1
|
Bali V, Adriano A, Byrne A, Akers KG, Frederickson A, Schelfhout J. Chronic cough: more than just a persistent cough: a systematic literature review to understand the impact of chronic cough on quality of life. Qual Life Res 2024; 33:903-916. [PMID: 38153616 DOI: 10.1007/s11136-023-03556-1] [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] [Accepted: 11/03/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Chronic cough (CC), defined as a cough persisting ≥ 8 weeks, can have a substantial negative impact on health-related quality of life (HRQoL). This is exacerbated by challenges with timely diagnosis and a lack of approved therapies. A systematic literature review (SLR) was conducted to identify evidence on HRQoL and health state utility values associated with refractory CC or unexplained CC. METHODS Electronic database searches were supplemented with searches of conference proceedings and health technology assessment body websites. Two independent reviewers assessed all citations for inclusion based on predefined inclusion/exclusion criteria. Key inclusion criteria were patient populations with CC and reporting of patient-reported outcomes or utilities using generic or disease-specific measures. RESULTS Following screening, 65 studies were identified for inclusion in the SLR. Of these, 23 studies assessed HRQoL among patients with CC who were not treated or treated with unspecified interventions, and 42 studies in patients who were treated with specified interventions. The studies indicated a substantial decrement to HRQoL as a result of CC, characterized by generic and disease-specific patient-reported outcome measures. HRQoL was impacted across multiple domains, including physical, psychological, and social functioning. The studies also demonstrated the potential for treatments to have a significant positive impact on HRQoL. CONCLUSIONS CC can substantially affect HRQoL in patients, across physical, psychological, and social domains. Although treatments can improve HRQoL in these patients, the available evidence is limited. There remains an unmet need for approved pharmacological treatments to alleviate CC and improve HRQoL for these patients.
Collapse
Affiliation(s)
- Vishal Bali
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, Rahway, NJ, USA.
- Merck & Co. Inc, 351 N Sumneytown Pike, Mailstop: UG4D-48, North Wales, PA, 19454, USA.
| | - Ada Adriano
- Outcomes Research, MSD (UK) Limited, London, UK
| | - Aidan Byrne
- Outcomes Research, MSD (UK) Limited, London, UK
| | | | | | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co. Inc, Rahway, NJ, USA
| |
Collapse
|
2
|
Koskela HO, Nurmi HM, Birring SS. Utility of Cough Provocation Tests in Chronic Cough and Respiratory Diseases: A Comprehensive Review and Introduction of New Reference Ranges for the Capsaicin Test. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:833-849. [PMID: 34734503 PMCID: PMC8569027 DOI: 10.4168/aair.2021.13.6.833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/09/2021] [Accepted: 08/17/2021] [Indexed: 01/20/2023]
Abstract
Cough provocation tests (CPTs) are an objective measurement of the sensitivity of the cough reflex arc. However, they are not established in clinical practice because a large variability of response in healthy subjects limits their diagnostic value. There is a paucity of studies that have investigated CPT reference ranges in healthy subjects. This systematic review describes the variability of the responses to CPTs in healthy subjects and factors that influence it. A new analysis of 134 healthy subjects was conducted to create reference ranges for single-breath capsaicin CPT by calculating the interquartile ranges for the provocative concentration of capsaicin to induce 2 and 5 coughs. Female subjects had a more sensitive cough reflex than male counterparts. The ability of CPTs to distinguish various respiratory diseases from healthy subjects was also reviewed. Cough sensitivity was consistently heightened in the following groups: unselected patients with chronic, refractory, or recurrent cough, unexplained chronic cough, gastro-esophageal reflux-associated cough, cough-variant asthma, lower airway symptoms induced by chemical irritants, and fibrotic interstitial lung diseases. In the following groups, hypersensitivity of the cough reflex was present in those individuals whose symptom profile was predominated by cough: asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and sarcoidosis. In the following conditions, patients usually cough in order to expectorate mucus from their airways, not because of a hypersensitive cough reflex arc: productive cough, asthma, upper airway cough syndrome, COPD, bronchiectasis, cystic fibrosis, and chronic respiratory infections. CPTs have the potential to identify patients with chronic respiratory symptoms due to cough reflex hypersensitivity, thereby providing a targeted approach for therapy.
Collapse
Affiliation(s)
- Heikki Olavi Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - Hanna Maria Nurmi
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Surinder Singh Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
3
|
Lee JWY, Tay TR, Borg BM, Sheriff N, Vertigan A, Abramson MJ, Hew M. Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge. Respirology 2021; 27:48-55. [PMID: 34617364 DOI: 10.1111/resp.14165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/13/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. METHODS We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio-recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k-means cluster analysis. RESULTS Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r = -0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female-predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender-balanced cluster with lower cough frequency and normal laryngeal sensitivity. CONCLUSION Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.
Collapse
Affiliation(s)
- Joy Wei-Yan Lee
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Brigitte M Borg
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Neha Sheriff
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anne Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Abu-Zaid A, Aljaili AK, Althaqib A, Adem F, Alhalal DA, Almubarak AF, Aldughaither SM, Alghabban SA, Alfaraj G, Masoud AT, Alsuhaibani NA. Safety and efficacy of gefapixant, a novel drug for the treatment of chronic cough: A systematic review and meta-analysis of randomized controlled trials. Ann Thorac Med 2021; 16:127-140. [PMID: 34012479 PMCID: PMC8109686 DOI: 10.4103/atm.atm_417_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIM We conducted this systematic review and meta-analysis to investigate the efficacy and safety of gefapixant, a novel P2X3 receptor antagonist, in patients with chronic cough. METHODS We searched four databases for randomized controlled trials (RCTs). We assessed the cough frequency, severity, total Leicester cough questionnaire (LCQ) score, and adverse events. We analyzed the data using Open Meta-Analyst and Review Manager Software. RESULTS We included four unique studies (comprising five stand-alone RCTs) with 439 patients. Compared to placebo, gefapixant had positive anti-tussive effects by improving awake cough frequency (mean difference [MD] = -5.27, 95% confidence interval [CI] [-6.12, -4.42], P < 0.00001), night cough frequency (MD = -3.71, 95% CI [-6.57, -0.85], P = 0. 01), 24 h cough frequency (MD = -4.18, 95% CI [-5.01, -3.36], P < 0.00001), cough severity using the Visual Analog Scale (MD = -13.36, 95% CI [-17.80, -8.92], P < 0.00001), cough severity diary (MD = -0.88, 95% CI [-1.25, -0.51], P < 0.00001), and total LCQ score (MD = 2.00, 95% CI [1.15, 2.86], P = 0. 00001). Meta-regression analyses showed a positive correlation between the gefapixant dose and the incidence of any adverse event (relative risk [RR] = 0.239, 95% CI [0.093, 1.839], P = 0.001) and incidence of adverse event related to treatment (RR = 0.520, 95% CI [0.117, 0.922], P = 0.011). CONCLUSIONS In patient with chronic cough, gefapixant exhibits favorable anti-tussive outcomes by improving the cough frequency, severity, and quality of life. While gefapixant is largely tolerable, its side effects (notably taste alteration) are dose dependent.
Collapse
Affiliation(s)
- Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Amnah Althaqib
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fatima Adem
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Ghaidaa Alfaraj
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
5
|
Koskela HO, Nurmi HM, Purokivi MK. Cough-provocation tests with hypertonic aerosols. ERJ Open Res 2020; 6:00338-2019. [PMID: 32337214 PMCID: PMC7167210 DOI: 10.1183/23120541.00338-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
Abstract
Recent advances in cough research suggest a more widespread use of cough-provocation tests to demonstrate the hypersensitivity of the cough reflex arc. Cough-provocation tests with capsaicin or acidic aerosols have been used for decades in scientific studies. Several factors have hindered their use in everyday clinical work: i.e. lack of standardisation, the need for special equipment and the limited clinical importance of the response. Cough-provocation tests with hypertonic aerosols (CPTHAs) involve provocations with hypertonic saline, hypertonic histamine, mannitol and hyperpnoea. They probably act via different mechanisms than capsaicin and acidic aerosols. They are safe and well tolerated and the response is repeatable. CPTHAs can assess not only the sensitivity of the cough reflex arc but also the tendency of the airway smooth muscles to constrict (airway hyper-responsiveness). They can differentiate between subjects with asthma or chronic cough and healthy subjects. The responsiveness to CPTHAs correlates with the cough-related quality of life among asthmatic subjects. Furthermore, the responsiveness to them decreases during treatment of chronic cough. A severe response to CPTHAs may indicate poor long-term prognosis in chronic cough. The mannitol test has been stringently standardised, is easy to administer with simple equipment, and has regulatory approval for the assessment of airway hyper-responsiveness. Manual counting of coughs during a mannitol challenge would allow the measurement of the function of the cough reflex arc as a part of clinical routine. Cough-provocation tests with hypertonic aerosols offer the possibility to measure the function of the cough reflex arc even in everyday clinical workhttp://bit.ly/2RTOfMI
Collapse
Affiliation(s)
- Heikki O Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Hanna M Nurmi
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Minna K Purokivi
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
6
|
Comparison of mannitol and citric acid cough provocation tests. Respir Med 2019; 158:14-20. [PMID: 31542680 DOI: 10.1016/j.rmed.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
RATIONALE Citric acid has been used as a cough provocation test for decades. However, the methods of administration have not been standardized. Inhaled mannitol is a novel cough provocation test, which has regulatory approval and can be performed utilizing a simple disposable inhaler in a standardized manner. OBJECTIVE To compare the mannitol and citric acid cough provocation tests with respect to their ability to identify subjects with chronic cough and their tolerability. METHODS Subjects with chronic cough (n = 36) and controls (n = 25) performed provocation tests with mannitol and citric acid. Both tests were video recorded. Cough sensitivity was expressed as coughs-to-dose ratios (CDR) and the cumulative doses to mannitol or concentration to citric acid evoking 5 coughs (C5). Forced expiratory volume in 1 s (FEV1), visual analogue scales (VAS), test completion rates and the total cough frequencies were analysed. RESULTS Mannitol and citric acid CDR both effectively separated those with cough and the control subjects (AUC 0.847 and 0.803, respectively) as did C5 (AUC 0.823 and 0.763, respectively). There was a good correlation between the cough sensitivity provoked by the two stimuli, either expressed as CDR (r = 0.65, p < 0.001) or C5 (r = 0.53, p = 0.001). Both tests were similarly tolerated in terms of VAS, although more patients discontinued the mannitol test early, primarily due to cough. CONCLUSIONS Mannitol and citric acid tests correlated well, equally identified subjects with chronic cough and their tolerability was similar. The feasibility issues, strict standardisation and regulatory approval may favour mannitol to be used in clinical cough research.
Collapse
|
7
|
Koskela HO, Lake C, Wong K, Brannan JD. Cough sensitivity to mannitol inhalation challenge identifies subjects with chronic cough. Eur Respir J 2018; 51:13993003.00294-2018. [PMID: 29545282 DOI: 10.1183/13993003.00294-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/06/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Heikki O Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Clair Lake
- Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Keith Wong
- Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia.,Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - John D Brannan
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, Australia
| |
Collapse
|
8
|
Johansson EL, Ternesten-Hasséus E, Gustafsson P, Pullerits T, Arvidsson M, Millqvist E. Small and large airway reactions to osmotic stimuli in asthma and chronic idiopathic cough. Pulm Pharmacol Ther 2018; 49:112-118. [PMID: 29438818 DOI: 10.1016/j.pupt.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic cough is a common symptom and related to several pulmonary, airway and heart diseases. When all likely medical explanations for the coughing are excluded, there remains a large group of patients with chronic coughing, which is mostly a cough reflex easily triggered by environmental irritants and noxious stimuli. The main aim of this study was to improve the diagnostic ability to differentiate chronic idiopathic cough (CIC) from asthma. METHODS Twenty-three patients with CIC, 16 patients with mild asthma and 21 control participants were included. The study consisted of three randomised bronchial provocations with osmotic stimuli: mannitol, eucapnic dry air and hypertonic saline. At each provocation lung function was assessed by spirometry and impulse oscillometry (IOS). RESULTS In a comparison of the groups, while the FEV1 measurements did not differ, the CIC group had increased airway resistance and reactance after provocation with hypertonic saline compared to the control subjects. After mannitol provocation the patients with asthma had significantly increased airway resistance compared to the controls and from eucapnic dry air provocations these patients had a significant reduction in spirometry values and increased airway resistance compared to both the patients with CIC and the controls. CONCLUSION The asthma group reacted in a predictable way with impaired lung function from osmotic provocations, whereas the patients with CIC demonstrated peripheral airway changes from hypertonic saline, also known to be a noxious stimulus. The IOS method uncovers differences between patients with CIC and control participants that contribute to our ability to provide a correct diagnosis.
Collapse
Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Ewa Ternesten-Hasséus
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Skovde, Sweden.
| | - Teet Pullerits
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Monica Arvidsson
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| |
Collapse
|
9
|
Demoulin-Alexikova S, Marchal F, Bonabel C, Demoulin B, Foucaud L, Coutier-Marie L, Schweitzer CE, Ioan I. Down-Regulation of Cough during Exercise Is Less Frequent in Healthy Children than Adults. Role of the Development and/or Atopy? Front Physiol 2017; 8:304. [PMID: 28567019 PMCID: PMC5434114 DOI: 10.3389/fphys.2017.00304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/27/2017] [Indexed: 11/18/2022] Open
Abstract
Cough is typically associated with physical activity in children with asthma, but the characteristics of the relationship between cough and exercise has not been established under physiological conditions. The aim of the study was to describe the effect of exercise on the reflex cough response elicited by a single breath of capsaicin in non-asthmatic children. A group of non-asthmatic adults was studied as reference. Thirty children and 29 adults were recruited. The cough reflex sensitivity to capsaicin was first determined to establish the dose that provokes 5 cough efforts (C5). The number of coughs elicited by C5 (NC5) was then compared at baseline and during a standardized submaximal treadmill exercise. Data are expressed as median (interquartile range). Children and adults showed a significant decrease in NC5 (respectively from 5.0 (4.0–6.0) to 2.5 (2.0–4.0), p < 0.0005 and from 6.0 (5.0–7.0) to 2.0 (0.0–3.0, p < 0.0005). During exercise, NC5 was observed to decrease in all adult subjects, but in only 24/30 children (80%, p = 0.02). A trend for a higher incidence of personal and familial atopy was observed in children that lacked cough down-regulation during exercise compared with other children. It is concluded that the cough reflex response to capsaicin is down regulated by exercise in both children and adults. The effect however is less consistently observed in the former. The difference may reflect maturation of descending inhibitory pathways of the cough reflex, but may also be associated to atopy. The data stress the importance of assessing the time relationship of cough and exercise in questionnaire studies of asthma.
Collapse
Affiliation(s)
- Silvia Demoulin-Alexikova
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - François Marchal
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Claude Bonabel
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France
| | - Laurent Foucaud
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France
| | - Laurianne Coutier-Marie
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Cyril E Schweitzer
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Iulia Ioan
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| |
Collapse
|
10
|
Tay TR, Hoy R, Richards AL, Paddle P, Hew M. Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test. J Voice 2016; 31:247.e19-247.e23. [PMID: 27567392 DOI: 10.1016/j.jvoice.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness. METHODS Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists. RESULTS Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006). CONCLUSION Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting.
Collapse
Affiliation(s)
- Tunn Ren Tay
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Ryan Hoy
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Amanda L Richards
- Department of Otolaryngology, Head and Neck Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Paddle
- Department of Otolaryngology, Head and Neck Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Hew
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Abdulqawi R, Dockry R, Holt K, Layton G, McCarthy BG, Ford AP, Smith JA. P2X3 receptor antagonist (AF-219) in refractory chronic cough: a randomised, double-blind, placebo-controlled phase 2 study. Lancet 2015; 385:1198-205. [PMID: 25467586 DOI: 10.1016/s0140-6736(14)61255-1] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Preclinical studies suggest that P2X3 receptors are expressed by airway vagal afferent nerves and contribute to the hypersensitisation of sensory neurons. P2X3 receptors could mediate sensitisation of the cough reflex, leading to chronic cough. We aimed to investigate the efficacy of a first-in-class oral P2X3 antagonist, AF-219, to reduce cough frequency in patients with refractory chronic cough. METHODS We did a double-blind, placebo-controlled, two-period, crossover study at one UK centre. With a computer-generated sequence, we randomly assigned patients with refractory chronic cough to AF-219, 600 mg twice a day, or to placebo (1:1), and then, after a 2 week washout, assigned patients to receive the other treatment. Patients, health-care providers, and investigators were masked to sequence assignment. We assessed daytime cough frequency (primary endpoint) at baseline and after 2 weeks of treatment using 24 h ambulatory cough recordings. The primary analysis used a mixed effects model with the intention-to-treat population. This study was registered at ClinicalTrials.gov, number NCT01432730. FINDINGS Of 34 individuals assessed between Sept 22, 2011, and Nov 29, 2012, we randomly assigned 24 patients (mean age 54·5 years; SD 11·1). In the observed case analysis, cough frequency was reduced by 75% when patients were allocated to AF-219 compared when allocated to placebo (p=0·0003). Daytime cough frequency fell from a mean 37 coughs per h (SD 32) to 11 (8) coughs per h after AF-219 treatment versus 65 (163) coughs per h to 44 (51) coughs per h after placebo. Six patients withdrew before the end of the study because of taste disturbances, which were reported by all patients taking AF-219. INTERPRETATION P2X3 receptors seem to have a key role in mediation of cough neuronal hypersensitivity. Antagonists of P2X3 receptors such as AF-219 are a promising new group of antitussives. FUNDING Afferent Pharmaceuticals.
Collapse
Affiliation(s)
- Rayid Abdulqawi
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; University Hospital of South Manchester, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Rachel Dockry
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; University Hospital of South Manchester, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | - Kimberley Holt
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; University Hospital of South Manchester, Education and Research Centre, University Hospital of South Manchester, Manchester, UK
| | | | | | | | - Jaclyn A Smith
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; University Hospital of South Manchester, Education and Research Centre, University Hospital of South Manchester, Manchester, UK.
| |
Collapse
|
12
|
Boulet LP, Coeytaux RR, McCrory DC, French CT, Chang AB, Birring SS, Smith J, Diekemper RL, Rubin B, Irwin RS. Tools for assessing outcomes in studies of chronic cough: CHEST guideline and expert panel report. Chest 2015; 147:804-814. [PMID: 25522203 PMCID: PMC5991766 DOI: 10.1378/chest.14-2506] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings. METHODS By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel. RESULTS We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges. CONCLUSIONS Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.
Collapse
Key Words
- ahrq, agency for healthcare research and quality
- cb, consensus-based
- cer, comparative effectiveness review
- chest, american college of chest physicians
- coi, conflict of interest
- cqlq, cough-specific quality-of-life questionnaire
- lcq, leicester cough questionnaire
- pcq, pediatric cough questionnaire
- pc-qol, parent cough-specific quality of life questionnaire
- picots, population of interest, interventions, comparators, outcomes, timing of outcomes, and settings
- qol, quality of life
- vas, visual analog scale
Collapse
Affiliation(s)
- Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada.
| | - Remy R Coeytaux
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Douglas C McCrory
- Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Cynthia T French
- Pulmonary, Allergy and Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Anne B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Herston, QLD, Australia
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, England
| | - Jaclyn Smith
- University Hospital of South Manchester, Manchester, England
| | | | - Bruce Rubin
- Virginia Commonwealth University, Richmond, VA
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
13
|
Khalid S, Murdoch R, Newlands A, Smart K, Kelsall A, Holt K, Dockry R, Woodcock A, Smith JA. Transient receptor potential vanilloid 1 (TRPV1) antagonism in patients with refractory chronic cough: a double-blind randomized controlled trial. J Allergy Clin Immunol 2014; 134:56-62. [PMID: 24666696 DOI: 10.1016/j.jaci.2014.01.038] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/29/2013] [Accepted: 01/16/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Inhalation of capsaicin, the extract of hot chili peppers, induces coughing in both animals and human subjects through activation of transient receptor potential vanilloid 1 (TRPV1) on airway sensory nerves. Therefore the TRPV1 receptor is an attractive target for the development of antitussive agents. OBJECTIVE We sought to assess the antitussive effect of TRPV1 antagonism in patients with refractory chronic cough. METHODS Twenty-one subjects with refractory chronic cough (>8 weeks) attending a specialist clinic were recruited to a randomized, double-blind, placebo-controlled crossover trial assessing a TRPV1 antagonist (SB-705498). Cough reflex sensitivity to capsaicin (concentration of capsaicin inducing at least 5 coughs) and 24-hour cough frequency were coprimary end points assessed after a single dose of SB-705498 (600 mg) and matched placebo. Cough severity and urge to cough were reported on visual analog scales, and cough-specific quality of life data were also collected. RESULTS Treatment with SB-705498 produced a significant improvement in cough reflex sensitivity to capsaicin at 2 hours and a borderline significant improvement at 24 hours compared with placebo (adjusted mean difference of +1.3 doubling doses at 2 hours [95% CI, +0.3 to +2.2; P = .0049] and +0.7 doubling doses at 24 hours [95% CI, +0.0 to +1.5; P = .0259]). However, 24-hour objective cough frequency was not improved compared with placebo. Patient-reported cough severity, urge to cough, and cough-specific quality of life similarly suggested no effect of SB-705498. CONCLUSION This study raises important questions about both the role of TRVP1-mediated mechanisms in patients with refractory chronic cough and also the predictive value of capsaicin challenge testing in the assessment of novel antitussive agents.
Collapse
Affiliation(s)
- Saifudin Khalid
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom
| | | | | | | | - Angela Kelsall
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom
| | - Kimberley Holt
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom
| | - Rachel Dockry
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom
| | - Ashley Woodcock
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jaclyn A Smith
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom.
| |
Collapse
|
14
|
Schmit KM, Coeytaux RR, Goode AP, McCrory DC, Yancy WS, Kemper AR, Hasselblad V, Heidenfelder BL, Sanders GD. Evaluating cough assessment tools: a systematic review. Chest 2014; 144:1819-1826. [PMID: 23928647 DOI: 10.1378/chest.13-0310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Little is known about the comparative validity, reliability, or responsiveness of instruments for assessing cough frequency or impact, where the term impact encompasses both cough severity and the impact of cough on health-related quality of life. METHODS We conducted a systematic review to evaluate instruments that assess cough frequency or impact in adults, adolescents, and children with acute or chronic cough. RESULTS Seventy-eight studies were included, of which eight were randomized controlled trials and 70 were observational studies. In all age groups, audio and video electronic recording devices had good reliability compared with other methods of assessing cough frequency but had variable correlation with other cough assessments, such as visual analog scale scores, quality-of-life questionnaires, cough diaries, and tussigenic challenges. Among adult and adolescent patients, the Leicester Cough Questionnaire (LCQ) and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) were valid and reliable, showing high intraclass and test-retest correlations. Among children, the Parent Cough-Specific Quality of Life Questionnaire and Pediatric Cough Questionnaire were valid and reliable. CONCLUSIONS Electronic recording devices can be valid assessments of cough frequency. The LCQ and CQLQ for adults and the Parent Cough-Specific Quality of Life questionnaire for children are valid instruments for assessing cough impact. There is limited but insufficient evidence to determine the reliability or concurrent validity of the different types of cough diaries or visual analog scale scores. There are also limited data to support the responsiveness of recording devices. There is good responsiveness data for the LCQ and CQLQ, but more evidence is needed.
Collapse
Affiliation(s)
- Kristine M Schmit
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.
| | - Remy R Coeytaux
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Adam P Goode
- Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Douglas C McCrory
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC
| | - Alex R Kemper
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Vic Hasselblad
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Brooke L Heidenfelder
- Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| | - Gillian D Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University, Durham, NC
| |
Collapse
|
15
|
Porsbjerg C, Sverrild A, Backer V. The usefulness of the mannitol challenge test for asthma. Expert Rev Respir Med 2014; 7:655-63. [DOI: 10.1586/17476348.2013.847370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
16
|
Abstract
This article reviews the diagnostic challenge methods-both exercise and surrogate-for diagnosis of exercise-induced bronchoconstriction (EIB) and EIB with known asthma. Indirect challenges that release the entire repertoire of mediators representative of EIB and asthma are more specific for diagnosis and are recommended over direct challenges such as methacholine challenge, which are sensitive but nonspecific. Self-reported history and empiric therapeutic trials are not adequate for diagnosis of EIB with or without known asthma. Objective pulmonary function documentation with bronchodilator reversibility or exercise or surrogate challenge are optimal for diagnosis of EIB or EIB with known asthma. Such objective pulmonary function documentation is optimal for the proper management and healthy lifestyle of the exercising athlete or individual.
Collapse
Affiliation(s)
- Christopher Randolph
- Department of Pediatrics/Medicine, Division of Allergy/Immunology Center for Allergy, Asthma, and Immunology, Yale University, Waterbury, CT 06708, USA.
| |
Collapse
|
17
|
Purokivi M, Koskela H, Brannan JD, Kontra K. Cough response to isocapnic hyperpnoea of dry air and hypertonic saline are interrelated. COUGH 2011; 7:8. [PMID: 21999754 PMCID: PMC3205007 DOI: 10.1186/1745-9974-7-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 10/14/2011] [Indexed: 01/13/2023]
Abstract
Background Mechanisms behind asthmatic cough are largely unknown. It is known that hyperosmolar challenges provoke cough in asthmatic but not in the healthy subjects. It has been postulated that isocapnic hyperpnea of dry air (IHDA) and hypertonic aerosols act via similar mechanisms in asthma to cause bronchoconstriction. We investigated whether there is an association between cough response induced by IHDA and hypertonic saline (HS) challenges. Methods Thirty-six asthmatic and 14 healthy subjects inhaled HS solutions with increasing osmolalities administered via ultrasonic nebuliser until 15 cumulative coughs were recorded. The IHDA consisted of three three-minute ventilation steps: 30%, 60% and 100% of maximal voluntary ventilation with an end-point of 30 cumulative coughs. The challenges were performed on separate days at least 48 hours between them and within one week. Inhaled salbutamol (400 mcg) was administered before the challenges to prevent bronchoconstriction. The cough response was expressed as the cough-to-dose ratio (CDR) which is the total number of coughs divided by the maximal osmolality inhaled or the maximal ventilation achieved. Results Cough response to IHDA correlated with the HS challenge (Rs = 0.59, p < 0.001). Cough response to IHDA was at its strongest during the first minute after the challenge. IHDA induced more cough among asthmatic than healthy subjects CDR being (mean ± SD) 0.464 ± 0.514 and 0.011 ± 0.024 coughs/MVV%, p < 0.001, respectively. Salbutamol effectively prevented bronchoconstriction to both challenges. Conclusions Asthmatic patients are hypersensitive to the cough-provoking effect of hyperpnoea, as they are to hypertonicity. Cough response induced by IHDA and HS correlated well suggesting similar mechanisms behind the responses.
Collapse
Affiliation(s)
- Minna Purokivi
- Department of Respiratory Medicine, Kuopio University Hospital, P,O, Box 1777, 70211 Kuopio, Finland.
| | | | | | | |
Collapse
|
18
|
Mäki-Arvela P, Salmi T, Holmbom B, Willför S, Murzin DY. Synthesis of sugars by hydrolysis of hemicelluloses--a review. Chem Rev 2011; 111:5638-66. [PMID: 21682343 DOI: 10.1021/cr2000042] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Päivi Mäki-Arvela
- Process Chemistry Centre, Åbo Akademi University, 20500 Turku/Åbo, Finland
| | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Performing a bronchial provocation test (BPT) using a direct or indirect stimulus to identify bronchial hyper-responsiveness (BHR) reduces the possibility of over and under-diagnosis of asthma based on history and symptoms. This review discusses some long-held beliefs of BPTs to include or exclude a diagnosis of asthma or exercise-induced bronchoconstriction (EIB). RECENT FINDINGS A high frequency of negative methacholine tests has been reported in 240 patients given a diagnosis of asthma at the end of the study, many of whom had documented EIB. This suggests that a negative methacholine test should not be relied upon to rule out asthma. Further, a positive methacholine test alone should be interpreted with caution as it may reflect airway injury rather than asthma or EIB. Mannitol, an indirect stimulus, identified a similar prevalence of BHR to methacholine and identified more patients than a single exercise test in three studies. However, neither mannitol nor methacholine identified all patients with EIB. Mannitol has a higher specificity for a physician diagnosis of asthma than methacholine. SUMMARY It is likely that both a direct test and an indirect test result may be required in some patients in order to confirm or exclude a diagnosis of asthma with certainty.
Collapse
|
20
|
Borges MDC, Ferraz E, Vianna EO. Bronchial provocation tests in clinical practice. SAO PAULO MED J 2011; 129:243-9. [PMID: 21971900 PMCID: PMC10896023 DOI: 10.1590/s1516-31802011000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 02/26/2009] [Accepted: 02/24/2011] [Indexed: 11/22/2022] Open
Abstract
Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.
Collapse
Affiliation(s)
- Marcos de Carvalho Borges
- MD, PhD. Visiting Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, and Adjunct Professor, Department of Medicine, Universidade de São Carlos (UFSCar), São Carlos, São Paulo, Brazil.
| | - Erica Ferraz
- PhD. Research Collaborator, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, Brazil.
| | - Elcio Oliveira Vianna
- MD, PhD. Associate Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|
21
|
Birring SS. Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 2010; 183:708-15. [PMID: 21148722 DOI: 10.1164/rccm.201007-1017ci] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic cough that cannot be explained after basic evaluation is a common reason for patients to be referred to respiratory outpatient clinics. Asthma, gastroesophageal reflux, and upper airway disorders frequently coexist with chronic cough. There is some controversy as to whether these conditions are causes or aggravants of cough. Heightened cough reflex sensitivity is an important feature in most patients. There is good evidence that it is reversible when associated with upper respiratory tract infection, angiotensin-converting enzyme inhibitor medications, and chronic cough associated with eosinophilic airway inflammation. In many patients, heightened cough reflex sensitivity is persistent and their cough is unexplained. There are few therapeutic options for patients with unexplained chronic cough. There is a pressing need to understand the genetic, molecular, and physiological basis of unexplained chronic cough and to develop novel antitussive drugs that down-regulate cough reflex sensitivity.
Collapse
Affiliation(s)
- Surinder S Birring
- King's College London, Division of Asthma, Allergy and Lung Biology, Denmark Hill, London SE5 9RS, UK.
| |
Collapse
|
22
|
McGarvey LPA, Elder J. Future directions in treating cough. Otolaryngol Clin North Am 2010; 43:199-211, xii. [PMID: 20172268 DOI: 10.1016/j.otc.2009.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cough is a common and troublesome symptom that can be difficult to treat. New therapeutic options that are safe and more effective than those currently available are needed. In this article, the authors offer opinion on future directions in the treatment of cough, with a particular emphasis on the clinical syndrome associated with cough reflex hypersensitivity. In addition, the article provides an overview of some of the diagnostic technologies and promising drug targets likely to emerge from current clinical and scientific endeavor.
Collapse
Affiliation(s)
- Lorcan P A McGarvey
- Centre for Infection and Immunity, The Queen's University of Belfast, Belfast, Northern Ireland, UK.
| | | |
Collapse
|
23
|
Spector S. Use of mannitol inhalation challenge in assessment of cough. Lung 2009; 188 Suppl 1:S99-103. [PMID: 19756864 PMCID: PMC2816235 DOI: 10.1007/s00408-009-9174-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/24/2009] [Indexed: 11/25/2022]
Abstract
Bronchial provocation testing uses a variety of direct and indirect inhalational challenges to evaluate airway hyperreactivity. Mannitol, a simple, easy-to-administer hypertonic stimulus available in many countries, is currently under review by the FDA in the US. Healthy subjects show no airway response to inhaled mannitol; asthmatic patients respond with airway narrowing similar to challenges with hypertonic saline and exercise. Mannitol challenge also has a tussive effect that is independent of bronchoconstriction, suggesting different physiologic pathways. Patients with chronic cough show increased sensitivity to mannitol, and mannitol testing may be useful for evaluating heterogeneity in the cough response.
Collapse
Affiliation(s)
- Sheldon Spector
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,
| |
Collapse
|
24
|
McGarvey L. The management of cough: a clinical year in review. Lung 2009; 188 Suppl 1:S3-8. [PMID: 19697083 DOI: 10.1007/s00408-009-9168-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 07/26/2009] [Indexed: 11/30/2022]
Abstract
As the number of published articles in the field of cough increases year on year, it is sometimes helpful to pause and review what might have passed us by. This "Clinical Year in Review" provides an opportunity to reflect on a number of important studies reported in the area of both adult and pediatric cough. It would be impossible to cover all the important published literature; therefore, this effort has been confined to selected topics published in the last 12 months with direct relevance to the clinical management, measurement, and treatment of cough. While this article reflects a personal commentary of the literature, it is hoped that it will contribute to improving "evidence-based" care for the many individuals burdened with a troublesome cough.
Collapse
Affiliation(s)
- Lorcan McGarvey
- Respiratory Medicine Research Group, Centre for Infection and Immunity, The Queen's University of Belfast, Grosvenor Road, Belfast, BT12 6BJ, Northern Ireland,
| |
Collapse
|
25
|
Ghoreishi S, Shahrestani RG. Innovative strategies for engineering mannitol production. Trends Food Sci Technol 2009. [DOI: 10.1016/j.tifs.2009.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|