Pflugers Arch 2019; 472:49-60. [PMID: 31884528 DOI: 10.1007/s00424-019-02341-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 01/16/2023]
Abstract
The nucleus of the solitary tract (NTS) is an important area of the brainstem that receives and integrates afferent cardiorespiratory sensorial information, including those from arterial chemoreceptors and baroreceptors. It was described that acetylcholine (ACh) in the commissural subnucleus of the NTS (cNTS) promotes an increase in the phrenic nerve activity (PNA) and antagonism of nicotinic receptors in the same region reduces the magnitude of tachypneic response to peripheral chemoreceptor stimulation, suggesting a functional role of cholinergic transmission within the cNTS in the chemosensory control of respiratory activity. In the present study, we investigated whether cholinergic receptor antagonism in the cNTS modifies the sympathetic and respiratory reflex responses to hypercapnia. Using an arterially perfused in situ preparation of juvenile male Holtzman rats, we found that the nicotinic antagonist (mecamylamine, 5 mM), but not the muscarinic antagonist (atropine, 5 mM), into the cNTS attenuated the hypercapnia-induced increase of hypoglossal activity. Furthermore, mecamylamine in the cNTS potentiated the generation of late-expiratory (late-E) activity in abdominal nerve induced by hypercapnia. None of the cholinergic antagonists microinjected in the cNTS changed either the sympathetic or the phrenic nerve responses to hypercapnia. Our data provide evidence for the role of cholinergic transmission in the cNTS, acting on nicotinic receptors, modulating the hypoglossal and abdominal responses to hypercapnia.
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Affiliation(s)
- Werner I Furuya
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Mirian Bassi
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - José V Menani
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Eduardo Colombari
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Daniel B Zoccal
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil
| | - Débora S A Colombari
- Department of Physiology and Pathology, School of Dentistry, UNESP - São Paulo State University, Araraquara, SP, Brazil.
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Plevkova J, Hanacek J, Tatar M. Cough and airway defence - Special issue of respiratory physiology and neurobiology. Respir Physiol Neurobiol 2018; 257:1-4. [PMID: 29660483 DOI: 10.1016/j.resp.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jana Plevkova
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Pathophysiology, Slovakia.
| | - Jan Hanacek
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Pathophysiology, Slovakia
| | - Milos Tatar
- Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Pathophysiology, Slovakia
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