1
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Quigley N, Mistry SG, Vasant DH, Vasani S. Practical multidisciplinary framework for the assessment and management of patients with unexplained chronic aerodigestive symptoms. BMJ Open Gastroenterol 2023; 10:e000883. [PMID: 37996120 PMCID: PMC10668155 DOI: 10.1136/bmjgast-2022-000883] [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: 04/02/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE Patients experiencing unexplained chronic throat symptoms (UCTS) are frequently referred to gastroenterology and otolaryngology outpatient departments for investigation. Often despite extensive investigations, an identifiable structural abnormality to account for the symptoms is not found. The objective of this article is to provide a concise appraisal of the evidence-base for current approaches to the assessment and management of UCTS, their clinical outcomes, and related healthcare utilisation. DESIGN This multidisciplinary review critically examines the current understanding of aetiological theories and pathophysiological drivers in UCTS and summarises the evidence base underpinning various diagnostic and management approaches. RESULTS The evidence gathered from the review suggests that single-specialty approaches to UCTS inadequately capture the substantial heterogeneity and pervasive overlaps among clinical features and biopsychosocial factors and suggests a more unified approach is needed. CONCLUSION Drawing on contemporary insights from the gastrointestinal literature for disorders of gut-brain interaction, this article proposes a refreshed interdisciplinary approach characterised by a positive diagnosis framework and patient-centred therapeutic model. The overarching aim of this approach is to improve patient outcomes and foster collaborative research efforts.
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Affiliation(s)
- Nathan Quigley
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Sandeep G Mistry
- Department of Ear Nose and Throat, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Gastroenterology Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarju Vasani
- Otolaryngology Department, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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2
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Misono S, Xu J, Oh J, Sombrio A, Stockness A, Mahnan A, Konczak J. Atypical Activation of Laryngeal Somatosensory-Motor Cortex During Vocalization in People With Unexplained Chronic Cough. JAMA Otolaryngol Head Neck Surg 2023; 149:820-827. [PMID: 37471077 PMCID: PMC10360007 DOI: 10.1001/jamaoto.2023.1757] [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: 02/16/2023] [Accepted: 05/23/2023] [Indexed: 07/21/2023]
Abstract
Importance Unexplained chronic cough is common and has substantial negative quality-of-life implications, yet its causes are not well understood. A better understanding of how peripheral and central neural processes contribute to chronic cough is essential for treatment design. Objective To determine if people with chronic cough exhibit signs of abnormal neural processing over laryngeal sensorimotor cortex during voluntary laryngeal motor activity such as vocalization. Design, Setting, and Participants This was a cross-sectional study of a convenience sample of participants with chronic cough and healthy participants. Testing was performed in an acoustically and electromagnetically shielded chamber. In a single visit, electroencephalographic (EEG) signals were recorded from participants with chronic cough and healthy participants during voice production. The chronic cough group participants presented with unexplained cough of 8 weeks or longer duration with prior medical evaluation including negative results of chest imaging. None of the participants had a history of any neurologic disease known to impair vocalization or swallowing. Data collection for the healthy control group occurred from February 2 to June 28, 2018, and for the chronic cough group, from November 22, 2021, to June 21, 2022. Data analysis was performed from May 1 to October 30, 2022. Exposure Participants with or without chronic cough. Main Outcome Measures Event-related spectral perturbation over the laryngeal area of somatosensory-motor cortex from 0 to 30 Hz (ie, θ, α, and β bands) and event-related coherence as a measure of synchronous activity between somatosensory and motor cortical regions. Results The chronic cough group comprised 13 participants with chronic cough (mean [SD] age, 63.5 [7.8] years; 9 women and 4 men) and the control group, 10 healthy age-matched individuals (mean [SD] age, 60.3 [13.9] years; 6 women and 4 men). In the chronic cough group, the typical movement-related desynchronization over somatosensory-motor cortex during vocalization was significantly reduced across θ, α, and β frequency bands when compared with the control group. Conclusions and Relevance This cross-sectional study found that the typical movement-related suppression of brain oscillatory activity during vocalization is weak or absent in people with chronic cough. Thus, chronic cough affects sensorimotor cortical activity during the asymptomatic voluntary activation of laryngeal muscles.
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Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Jiapeng Xu
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis
| | - Jinseok Oh
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis
- Center for Clinical Movement Science, University of Minnesota, Minneapolis
- Department of Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Anna Sombrio
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Ali Stockness
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Arash Mahnan
- Reality Labs Health and Safety UXR, Meta, Redmond, Washington
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis
- Center for Clinical Movement Science, University of Minnesota, Minneapolis
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3
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Morice A, Dicpinigaitis P, McGarvey L, Birring SS. Chronic cough: new insights and future prospects. Eur Respir Rev 2021; 30:30/162/210127. [PMID: 34853095 PMCID: PMC9488126 DOI: 10.1183/16000617.0127-2021] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Chronic cough is defined in adults as a cough that lasts for ≥8 weeks. When it proves intractable to standard-of-care treatment, it can be referred to as refractory chronic cough (RCC). Chronic cough is now understood to be a condition of neural dysregulation. Chronic cough and RCC result in a serious, often unrecognized, disease burden, which forms the focus of the current review. The estimated global prevalence of chronic cough is 2–18%. Patients with chronic cough and RCC report many physical and psychological effects, which impair their quality of life. Chronic cough also has a significant economic burden for the patient and healthcare systems. RCC diagnosis and treatment are often delayed for many years as potential treatable triggers must be excluded first and a stepwise empirical therapeutic regimen is recommended. Evidence supporting most currently recommended treatments is limited. Many treatments do not address the underlying pathology, are used off-label, have limited efficacy and produce significant side-effects. There is therefore a significant unmet need for alternative therapies for RCC that target the underlying disease mechanisms. Early clinical data suggest that antagonists of the purinergic P2X3 receptor, an important mediator of RCC, are promising, though more evidence is needed. Chronic cough exerts a considerable burden on patients and healthcare systems. In addition to effective targeted therapies, further data are needed to understand the pathophysiology, epidemiology and disease burden.https://bit.ly/3Be9JZI
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Affiliation(s)
- Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, UK
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
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4
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Al-Kandery ASA, Rao MS, El-Hashim AZ. Prostaglandin E 2 sensitizes the cough reflex centrally via EP3 receptor-dependent activation of NaV 1.8 channels. Respir Res 2021; 22:296. [PMID: 34794450 PMCID: PMC8603488 DOI: 10.1186/s12931-021-01889-4] [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: 07/30/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Cough hypersensitivity is a major characteristic feature associated with several types of cough, including chronic cough, but its underlying mechanisms remain to be fully understood. Inflammatory mediators, such as prostaglandin E2 (PGE2), have been implicated in both peripheral induction and sensitization of the cough reflex. In this study, using a conscious guinea pig model of cough, we investigated whether PGE2 can sensitize the cough reflex via central actions and, if so, via which mechanisms. Methods All drugs were administered by intracerebroventricular (i.c.v.) route and whole-body plethysmograph set-up was used for both induction, using aerosolized citric acid (0.2 M), and recording of cough. Immunohistochemistry was performed to confirm the expression of NaV 1.8 channels in the nucleus tractus solitarius (nTS). Results We show that both PGE2 and the non-selective EP1/EP3 agonist, sulprostone, dose-dependently enhanced the citric acid-induced cough (P ≤ 0.001, P ≤ 0.01, respectively). Pretreatment with the EP1 antagonist, ONO-8130, did not affect the sulprostone-induced cough sensitization, whilst the EP3 antagonist, L-798,106, dose-dependently inhibited this effect (P ≤ 0.05). Furthermore, treatment with either the EP2 agonist, butaprost or the EP4 agonist, L-902,688, had no effect on cough sensitization. Additionally, pretreatment with either the TRPV1 antagonist, JNJ-17203212 or the TRPA1 antagonist, HC-030031, alone or in combination, nor with the NaV 1.1, 1.2, 1.3, 1.4, 1.6 and 1.7 channel blocker, tetrodotoxin, had any effect on the cough. In contrast, pretreatment with the NaV 1.8 antagonist, A-803467, dose-dependently inhibited this effect (P ≤ 0.05). Furthermore, NaV 1.8 channels were shown to be expressed in the nTS. Conclusion Collectively, our findings show that PGE2 sensitizes the cough reflex centrally via EP3 receptor-dependent activation of NaV 1.8 but independently of TRPV1,TRPA1 and TTX-sensitive sodium channel activation. These results indicate that PGE2 plays an important role in central sensitization of the cough reflex and suggest that central EP3 receptors and/or NaVv 1.8 channels may represent novel antitussive molecular targets. Graphical Abstract ![]()
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Affiliation(s)
- Al-Shaimaa A Al-Kandery
- Department of Pharmacology & Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Muddanna S Rao
- Department of Anatomy, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Z El-Hashim
- Department of Pharmacology & Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait.
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5
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Santini D, Armento G, Giusti R, Ferrara M, Moro C, Fulfaro F, Bossi P, Arena F, Ripamonti CI. Management of orphan symptoms: ESMO Clinical Practice Guidelines for diagnosis and treatment †. ESMO Open 2021; 5:e000933. [PMID: 33208491 PMCID: PMC7674109 DOI: 10.1136/esmoopen-2020-000933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- D Santini
- Department of Clinical Oncology, University Campus Bio-Medico of Rome, Oncologia Medica, Italy
| | - G Armento
- Department of Clinical Oncology, University Campus Bio-Medico of Rome, Oncologia Medica, Italy
| | - R Giusti
- Department of Oncology, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - M Ferrara
- Oncology- Supportive Care in Cancer Unit, Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Moro
- Department of Clinical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F Fulfaro
- Department of Clinical Oncology, Policlinico Paolo Giaccone, Palermo, Italy
| | - P Bossi
- Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - F Arena
- Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, Italy
| | - C I Ripamonti
- Oncology- Supportive Care in Cancer Unit, Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Arinze JT, Verhamme KMC, Luik AI, Stricker B, van Meurs JBJ, Brusselle GG. The interrelatedness of chronic cough and chronic pain. Eur Respir J 2021; 57:13993003.02651-2020. [PMID: 33122337 DOI: 10.1183/13993003.02651-2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
Since chronic cough has common neurobiological mechanisms and pathophysiology with chronic pain, both clinical disorders might be interrelated. Hence, we examined the association between chronic cough and chronic pain in adult subjects in the Rotterdam Study, a large prospective population-based cohort study.Using a standardised questionnaire, chronic pain was defined as pain lasting up to 6 months and grouped into a frequency of weekly/monthly or daily pain. Chronic cough was described as daily coughing for at least 3 months duration. The longitudinal and cross-sectional associations were investigated bi-directionally.Of 7141 subjects in the study, 54% (n=3888) reported chronic pain at baseline. The co-prevalence of daily chronic pain and chronic cough was 4.4%. Chronic cough was more prevalent in subjects with daily and weekly/monthly chronic pain compared with those without chronic pain (13.8% and 10.3% versus 8.2%; p<0.001). After adjustment for potential confounders, prevalent chronic pain was significantly associated with incident chronic cough (OR 1.47, 95% CI 1.08-1.99). The association remained significant in subjects with daily chronic pain (OR 1.49, 95% CI 1.06-2.11) with a similar effect estimate, albeit non-significant in those with weekly/monthly chronic pain (OR 1.43, 95% CI 0.98-2.10). After adjustment for covariables, subjects with chronic cough had a significant risk of developing chronic pain (OR 1.63, 95% CI 1.02-2.62) compared with those without chronic cough.Chronic cough and chronic pain confer risk on each other among adult subjects, indicating that both conditions might share common risk factors and/or pathophysiologic mechanisms.
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Affiliation(s)
- Johnmary T Arinze
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katia M C Verhamme
- Dept of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Bioanalysis, Ghent University, Ghent, Belgium
| | - Annemarie I Luik
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno Stricker
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Dept of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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7
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La tos crónica refractaria en la encrucijada. Arch Bronconeumol 2020; 56:545-546. [DOI: 10.1016/j.arbres.2019.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022]
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8
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Du Q, Liao Q, Chen C, Yang X, Xie R, Xu J. The Role of Transient Receptor Potential Vanilloid 1 in Common Diseases of the Digestive Tract and the Cardiovascular and Respiratory System. Front Physiol 2019; 10:1064. [PMID: 31496955 PMCID: PMC6712094 DOI: 10.3389/fphys.2019.01064] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/02/2019] [Indexed: 01/30/2023] Open
Abstract
Transient receptor potential vanilloid subtype 1 (TRPV1), a member of the transient receptor potential vanilloid (TRPV) channel family, is a nonselective cation channel that is widely expressed in sensory nerve fibers and nonneuronal cells, including certain vascular endothelial cells and smooth muscle cells. The activation of TRPV1 may be involved in the regulation of various physiological functions, such as the release of inflammatory mediators in the body, gastrointestinal motility function, and temperature regulation. In recent years, a large number of studies have revealed that TRPV1 plays an important role in the physiological and pathological conditions of the digestive system, cardiovascular system, and respiratory system, but there is no systematic report on TRPV1. The objective of this review is to explain the function and effects of TRPV1 on specific diseases, such as irritable bowel syndrome, hypertension, and asthma, and to further investigate the intrinsic relationship between the expression and function of TRPV1 in those diseases to find new therapeutic targets for the cure of related diseases.
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Affiliation(s)
| | | | | | | | - Rui Xie
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical University, Zunyi, China
| | - Jingyu Xu
- Department of Gastroenterology, Affiliated Hospital to Zunyi Medical University, Zunyi, China
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9
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Abstract
RATIONALE Chronic refractory cough (CRC) is a common clinical problem which is more likely associated with some physical problems. Although many patients have received satisfactory treatment, there were still many patients suffered from long-term cough symptoms after standardized treatment. PATIENT CONCERNS A patient suffered from postherpetic neuralgia (PHN) and also he complained CRC for more than 20 years. DIAGNOSIS The patient was diagnosed with PHN and CRC. INTERVENTIONS Pregabalin was originally administered to treat PHN. OUTCOMES pregabalin not only alleviated her pain of PHN but also relieved chronic cough. LESSONS This report demonstrated the surprising effect of pregabalin on the treatment of CRC.
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Affiliation(s)
- Jun Li
- Department of Pain Management and National Clinical Research Center for Geriatrics
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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10
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Abstract
Chronic cough is common and impactful, frustrating both patients and clinicians. An empirical trial of therapy is often done with inhaled corticosteroids, but this practice should be replaced with attempting to make an accurate diagnosis. The three most common causes are upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), but there are often multiple causes involved. Minimal investigations after history, physical exam, travel history, and drug history include a chest radiograph and spirometry. Empirical trial of therapy with inhaled corticosteroids is reasonable if there is evidence of eosinophilic inflammation. Empiric therapy for GERD may also be reasonable in those with symptoms. Red flags should especially be considered an urgency to make the correct diagnosis.
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11
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Airway reflux: an emerging topic in respiratory medicine. THE LANCET RESPIRATORY MEDICINE 2018; 6:810-812. [DOI: 10.1016/s2213-2600(18)30376-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022]
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12
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Bowen AJ, Huang TL, Nowacki AS, Trask D, Kaltenbach J, Taliercio R, Benninger MS, Milstein CF, Bryson PC. Tachyphylaxis and Dependence in Pharmacotherapy for Unexplained Chronic Cough. Otolaryngol Head Neck Surg 2018; 159:705-711. [PMID: 30016197 DOI: 10.1177/0194599818788062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Unexplained chronic cough (UCC) is a perplexing condition treated with neuromodulators. Although previous literature describes the effectiveness of neuromodulators, there is little on the development of tachyphylaxis or dependence to neuromodulators over time. Our objective is to capture the experience of a large cohort of patients with UCC over an extended period, looking for these 2 phenomena. Study Design Case series with chart review. Setting Tertiary care hospital. Subjects and Methods We performed a retrospective review of patients diagnosed with UCC from 2010 to 2014. Patient outcomes were measured through percentage improvement scores. Treatment failures were attributed to no benefit, intolerable side effects, or tachyphylaxis. Tachyphylaxis was defined as the need for higher doses of medication following diminishing therapeutic benefit, while dependence was defined as a failure to stop therapy following attempted de-escalation or resurgence following drug cessation. Results Sixty-eight patients were included in the study. Tachyphylaxis was observed among 35% of patients while dependence was observed among 27% of successfully treated patients, together effecting >50% of the cohort. Sixty-eight percent of patients ultimately experienced successful treatment with neuromodulators, demonstrating strikingly distinct responses to different neuromodulator drug classes. Conclusion Tachyphylaxis and dependence occur frequently during UCC treatment and have a major impact on treatment outcomes. Patients sometimes demonstrate distinct responses to different neuromodulator classes. The majority of patients will experience successful treatment for their cough, although several trials may be required.
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Affiliation(s)
- Andrew J Bowen
- 1 Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tiffany L Huang
- 2 School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Amy S Nowacki
- 3 Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Douglas Trask
- 4 Verity Health System, Los Angeles, California, USA
| | - James Kaltenbach
- 3 Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | | | | | | | - Paul C Bryson
- 6 Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
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13
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Affiliation(s)
- Michael S Benninger
- Chairman, Head and Neck Institute, The Cleveland Clinic, Cleveland, United States.
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14
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Bowen AJ, Nowacki AS, Contrera K, Trask D, Kaltenbach J, Milstein CF, Adessa M, Benninger MS, Taliercio R, Bryson PC. Short- and Long-term Effects of Neuromodulators for Unexplained Chronic Cough. Otolaryngol Head Neck Surg 2018; 159:508-515. [DOI: 10.1177/0194599818768517] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the short- and long-term effects of tricyclic antidepressants (TCAs) and gabapentin in the treatment of unexplained chronic cough (UCC). Study Design Prospective cohort. Setting Tertiary care hospital. Subjects and Methods Patients seen between July 2016 and March 2017 were included following a formal workup and clinical evaluation indicative of UCC. Patients were placed on either a TCA (amitriptyline or nortriptyline) or gabapentin. Leicester Cough Questionnaire (LCQ) and percentage improvement scores were obtained prior to treatment initiation and at 2 and 6 months of neuromodulator treatment. A linear mixed model assessed the change in LCQ score between the 2 treatment time points and baseline scores. Results Twenty-eight patients completed a total of 37 neuromodulator trials. Gabapentin demonstrated statistically significant improvement in LCQ scores at 2 months (2.48 points, P≤ .01) and 6 months (5.40 points, P = .01) of treatment as compared with baseline. Patients taking TCAs demonstrated statistically significant improvement of LCQ scores at 2 months of treatment (3.46 points, P≤ .01). However, the majority of patients discontinued treatment, most commonly secondary to the development of tachyphylaxis after 2 months, precluding analysis at 6 months. Conclusion While both neuromodulator classes demonstrated short-term benefit, the majority of patients discontinue treatment prior to 6 months, with patients taking TCAs discontinuing more frequently than patients on gabapentin. Future investigations are warranted evaluating tachyphylaxis and the utility of dual treatment therapies designed to address peripheral and central sensory pathways involved in UCC.
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Affiliation(s)
- Andrew Jay Bowen
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Amy S. Nowacki
- Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Kevin Contrera
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Douglas Trask
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - James Kaltenbach
- Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | | | - Michelle Adessa
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | - Paul C. Bryson
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
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15
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Andersson C, Bonvini SJ, Horvath P, Marquez E, Satia I, Kirkham P, Schleich F, Idzko M, Gosens R, Lopez-Campos JL, Bossios A, Usmani O, Spanevello A, Adcock IM, Mathioudakis AG. Research highlights from the 2017 ERS International Congress: airway diseases in focus. ERJ Open Res 2018; 4:00163-2017. [PMID: 29546046 PMCID: PMC5847812 DOI: 10.1183/23120541.00163-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/11/2018] [Indexed: 11/24/2022] Open
Abstract
For another year, high-quality research studies from around the world transformed the annual ERS International Congress into a vivid platform to discuss trending research topics, to produce new research questions and to further push the boundaries of respiratory medicine and science. This article reviews only some of the high-quality research studies on asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and chronic cough that were presented during the congress through the Airway Diseases Assembly (ERS Assembly 5) and places them into the context of current knowledge and research challenges. Members of the @ERStalk Airway Diseases Assembly discuss clinical highlights from #ERSCongress 2017http://ow.ly/G51Y30i7fMR
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Affiliation(s)
| | - Sara J Bonvini
- National Heart and Lung Institute, Imperial College, London, UK
| | - Peter Horvath
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Eduardo Marquez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Campus Hospital Universitario Virgen del Rocío and Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES) and Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Imran Satia
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Paul Kirkham
- Dept of Biomedical Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Florence Schleich
- Dept of Respiratory Medicine, Centre Hospitalier Universitaire (CHU) de Liège and Research Group GIGA I3, University of Liège, Liège, Belgium
| | - Marco Idzko
- Dept of Pneumology, Medical University of Vienna, Vienna, Austria
| | - Reinoud Gosens
- Dept of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Jose Luis Lopez-Campos
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES) and Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Apostolos Bossios
- Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.,Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Omar Usmani
- National Heart and Lung Institute, Imperial College, London, UK
| | - Antonio Spanevello
- Università degli Studi dell'Insubria and Fondazione S. Maugeri, Varese, Italy
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College, London, UK
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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16
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Risks and Cough-Aggravating Factors in Prolonged Cough. Epidemiological Observations from the Nagahama Cohort Study. Ann Am Thorac Soc 2018; 14:698-705. [PMID: 28186843 DOI: 10.1513/annalsats.201608-616bc] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Chronic cough hypersensitivity, a potentially important concept of chronic or prolonged cough, is featured by heightened cough response to low-intensity stimuli, which may be generated in the absence of airflow limitations or allergic conditions. However, there is little epidemiological evidence to support this. OBJECTIVES In this large-scale community survey, we aimed to determine risks and cough-aggravating factors of prolonged cough while focusing on serum IgE levels. METHODS Prevalence of prolonged cough, defined as cough lasting 3 weeks or longer, was determined in 9,804 residents from a baseline measurement of the Nagahama Cohort Study, conducted from 2008 to 2010. Risk assessment of prolonged cough was confined to subjects without asthma (n = 9,402). A follow-up measurement of the Nagahama Study was successively conducted from 2013 to 2015, recruiting the same residents living in Nagahama City, Japan (n = 8,292). Validation analysis was performed in the follow-up measurement. RESULTS In a baseline measurement, prolonged cough was reported by 9.5% of subjects without asthma and 32.3% of subjects with asthma. In subjects without asthma, various cough-aggravating factors were associated with prolonged cough. On the multivariate analysis, several cough-aggravating factors, including nighttime or early morning, weather, pollen season, and common cold, were associated with prolonged cough, independent of female sex, younger age, chronic obstructive pulmonary disease, postnasal drip, daytime sputum, and lower serum total IgE. Serum-specific IgE levels against Japanese cedar pollen were significantly higher in subjects who responded "yes" to "cough in the pollen season" than in those who did not respond, whereas, among subjects who responded "yes" to "cough in the pollen season," prolonged coughers showed lower serum IgE levels against Japanese cedar pollen than temporal coughers. Validation analysis in a follow-up measurement confirmed the associations between prolonged cough and cough-aggravating factors observed in the baseline measurement. CONCLUSIONS The presence of several cough-aggravating factors in the absence of severe allergic conditions may support the presence of cough hypersensitivity.
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Bonvini SJ, Belvisi MG. Cough and airway disease: The role of ion channels. Pulm Pharmacol Ther 2017; 47:21-28. [PMID: 28669932 DOI: 10.1016/j.pupt.2017.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023]
Abstract
Cough is the most common reason for patients to visit a primary care physician, yet it remains an unmet medical need. It can be idiopathic in nature but can also be a troublesome symptom across chronic lung diseases such as asthma, COPD and idiopathic pulmonary fibrosis (IPF). Chronic cough affects up to 12% of the population and yet there are no safe and effective therapies. The cough reflex is regulated by vagal, sensory afferent nerves which innervate the airway. The Transient Receptor Potential (TRP) family of ion channels are expressed on sensory nerve terminals, and when activated can evoke cough. This review focuses on the role of 4 TRP channels; TRP Vannilloid 1 (TRPV1), TRP Ankyrin 1 (TRPA1), TRP Vannilloid 4 (TRPV4) and TRP Melastatin 8 (TRPM8) and the purinergic P2X3 receptor and their possible role in chronic cough. We conclude that these ion channels, given their expression profile and their role in the activation of sensory afferents and the cough reflex, may represent excellent therapeutic targets for the treatment of respiratory symptoms in chronic lung disease.
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Affiliation(s)
- Sara J Bonvini
- Respiratory Pharmacology Group, Airway Disease Section, National Heart & Lung Institute, Imperial College, Exhibition Road, London SW7 2AZ, UK
| | - Maria G Belvisi
- Respiratory Pharmacology Group, Airway Disease Section, National Heart & Lung Institute, Imperial College, Exhibition Road, London SW7 2AZ, UK.
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van Manen MJG, Birring SS, Vancheri C, Cottin V, Renzoni EA, Russell AM, Wijsenbeek MS. Cough in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 25:278-86. [PMID: 27581827 DOI: 10.1183/16000617.0090-2015] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 01/30/2016] [Indexed: 01/22/2023] Open
Abstract
Many patients with idiopathic pulmonary fibrosis (IPF) complain of chronic refractory cough. Chronic cough is a distressing and disabling symptom with a major impact on quality of life. During recent years, progress has been made in gaining insight into the pathogenesis of cough in IPF, which is most probably "multifactorial" and influenced by mechanical, biochemical and neurosensory changes, with an important role for comorbidities as well. Clinical trials of cough treatment in IPF are emerging, and cough is increasingly included as a secondary end-point in trials assessing new compounds for IPF. It is important that such studies include adequate end-points to assess cough both objectively and subjectively. This article summarises the latest insights into chronic cough in IPF. It describes the different theories regarding the pathophysiology of cough, reviews the different methods to assess cough and deals with recent and future developments in the treatment of cough in IPF.
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Affiliation(s)
- Mirjam J G van Manen
- Dept of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Carlo Vancheri
- Dept of Clinical and Experimental Medicine, Section of Respiratory Disease, University of Catania, Catania, Italy
| | - Vincent Cottin
- Dept of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | | | - Anne-Marie Russell
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK
| | - Marlies S Wijsenbeek
- Dept of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Pacheco A. Tos crónica. La necesidad de optimizar su tratamiento. Med Clin (Barc) 2016; 147:248-9. [DOI: 10.1016/j.medcli.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/30/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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Francis DO, Slaughter JC, Ates F, Higginbotham T, Stevens KL, Garrett CG, Vaezi MF. Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough. Clin Gastroenterol Hepatol 2016; 14:378-84. [PMID: 26492842 PMCID: PMC4761487 DOI: 10.1016/j.cgh.2015.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/23/2015] [Accepted: 10/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although chronic cough is common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough. METHODS We performed a blinded, cross-sectional study of nonsmoking patients with chronic cough (duration, >8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression. RESULTS Seventeen patients met the inclusion criteria (88% female; 100% white; median age, 63 years [interquartile age range, 52-66 years]; mean body mass index, 30.6 [interquartile range, 27.9-34.0]); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 minutes after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17-1.82; P < .001) and 1.71-fold in association with the combination of phonation and reflux events. CONCLUSIONS Antecedent phonation and reflux increased the rate of cough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough ClinicalTrials.gov number: NCT01263626.
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Affiliation(s)
- David O. Francis
- Vanderbilt Voice Center, Vanderbilt University Medical Center,Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center
| | | | - Fehmi Ates
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center
| | - Tina Higginbotham
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center
| | - Kristin L. Stevens
- Vanderbilt University Medical School, Vanderbilt University Medical Center
| | | | - Michael F. Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center
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Pacheco A, de Diego A, Domingo C, Lamas A, Gutierrez R, Naberan K, Garrigues V, López Vime R. Tos crónica. Arch Bronconeumol 2015; 51:579-89. [DOI: 10.1016/j.arbres.2015.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/21/2015] [Accepted: 03/23/2015] [Indexed: 12/16/2022]
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