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Harvanová G, Csanády A, Duranková S. Impact of pollen season and viral disease COVID-19 on respiratory function of the adult population in Eastern Slovakia: analysis of spirometric data and results of a questionnaire survey. J Asthma 2024; 61:745-753. [PMID: 38193466 DOI: 10.1080/02770903.2024.2303762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Asthma is a chronic heterogeneous disease with characteristic symptoms, but with proper treatment the patient can lead a full life. In patients with allergic asthma, symptoms appear after irritation with an allergen, most often in the pollen season. In 2019, the viral disease COVID-19 appeared, which, especially in people with asthma, led not only to an asthma attack, but also to other serious diseases. METHODS The main aim was to investigate differences in patients' health status by comparing spirometric values in and out of pollen season (A), spirometric values before and after COVID-19 viral illness (B) and an anonymous questionnaire (C). Spirometric values were recorded in each patient (control group - patients diagnosed with asthma, research group - patients after overcoming COVID-19 disease) in 3 cycles, namely (in the pollen period, in the non-pollen period and after overcoming COVID-19 disease - at an interval of 2 months after a negative PCR test). RESULTS We observed significant results during the individual spirometry performed (A) during the pollen season and non-pollen season. We observed the same in patients after they received COVID-19 treatment (B). Patients were also asked questions regarding family history, symptoms and their variability, worsening of the condition or correct inhalation technique (C). CONCLUSION Our research shows that the PEF parameter is most affected by the pollen and non-pollen season in asthmatic patients. Significant differences in PEF parameter were observed between genders, where we observed highly significant statistical significance of PEF parameter in pollen and non-pollen season in females.
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Affiliation(s)
- Gabriela Harvanová
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
| | - Alexander Csanády
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
| | - Silvia Duranková
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Prešov, Prešov, Slovakia
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Ibrahim Arif S, Amer YS, Adnan Alkamal T, Abdulrahman Binsaeed M, Ibrahim Arif B, Dhaifallah Albaqami M, Bakri Alfahed O. Patient response to the management during the acute presentation of cough variant Asthma: Retrospective cohort study. Saudi J Biol Sci 2023; 30:103875. [PMID: 38058763 PMCID: PMC10696240 DOI: 10.1016/j.sjbs.2023.103875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
The clinical improvement after assessing patients with cough variant asthma in outpatient clinics, and therapy success varied depending on the subjective improvement. Cough could be controlled within appropriate time and subsequent management can consist of inhaled corticosteroids. In this study we used the cough improvement, the only available clinical response, as a predictable factor to determine the effect of different modalities of treatment among patients with cough variant asthma. Retrospective observational analysis was performed in Saudi Arabia's King Saud University Medical City, on the presentation, diagnosis, course of therapy, and responsiveness to oral and inhaled steroids in patients with cough variant asthma. All patients who visited the clinic on multiple occasions with persistent, acute coughing without being pre-screened between September 2021 and September 2022 included based on medical records. Cough resembles cough variant asthma is the term used to describe a cough without a diagnosed etiology. To identify patients eligible for CVA treatment, iindividuals having GERD-associated cough, allergic rhinitis, bronchial asthma, smokers and atopic cough was excluded. For the examination of these findings, IBM SPSS version 28 (Armonk, NY, USA) was employed. As a result of using budesonide-formoterol inhaler, most patients (86.3 %) showed improvement in their cough symptoms (with 95 %CI: 78.3 to 94.9). There was a significant yet weak positive correlation between the frequency of cough symptoms before and after using budesonide-formoterol (r = 0.318, P value < 0.001). The understanding of treatment response and patient selection for budesonide-formoterol inhaler therapy, providing clinicians with valuable information to optimize patient care.
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Affiliation(s)
- Samir Ibrahim Arif
- Family Medicine Center, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser S. Amer
- CPG and Quality Research Unit, Quality Management Department, Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | | | - Bandar Ibrahim Arif
- Intern, Clinical Pharmacy, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Meshari Dhaifallah Albaqami
- Nursing Services Department, Occupational Health and Safety Clinic King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ousama Bakri Alfahed
- Family Medicine Center, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
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Hirons B, Rhatigan K, Kesavan H, Turner RD, Birring SS, Cho PSP. Cough in chronic lung disease: a state of the art review. J Thorac Dis 2023; 15:5823-5843. [PMID: 37969279 PMCID: PMC10636467 DOI: 10.21037/jtd-22-1776] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Chronic cough (CC; ≥8 weeks in duration) is a common and burdensome feature of respiratory diseases. The understanding of cough has progressed significantly in recent years, albeit largely in refractory (unexplained) chronic cough (RCC) in the absence of other respiratory conditions. The prevalence of CC in respiratory diseases is poorly described, but estimates have been reported: asthma (8-58%), chronic obstructive pulmonary disease (COPD; 10-74%), bronchiectasis (82-98%), interstitial lung disease (ILD; 50-89%) and sarcoidosis (3-64%). CC in respiratory conditions generally predicts impaired health status and more severe disease. It is associated with increased symptom burden and disease severity in asthma, COPD, bronchiectasis and ILD, higher exacerbation frequency in asthma and bronchiectasis, and increased mortality and lung transplantation in idiopathic pulmonary fibrosis (IPF). Physiologically, heightened cough reflex sensitivity (CRS) has been reported and postulated to be mechanistic in isolated RCC. Cough reflex hypersensitivity (CRH) has also been reported in asthma, COPD, bronchiectasis, ILD and sarcoidosis. Unlike recent advances in isolated RCC, there are limited studies and understanding of central cough neuropathways in other respiratory conditions. Of note, dysfunctional central voluntary cough suppression neuropathways and physiology were observed in isolation in RCC; cough suppression is preserved in COPD. Understanding in the mechanism of RCC cannot be simply extrapolated to other respiratory conditions. The restricted understanding of cough mechanisms in these conditions has limited cough-specific therapeutic options in this context. There is currently an unmet need to expand our understanding of cough in chronic respiratory conditions, both in order to improve the quality of life of patients, and to improve knowledge of cough in general. This review aims to describe the prevalence, impact, pathophysiology and management of CC in asthma, COPD, bronchiectasis, ILD and sarcoidosis.
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Affiliation(s)
- Barnaby Hirons
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- 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
| | - Katherine Rhatigan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- 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
| | - Harini Kesavan
- Department of Respiratory Medicine, King’s College Hospital, London, UK
| | - Richard D. Turner
- Department of Respiratory Medicine, Gold Coast University Hospital, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Surinder S. Birring
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- 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
| | - Peter S. P. Cho
- Department of Respiratory Medicine, King’s College Hospital, London, UK
- 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
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Siegel C, Tecce E, Vaile JR, Maheu A, Close J. Asthma Prevalence among Athletes in an Urban Adolescent Population. J Community Health 2023; 48:898-902. [PMID: 37219790 DOI: 10.1007/s10900-023-01239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To identify individuals at risk of asthma by assessing the prevalence of asthma in an urban, athletic adolescent population using preparticipation physical evaluation (PPE) data. STUDY DESIGN Using the Athlete Health Organization (AHO) PPE data from 2016 to 2019, asthma prevalence was collected by reported diagnosis in the history or physical. Chi-square tests and logistic regression were performed to characterize the relationship between asthma and social factors such as race, ethnicity, and income. Control variables such as age, body mass index, blood pressure, sex, and family history were also collected. RESULTS Over 2016-2019, 1,400 athletes ranging from 9 to 19 years of age had completed PPEs (Table 1). A large percentage of student-athletes were found to have asthma (23.4%), of whom a majority 86.3% resided in low-income zip-codes. Additionally, 65.5% of athletes with asthma identified as Black, with race being associated with asthma prevalence (p < 0.05). Demographic factors like income, age, and gender were not significantly associated with asthma prevalence. CONCLUSIONS Self-identified Black individuals reported higher prevalence of asthma when compared to the general population. Identifying factors like race and income that place adolescent athletes at risk of asthma is a key step to understanding the complex relationship between asthma and social determinants of health. This work advances the conversation for establishing best practices for serving vulnerable populations, as seen in this urban population of children with asthma.
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Affiliation(s)
- Charles Siegel
- Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St. Suite 401, Philadelphia, PA, 19107, USA.
| | - Eric Tecce
- Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St. Suite 401, Philadelphia, PA, 19107, USA
| | - John R Vaile
- Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St. Suite 401, Philadelphia, PA, 19107, USA
| | - Arlene Maheu
- Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut St. Suite 401, Philadelphia, PA, 19107, USA
| | - Jeremy Close
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA, USA
- Athlete Health Organization, Philadelphia, PA, USA
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Barata F, Cleres D, Tinschert P, Iris Shih CH, Rassouli F, Boesch M, Brutsche M, Fleisch E. Nighttime Continuous Contactless Smartphone-Based Cough Monitoring for the Ward: Validation Study. JMIR Form Res 2023; 7:e38439. [PMID: 36655551 PMCID: PMC9989914 DOI: 10.2196/38439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/17/2022] [Accepted: 01/17/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinical deterioration can go unnoticed in hospital wards for hours. Mobile technologies such as wearables and smartphones enable automated, continuous, noninvasive ward monitoring and allow the detection of subtle changes in vital signs. Cough can be effectively monitored through mobile technologies in the ward, as it is not only a symptom of prevalent respiratory diseases such as asthma, lung cancer, and COVID-19 but also a predictor of acute health deterioration. In past decades, many efforts have been made to develop an automatic cough counting tool. To date, however, there is neither a standardized, sufficiently validated method nor a scalable cough monitor that can be deployed on a consumer-centric device that reports cough counts continuously. These shortcomings limit the tracking of coughing and, consequently, hinder the monitoring of disease progression in prevalent respiratory diseases such as asthma, chronic obstructive pulmonary disease, and COVID-19 in the ward. OBJECTIVE This exploratory study involved the validation of an automated smartphone-based monitoring system for continuous cough counting in 2 different modes in the ward. Unlike previous studies that focused on evaluating cough detection models on unseen data, the focus of this work is to validate a holistic smartphone-based cough detection system operating in near real time. METHODS Automated cough counts were measured consistently on devices and on computers and compared with cough and noncough sounds counted manually over 8-hour long nocturnal recordings in 9 patients with pneumonia in the ward. The proposed cough detection system consists primarily of an Android app running on a smartphone that detects coughs and records sounds and secondarily of a backend that continuously receives the cough detection information and displays the hourly cough counts. Cough detection is based on an ensemble convolutional neural network developed and trained on asthmatic cough data. RESULTS In this validation study, a total of 72 hours of recordings from 9 participants with pneumonia, 4 of whom were infected with SARS-CoV-2, were analyzed. All the recordings were subjected to manual analysis by 2 blinded raters. The proposed system yielded a sensitivity and specificity of 72% and 99% on the device and 82% and 99% on the computer, respectively, for detecting coughs. The mean differences between the automated and human rater cough counts were -1.0 (95% CI -12.3 to 10.2) and -0.9 (95% CI -6.5 to 4.8) coughs per hour within subject for the on-device and on-computer modes, respectively. CONCLUSIONS The proposed system thus represents a smartphone cough counter that can be used for continuous hourly assessment of cough frequency in the ward.
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Affiliation(s)
- Filipe Barata
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - David Cleres
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Peter Tinschert
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Resmonics AG, Zurich, Switzerland
| | - Chen-Hsuan Iris Shih
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Resmonics AG, Zurich, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Martin Brutsche
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
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Masson V, Kier C, Chandran L. Cough Conundrums: A Guide to Chronic Cough in the Pediatric Patient. Pediatr Rev 2022; 43:691-703. [PMID: 36450640 DOI: 10.1542/pir.2021-005398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Vicki Masson
- Division of Pediatric Pulmonology and Sleep Medicine
| | - Catherine Kier
- Division of Pediatric Pulmonology, Stony Brook University, Stony Brook, NY
| | - Latha Chandran
- Department of Medical Education and Pediatrics, University of Miami, Miller School of Medicine, Miami, FL
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Menezes PMN, Pereira ECV, Lima KSB, Silva BAOD, Brito MC, Araújo TCDL, Neto JA, Ribeiro LADA, Silva FS, Rolim LA. Chemical Analysis by LC-MS of Cannabis sativa Root Samples from Northeast Brazil and Evaluation of Antitussive and Expectorant Activities. PLANTA MEDICA 2022; 88:1223-1232. [PMID: 34715694 DOI: 10.1055/a-1628-2299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cannabis sativa is a millenary medicinal plant. However, contrary to worldwide paradigm-shifting, countries like Brazil still prohibit C. sativa cultivation and its medicinal use, even though many populations use aerial parts and roots of this plant for healthcare. As such, the objective of this work was to identify substances in the samples of the C. sativa roots, tracing a correlation with antitussive and expectorant effects. Therefore, samples of C. sativa roots were donated by the Polícia Federal Brasileira, and its aqueous extract (AECsR) was prepared with subsequent lyophilization, to maintain the material stability. After that, the material was analyzed by LC-MS to observe its chemical profile. Four samples (AECsR-A, B, C, and D) were tested in animal models of citric acid-induced cough (0.4 M) and phenol red expectoration (500 mg/kg). Using LC-MS it was possible to identify 5 molecules in C. sativa roots: p-coumaroyltyramine, tetrahydrocannabinol-C4, feruoiltyramine, anhydrocanabisativine, and cannabisativine. In experimental protocols, male mice (Mus musculus) were treated with samples of AECsR at doses of 12.5, 25, or 50 mg/kg regardless of the pharmacological test. In these tests, all samples showed the potential to treat cough and promote fluid expectoration, differing only in the dose at which these effects were observed. Therefore, the data showed that the C. sativa roots of the Brazilian Northeast showed antitussive and expectorant effects, even with intense secondary metabolites' variation, which alters its potency, but not its effect. This highlights the importance of this medicinal plant for future therapy and corroborates to traditional use.
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Affiliation(s)
| | | | - Kátia Simoni Bezerra Lima
- Universidade Federal do Vale do São Francisco - UNIVASF, Colegiado de Enfermagem (CENF), Petrolina/PE - Brasil
| | | | - Mariana Coelho Brito
- Pós-graduação em Biotecnologia - PPGBIOTEC, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana/BA - Brasil
| | | | - Janaine Almeida Neto
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE - Brasil
| | | | - Fabrício Souza Silva
- Pós-graduação em Biotecnologia - PPGBIOTEC, Universidade Estadual de Feira de Santana - UEFS, Feira de Santana/BA - Brasil
- Universidade Federal do Vale do São Francisco - UNIVASF, Colegiado de Farmácia (CFARM), Petrolina/PE - Brasil
| | - Larissa Araújo Rolim
- Pós-graduação em Biotecnologia - RENORBIO, Universidade Federal Rural de Pernambuco- UFRPE, Recife/PE - Brasil
- Pós-graduação em Biociências - PGB, Universidade Federal do Vale do São Francisco - UNIVASF, Petrolina/PE - Brasil
- Universidade Federal do Vale do São Francisco - UNIVASF, Colegiado de Farmácia (CFARM), Petrolina/PE - Brasil
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Zhou J, Yi F, Wu F, Xu P, Chen M, Shen H, Lin L, Zhang Y, Li S, Wu C, Yuan Y, Wang G, Ye X, Zhang P, Tang H, Ma Q, Huang L, Qiu Z, Deng H, Qiu C, Shi G, Pan J, Luo W, Chung KF, Zhong N, Lai K. Characteristics of different asthma phenotypes associated with cough: a prospective, multicenter survey in China. Respir Res 2022; 23:243. [PMID: 36096782 PMCID: PMC9469623 DOI: 10.1186/s12931-022-02104-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is a heterogeneous disease with variable symptoms, which presents with cough either as the sole or predominant symptom with or without wheezing. We compared the clinical and pathophysiological characteristics of cough predominant asthma (CPA), cough variant asthma (CVA) and classic asthma (CA) in order to determine any differential phenotypic traits. Methods In 20 clinics across China, a total of 2088 patients were finally recruited, including 327 CVA, 1041 CPA and 720 CA patients. We recorded cough and wheezing visual analogue scale, Leicester cough questionnaire (LCQ) and asthma control test scores. Fractional exhaled nitric oxide (FeNO), induced sputum cell counts, and capsaicin cough challenge were also measured and compared. Results CPA patients more frequently presented with cough as the initial symptom, and laryngeal symptoms (p < 0.001), had less symptoms related with rhinitis/sinusitis and gastroesophageal reflux (p < 0.05) than CA patients. Comorbidities including rhinitis and gastroesophageal reflux were similar, while the proportion of COPD and bronchiectasis was higher in CA patients. There were no differences in FeNO levels, sputum eosinophil and neutrophil counts, FEV1 (%pred) decreased from CVA to CPA to CA patients (p < 0.001). Cough sensitivity was higher in CVA and CPA compared to CA (p < 0.001), and was positively correlated with LCQ scores. Conclusions CVA, CPA and CA can be distinguished by the presence of laryngeal symptoms, cough sensitivity and airflow obstruction. Asthma-associated chronic cough was not associated with airway inflammation or comorbidities in our cohort. Trial registration The Chinese Clinical Trial Registration Center, ChiCTR-POC-17011646, 13 June 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02104-8.
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Affiliation(s)
- Jianmeng Zhou
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Fang Yi
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Feng Wu
- Department of Pulmonary and Critical Care Medicine, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Pusheng Xu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meihua Chen
- Dongguan Third People's Hospital, Dongguan, China
| | - Huahao Shen
- The Second Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yunhui Zhang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Suyun Li
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Changgui Wu
- Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yadong Yuan
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Wang
- West China School of Medicine/West China Hospital of Sichuan University, Chengdu, China
| | - Xianwei Ye
- Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ping Zhang
- Dongguan People's Hospital, Dongguan, China
| | | | - Qianli Ma
- Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | | | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Haiyan Deng
- The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Chen Qiu
- Shenzhen People's Hospital, Shenzhen, China
| | - Guochao Shi
- Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayu Pan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Wei Luo
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, & Royal Brompton and Harefield Foundation NHS Trust, London, UK
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China
| | - Kefang Lai
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiang Rd., Guangzhou, 510120, China.
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9
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Li P, Wang J, Wang C, Cheng L, Ma Q, Li Y, An Y, Dai H, Duan Y, Wang T, Ma X, Zhang M, Wang T, Zhao B. Therapeutic effects and mechanisms study of Hanchuan Zupa Granule in a Guinea pig model of cough variant asthma. JOURNAL OF ETHNOPHARMACOLOGY 2021; 269:113719. [PMID: 33358856 DOI: 10.1016/j.jep.2020.113719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hanchuan Zupa Granule (HCZP), a traditional Chinese ethnodrug, has the functions of supressing a cough, resolving phlegm, warming the lungs, and relieving asthma. In clinical practice employing traditional Chinese medicine (TCM), HCZP is commonly used to treat acute colds, cough and abnormal mucous asthma caused by a cold, or "Nai-Zi-Lai" in the Uygur language. Studies have confirmed the use of HCZP to treat cough variant asthma (CVA) and other respiratory diseases. However, the pharmacological mechanisms of HCZP remain unrevealed. AIM OF THE STUDY To investigate the anti-tussive and anti-asthmatic effects and the possible pharmacological mechanisms of HCZP in the treatment of CVA. MATERIALS AND METHODS A guinea pig CVA animal model was established by intraperitoneal injection of ovalbumin (OVA) combined with intraperitoneal injection of aluminium hydroxide adjuvant and atomized OVA. Meanwhile, guinea pigs with CVA received oral HCZP (at dosages of 0.571, 0.285 and 0.143 g/kg bodyweight). The number of coughs induced by aerosol capsaicin was recorded, and the airway hyperresponsiveness (AHR) of CVA guinea pigs was detected with the FinePointe series RC system. H&E staining of lung tissues was performed to observe pathological changes. ELISA was used to detect inflammatory cytokines. qRT-PCR and western blotting analyses were used to detect the expression of Th1-specific transcription factor (T-bet), Th2-specific transcription factor (GATA3), and Toll-like receptor 4 (TLR4) signal transduction elements. These methods were performed to assess the protective effects and the potential mechanisms of HCZP on CVA. RESULTS Great changes were found in the CVA guinea pig model after HCZP treatment. The number of coughs induced by capsaicin in guinea pigs decreased, the body weights of guinea pigs increased, and inflammation of the eosinophilic airway and AHR were reduced simultaneously. These results indicate that HCZP has a significant protective effect on CVA. A pharmacological study of HCZP showed that the levels of interleukin-4 (IL-4) and IL-5 and tumour necrosis factor-α (TNF-α) in serum decreased. The amount of interferon-γ (IFN-γ) increased, mRNA and protein expression of TLR4 and GATA3 weakened, and mRNA and protein expression of T-bet increased. CONCLUSIONS HCZP ameliorated the symptoms of guinea pigs with CVA induced by OVA by regulating the Th1/Th2 imbalance and TLR4 receptors.
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Affiliation(s)
- Pengfei Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jingkang Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chunguo Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Long Cheng
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Quantao Ma
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yaqi Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yongcheng An
- College of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Hongyu Dai
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yuhui Duan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Tieshan Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xuan Ma
- Xinjiang Qimu Medical Research Institute (Co., Ltd.), Xinjiang 830011, China
| | - Minghui Zhang
- Xinjiang Qimu Medical Research Institute (Co., Ltd.), Xinjiang 830011, China
| | - Ting Wang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Baosheng Zhao
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
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10
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Chen YB, Shergis JL, Wu ZH, Guo XF, Zhang AL, Wu L, Fan FT, Xu YJ, Xue CC, Lin L. Herbal Medicine for Adult Patients with Cough Variant Asthma: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5853137. [PMID: 33747103 PMCID: PMC7943289 DOI: 10.1155/2021/5853137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Herbal medicine is commonly used by patients with chronic cough, but the role of herbal medicine for cough variant asthma (CVA) has not yet been clearly defined. For the first time, we performed a meta-analysis to integrate the current evidence of randomized controlled trials (RCTs) on this topic and assess the efficacy of herbal medicine in adults with CVA. METHODS A comprehensive search was conducted in electronic databases to identify RCTs of herbal medicine for adult CVA. Cochrane systematic review methods were followed, and the Grading of Recommendations Assessment, Development, and Evaluation was performed to evaluate the quality of evidence. RESULTS Twenty-eight RCTs were included. Compared with placebo, moderate-quality evidence from two studies showed that herbal medicine was associated with reduced cough symptom score (CSS) (MD -1.15 points; 95% CI, -1.67 to -0.63) and visual analogue scale (VAS) (MD -1.76 points; 95% CI, -2.66 to -0.86). Compared with montelukast, low- to moderate-quality evidence from 11 studies indicated that herbal medicine was associated with improved Leicester Cough Questionnaire (LCQ) (MD 2.38 points; 95% CI, 1.32 to 3.44), reduced CSS (SMD -0.81 points; 95% CI, -1.09 to -0.53), and VAS (MD -1.34 points; 95% CI, -1.82 to -0.86). There were no significant differences between herbal medicine and ICS plus bronchodilator. CONCLUSIONS In adults with CVA, herbal medicine may result in improved quality of life and reduced cough frequency and severity scores compared with placebo or montelukast. Herbal medicine was not better than ICS plus a bronchodilator but the evidence is very uncertain.
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Affiliation(s)
- Yuan-Bin Chen
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Johannah L Shergis
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Zhen-Hu Wu
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xin-Feng Guo
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Anthony L Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Lei Wu
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fei-Ting Fan
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yin-Ji Xu
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Charlie C Xue
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Lin Lin
- Department of Respiratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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11
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Lin J, Wang Z, Qiu C, Wang Z, Jiang S, Tang H, Wang X, Qiu Z, He Y, Zhao J, Shi G, Sun S, Wang L, Chen L, Wang J, Mao A. A multicenter, prospective, observational study on montelukast monotherapy or montelukast-based combinations treating cough variant asthma. J Thorac Dis 2020; 12:6573-6585. [PMID: 33282359 PMCID: PMC7711367 DOI: 10.21037/jtd-20-1989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Evidence of treatment against cough variant asthma (CVA) is insufficient for the clinical practice in China. We aimed at evaluating the real-world effectiveness of montelukast (MONT) alone or in combination with low-dose inhaled corticosteroids (ICS) and low-dose ICS plus long-acting beta-2-agonists (LABA) for Chinese CVA patients in a multicentre, prospective, cohort study. Methods Adult patients diagnosed with CVA defined as chronic cough >8 weeks with a positive bronchial provocation test and normal chest X-ray findings were enrolled at respiratory clinics. Study treatment followed routine clinical practice. The investigators initiated MONT by 10 mg/day alone or in combination with a low-dose ICS +/− LABA and followed up treatment outcomes for 4 weeks. The primary outcome measure was the change in cough score (CS) from baseline. Results The study enrolled 247 patients (MONT =146, MONT + ICS =38, MONT + ICS/LABA =63). In the primary analysis, the mean change (95% CI) in CS at the end of the study was −1.2 (−1.6, −0.9), −0.9 (−1.5, −0.4), and −1.3 (−1.7, −0.8) in the three groups, respectively. MONT monotherapy had a satisfactory rate of weekly asthma control at the end of the study (83.5%, 95% CI: 75.1%, 89.4%) in the per-protocol analysis. Rates of weekly asthma control were similar in two MONT-based combination regimens (83.9%, 81.4%). Short-acting beta-2-agonist (SABA) user (≥2 times per week) was 16.8% in the MONT group. Conclusions The real-world effectiveness of MONT alone or in combination with ICS or ICS and LABA was acceptable for CVA short-term control.
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Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zaiyi Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chen Qiu
- Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Zhen Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huaping Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xuefen Wang
- Department of Respiratory, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong He
- Department of Pulmonary and Critical Care Medicine, Daping Hospital, Amy Military Medical University, Chongqing, China
| | - Jianping Zhao
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghua Sun
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Limin Wang
- Department of Pulmonary and Critical Care Medicine, Hangzhou First People's Hospital, Hangzhou, China
| | - Lin Chen
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Annhua Mao
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
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12
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Yi F, Han L, Liu B, Zhang X, Xue Y, Luo W, Chen Q, Lai K. Determinants of response to bronchodilator in patients with cough variant asthma- A randomized, single-blinded, placebo-controlled study. Pulm Pharmacol Ther 2020; 61:101903. [PMID: 32092472 DOI: 10.1016/j.pupt.2020.101903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 02/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Not all patients with cough variant asthma (CVA) show responsiveness to bronchodilators (RB) in clinic. Whether there are specific clinical and pathophysiological features can indicate RB in patients with CVA needs further investigation. Thus, we aimed to investigate the RB in patients with CVA and associated factors. METHODS Forty-two CVA patients were randomized in a 2:1 ratio to receive oral bambuterol hydrochloride (10 mg, once daily, for 3 days) or matched placebo, 36 patients (24 with bronchodilator and 12 with placebo) completed the study eventually. RB was considered when cough visual analogue scale (VAS) score decreased 30% or more after 3 days treatment. The baseline clinical and pathophysiological characteristics between patients with RB and patients without RB were compared. CRS was presented with the lowest concentration of capsaicin inducing at least 5 coughing (C5). RESULTS The responsive rate of patients with bronchodilator was significantly higher than that with placebo (62.5% vs 16.7%, p < 0.01). Patients with RB showed a significant greater mean decline of FEV1% predicted after bronchial provocation (26.7% vs 22.4%, p < 0.05) and higher geometric mean of sputum eosinophils (1.37 vs 0.69, p < 0.05) as compared with these without RB. No significant differences in sputum neutrophil, Log C5 were found between patients with RB and patients without RB. There was a moderate correlation between the decline of FEV1% pred and RB (rs = 0.443, p < 0.05). The regression analysis showed that nocturnal cough was a predictor of RB (OR, 7.33, 95% CI: 1.11-48.26, p = 0.038). No adverse events were reported by all of the patients after the study. CONCLUSION More than one-third of patients with CVA do not respond to bronchodilator treatment, indicating that the response to bronchodilator should not be a diagnostic requirement of CVA. CVA patients with higher airway responsiveness will more likely respond to bronchodilator. Cough of CVA might be elicited by different mechanisms, which suggests that CVA could be divided into two phenotypes according to the response to bronchodilators.
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Affiliation(s)
- Fang Yi
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Lina Han
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Baojuan Liu
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Xu Zhang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Yongxin Xue
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Wei Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Qiaoli Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, China.
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13
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Abstract
Cough is a common symptom often confronted in the clinical setting. Time and resources attributed to cough place an undue burden on patients and the health care system. One characteristic of cough that likely contributes to this is the multifactorial nature of cough. Physicians are trained to find a single diagnosis to explain symptoms. With cough, if all factors contributing are not identified and treated together, the cough often remains unresolved. This article provides a practical approach to treatment and management of cough, emphasizing causes and potentiators.
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Affiliation(s)
- Baotran B Tran
- Division of Allergy-Immunology, Northwestern Medicine, Chicago, IL, USA
| | - Anne Marie Ditto
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, 211 East Ontario Ste. 1000, Chicago, IL 60611, USA.
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14
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Sun X, Yang W, Gong S, Liang S, Gu S, Lu H, Liu J, Xu J. Diagnostic value of volumetric capnography in patients with chronic cough variant asthma. Clinics (Sao Paulo) 2020; 75:e1662. [PMID: 33084765 PMCID: PMC7536889 DOI: 10.6061/clinics/2020/e1662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the quantitative changes and diagnostic performance of volumetric capnography (VCap) parameters in patients with cough variant asthma. METHODS This cross-sectional study enrolled 31 patients with cough variant asthma and 30 patients with chronic cough without asthma between November 2010 and March 2012. VCap measurements were recorded at baseline, during the five steps of the histamine challenge, and after bronchodilation with salbutamol. They were then compared between the baseline and histamine challenge, and between the two groups. Receiver operating characteristic curve analysis was performed for different VCap measurements. RESULTS The slope of phase III (dc\dv3) and the ratio of phase III slope to phase II slope (SR23%) decreased from baseline upon challenge with 1.1 mg histamine in cough variant asthma patients but increased in patients with chronic cough without asthma. Additionally, the change upon challenge with 1.1 mg histamine in dc\dv3 from baseline (S6-S1dc\dv3) in cough variant asthma patients had the largest area under the curve (AUC) (0.814, 95% CI: 0.697-0.931; p<0.001). The AUC for change upon challenge with 1.1 mg histamine in SR23% from baseline was 0.755 (95%CI: 0.632-0.878; p<0.001). At a cutoff of 19.8, S6-S1 dc\dv3 had a sensitivity of 74.2% and specificity of 90.0% and at a cutoff of 40.7, S6-S1 SR23% had a sensitivity of 48.4% and specificity of 96.7%. CONCLUSION Patients with cough variant asthma exhibit distinct VCap responses for dead space parameters upon challenge with histamine in comparison to patients with chronic cough. VCap parameters like phase III slope and phase III/phase II slope ratio could be used to aid the diagnosis of cough variant asthma.
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Affiliation(s)
- Xiaoli Sun
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Wenlan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Sugang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Shuo Liang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Shuyi Gu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Haiwen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Jinmin Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
- *Corresponding author. E-mail:
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15
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Abstract
Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.
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Affiliation(s)
- A Mathur
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - P S K Liu-Shiu-Cheong
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - G P Currie
- Department of Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
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16
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Development of Machine Learning for Asthmatic and Healthy Voluntary Cough Sounds: A Proof of Concept Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9142833] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
(1) Background: Cough is a major presentation in childhood asthma. Here, we aim to develop a machine-learning based cough sound classifier for asthmatic and healthy children. (2) Methods: Children less than 16 years old were randomly recruited in a Children’s Hospital, from February 2017 to April 2018, and were divided into 2 cohorts—healthy children and children with acute asthma presenting with cough. Children with other concurrent respiratory conditions were excluded in the asthmatic cohort. Demographic data, duration of cough, and history of respiratory status were obtained. Children were instructed to produce voluntary cough sounds. These clinically labeled cough sounds were randomly divided into training and testing sets. Audio features such as Mel-Frequency Cepstral Coefficients and Constant-Q Cepstral Coefficients were extracted. Using a training set, a classification model was developed with Gaussian Mixture Model–Universal Background Model (GMM-UBM). Its predictive performance was tested using the test set against the physicians’ labels. (3) Results: Asthmatic cough sounds from 89 children (totaling 1192 cough sounds) and healthy coughs from 89 children (totaling 1140 cough sounds) were analyzed. The sensitivity and specificity of the audio-based classification model was 82.81% and 84.76%, respectively, when differentiating coughs from asthmatic children versus coughs from ‘healthy’ children. (4) Conclusion: Audio-based classification using machine learning is a potentially useful technique in assisting the differentiation of asthmatic cough sounds from healthy voluntary cough sounds in children.
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17
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Shi R, Xu JW, Xiao ZT, Chen RF, Zhang YL, Lin JB, Cheng KL, Wei GY, Li PB, Zhou WL, Su WW. Naringin and Naringenin Relax Rat Tracheal Smooth by Regulating BK Ca Activation. J Med Food 2019; 22:963-970. [PMID: 31259654 DOI: 10.1089/jmf.2018.4364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Naringin and its aglycone, naringenin, occur naturally in our regular diet and traditional Chinese medicines. This study aimed to detect an effective therapeutic approach for cough variant asthma (CVA) through evaluating the relaxant effect of these two bioactive herbal monomers as antitussive and antiasthmatic on rat tracheal smooth muscle. The relaxant effect was determined by measuring muscular tension with a mechanical recording system in rat tracheal rings. Cytosolic Ca2+ concentration was measured using a confocal imaging system in primary cultured tracheal smooth muscle cells. In rat tracheal rings, addition of both naringin and naringenin could concentration dependently relax carbachol (CCh)-evoked tonic contraction. This epithelium-independent relaxation could be suppressed by BaCl2, tetraethylammonium, and iberiotoxin (IbTX), but not by glibenclamide. After stimulating primary cultured tracheal smooth muscle cells by CCh or high KCl, the intracellular Ca2+ increase could be inhibited by both naringin and naringenin, respectively. This reaction was also suppressed by IbTX. These results demonstrate that both naringin and naringenin can relax tracheal smooth muscle through opening big conductance Ca2+-activated K+ channel, which mediates plasma membrane hyperpolarization and reduces Ca2+ influx. Our data indicate a potentially effective therapeutic approach of naringin and naringenin for CVA.
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Affiliation(s)
- Rui Shi
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jia-Wen Xu
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Zi-Ting Xiao
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Ruo-Fei Chen
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Yi-Lin Zhang
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Jia-Bi Lin
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Ke-Ling Cheng
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Gu-Yi Wei
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Pei-Bo Li
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Wen-Liang Zhou
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China
| | - Wei-Wei Su
- Guangdong Engineering and Technology Research Center for Quality and Efficacy Reevaluation of Postmarket Traditional Chinese Medicine, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,School of Life Sciences, Sun Yat-sen University, Guangzhou, China
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18
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Abstract
Asthma is one of the commonest respiratory diseases in the United States, affecting approximately 8% of adults. This article reviews the epidemiology, diagnosis, and treatment of asthma, with integration of recommendations from professional societies, with special attention to differential diagnosis. A framework for outpatient management of patients with asthma is presented, including indications for subspecialist referral. With integration of objective diagnostic information, systematic approach through modification of disease triggers and adjustment of controller medications, and patient empowerment to respond to varying symptoms using an asthma action plan, most individuals with asthma are successfully managed in the primary care setting.
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Affiliation(s)
- Tianshi David Wu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - Emily P Brigham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA.
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19
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Mathur A, Liu-Shiu-Cheong PSK, Munro A, Currie GP. Chronic cough: a practical approach to assessment and management. Drug Ther Bull 2019; 57:74-79. [PMID: 30904833 DOI: 10.1136/dtb.2018.000014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Abhinav Mathur
- Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | | | - Ami Munro
- Banchory Group Practice, Dee St, Banchory, UK
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20
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Çolak Y, Afzal S, Lange P, Laursen LC, Nordestgaard BG, Dahl M. Role and Impact of Chronic Cough in Individuals with Asthma From the General Population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1783-1792.e8. [PMID: 30836227 DOI: 10.1016/j.jaip.2019.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cough is a well-recognized symptom in asthma, but the role and impact of chronic cough in individuals with asthma has not been described in the general population. OBJECTIVE We hypothesized that among individuals with asthma, those with chronic cough versus those without have a more severe disease phenotype. METHODS We identified individuals with asthma and chronic cough among 14,740 adults from the Copenhagen General Population Study, and investigated respiratory symptoms, health care utilizations, lung function, and biomarkers in blood. RESULTS A total of 855 (6%) individuals suffered from asthma, and 70 (8%) had chronic cough. Individuals with asthma and chronic cough had a Leicester Cough Questionnaire median total score of 16.8 (25th and 75th percentiles, 14.8-18.9), corresponding to 5.4 (4.6-6.0) for the physical domain, 5.7 (4.6-6.4) for the psychological domain, and 6.0 (5.3-6.8) for the social domain. Among individuals with asthma, those with chronic cough versus those without reported more often wheezing (70% vs 54%), dyspnea (74% vs 49%), night-time dyspnea (27% vs 11%), sputum production (59% vs 14%), chest pain/tightness (14% vs 4%), acute bronchitis/pneumonia episodes, and general practitioner visits. Furthermore, these individuals had more often FEV1 predicted value of less than 60% (14% vs 7%) and higher levels of neutrophils, leukocytes, and fibrinogen in blood, but there were no differences with regard to levels of high-sensitive C-reactive protein, eosinophils, and IgE in blood. CONCLUSIONS Chronic cough in individuals with asthma is associated with a more severe disease phenotype in terms of worse respiratory symptoms, greater health care utilizations, lower lung function, and higher levels of systemic inflammatory biomarkers in blood.
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Affiliation(s)
- Yunus Çolak
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Peter Lange
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars C Laursen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Dahl
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark.
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Sugawara H, Saito A, Yokoyama S, Tsunematsu K, Takahashi H. Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system. Respir Res 2019; 20:41. [PMID: 30808365 PMCID: PMC6390374 DOI: 10.1186/s12931-019-1005-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cough variant asthma (CVA) is one of the most common causes of chronic persistent cough, and early treatment with inhaled corticosteroids (ICSs) is recommended to attenuate the inflammation and remodeling. The impulse oscillometry system (IOS) is a novel device for respiratory functional assessment that has not yet been assessed in terms of CVA. Therefore, we investigated the relationship between CVA and IOS, and the difference in therapeutic effects of ICSs among the subtype classifications by IOS. METHODS The following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). Treatment effects were assessed by the Leicester cough questionnaire (LCQ) and were compared among three separated subtypes based on IOS measurements: central, peripheral, and resistless. RESULTS Regarding LCQ scores, in the central type, the LCQ of the MF group was significantly lower than FP and BUD. In the peripheral type, the LCQ of the FP group was significantly lower than MF and BUD. In the resistless type, the LCQ of the MF group was significantly lower than BUD. Also, IOS factors were improved by 4 weeks of therapy with ICS. Thus, there was strong relationship between subtypes and particle size in terms of effectiveness. CONCLUSIONS There is a strong relationship between IOS subtype classification and ICS particle size in terms of therapeutic efficiency in CVA. It appears important to determine the ICS particle size, based on the IOS subtype classification, before treatment.
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Affiliation(s)
- Hiroyuki Sugawara
- Sugawara Internal Medicine and Respiratory Clinic, Tomakomai, 053-0821, Japan
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Atsushi Saito
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan.
- Department of Biochemistry, Sapporo Medical University School of Medicine, Sapporo, 060-8556, Japan.
| | - Saori Yokoyama
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
| | - Kazunori Tsunematsu
- Sugawara Internal Medicine and Respiratory Clinic, Tomakomai, 053-0821, Japan
| | - Hiroki Takahashi
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8543, Japan
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22
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Patel S. Phytochemicals for taming agitated immune-endocrine-neural axis. Biomed Pharmacother 2017; 91:767-775. [DOI: 10.1016/j.biopha.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023] Open
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Jiang G, Huang X, Li T, Xu D. Chronic cough: clinical characteristics and etiologies of 510 cases. Turk J Med Sci 2016; 46:1734-1739. [PMID: 28081319 DOI: 10.3906/sag-1508-133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To investigate the clinical features and underlying etiologies of chronic cough (CC). MATERIALS AND METHODS Five hundred and ten CC patients were enrolled. The phases, characteristics and associated clinical manifestations of CC among the gastroesophageal reflux cough (GERC), cough-variant asthma (CVA), and upper airway cough syndrome (UACS) groups were compared, and the diagnostic values of each group were evaluated by multiple regression analysis. RESULTS In the 510 patients, 404 had CC with single etiology-GERC (n = 175), CVA (n = 134), and UACS (n = 95). The characteristic features of GERC included gastric acid backflow symptoms such as sour-tasting regurgitation, heartburn, endoscopic esophagitis, poststimulation cough, frequent throat clearing, daytime mono-cough, and feelings of heaviness and pain in the chest. Patients with CVA typically exhibited sensitivity to smog and other irritants; the cough occurred mostly at night, and was associated with positive bronchodilator and provocation test results. The typical features of UACS included a history and/or symptoms of rhinitis, retropharyngeal postnasal drip, and wet cough occurring mostly during the daytime. The diagnostic specificities of above factors were >70%. CONCLUSION The most common causes of CC include GERC, CVA, and UACS, and their diagnosis is based on the characteristics of the underlying disease.
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Affiliation(s)
- Guiyuan Jiang
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Xinying Huang
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Tianlin Li
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
| | - Dongping Xu
- Respiratory Department, Xiamen Chang Gung Hospital, Xiamen, P.R. China
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Raju KRS, Ambhore NS, Mulukutla S, Gupta S, Murthy V, Kumar MNK, Madhunapantula SRV, Kuppuswamy G, Elango K. Salicylic acid derivatives as potential anti asthmatic agents using disease responsive drug delivery system for prophylactic therapy of allergic asthma. Med Hypotheses 2015; 87:75-9. [PMID: 26643666 DOI: 10.1016/j.mehy.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022]
Abstract
Asthma is a multi-factorial and complicated lung disorder of the immune system which has expanded to a wider ambit unveiling its etiology to be omnipresent at both ends of the spectrum involving basic pharmacology and in-depth immunology. As asthma occurs through triggered activation of various immune cells due to different stimuli, it poses a great challenge to uncover specific targets for therapeutic interventions. Recent pharmacotherapeutic approaches for asthma have been focused on molecular targeting of transcription factors and their signaling pathways; mainly nucleus factor kappa B (NFκB) and its associated pathways which orchestrate the synthesis of pro-inflammatory cytokines (IL-1β, TNF-α, GM-CSF), chemokines (RANTES, MIP-1a, eotaxin), adhesion molecules (ICAM-1, VCAM-1) and inflammatory enzymes (cyclooxygenase-2 and iNOS). 5-aminosalicylic acid (5-ASA) and sodium salicylate are known to suppress NFκB activation by inhibiting inhibitor of kappa B kinase (IKκB). In order to target the transcription factor, a suitable carrier system for delivering the drug to the intracellular space is essential. 5-ASA and sodium salicylate loaded liposomes incorporated into PEG-4-acrylate and CCRGGC microgels (a polymer formed by crosslinking of trypsin sensitive peptide and PEG-4-acrylate) could probably suit the needs for developing a disease responsive drug delivery system which will serve as a prophylactic therapy for asthmatic patients.
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Affiliation(s)
| | - Nilesh S Ambhore
- Department of Pharmacology, JSS College of Pharmacy, Ootacamund, JSS University, Mysore, Tamilnadu 643001, India
| | - Shashank Mulukutla
- Department of Pharmacology, JSS College of Pharmacy, Ootacamund, JSS University, Mysore, Tamilnadu 643001, India
| | - Saurabh Gupta
- Department of Pharmacology, Indore Institute of Pharmacy, Indore, Madhya Pradesh, India
| | - Vishakantha Murthy
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - M N Kiran Kumar
- Department of Dermatology and Allergology, Allergy-Centrum-Charité, CCM, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Gowthamarajan Kuppuswamy
- Department of Pharmaceutics, JSS College of Pharmacy, Ootacamund, JSS University, Mysore, Tamilnadu, India
| | - Kannan Elango
- Department of Pharmacology, JSS College of Pharmacy, Ootacamund, JSS University, Mysore, Tamilnadu 643001, India
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25
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Saito N, Itoga M, Tamaki M, Yamamoto A, Kayaba H. Cough variant asthma patients are more depressed and anxious than classic asthma patients. J Psychosom Res 2015; 79:18-26. [PMID: 25837530 DOI: 10.1016/j.jpsychores.2015.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/12/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many recent studies have indicated that depression and anxiety are more common in asthmatic patients than in the general population and psychological stress can lead to asthma exacerbations, but no study specifically targets cough variant asthma (CVA) patients. The purpose of this study was to evaluate depression and anxiety levels in CVA patients compared with classic asthma patients and to identify the psychological features of CVA patients. METHODS Fifty-nine outpatients with CVA and 128 outpatients with classic asthma were interviewed about psychosomatic and psychiatric symptoms, and they underwent three psychological tests: Self-rating Depression Scale (SDS), State-Trait Anxiety Inventory (STAI), and Comprehensive Asthma Inventory (CAI). They were ultimately screened for major and minor depression, dysthymia, panic disorder, generalized anxiety disorder, social anxiety disorder, and other anxiety disorders. RESULTS CVA patients showed higher SDS and STAI scores than classic asthma patients, and mood disorders and anxiety disorders were more common than in classic asthma outpatients. The psychological factors 'frustration', 'fright into illness', and 'distorted lifestyle' were more prominent in CVA patients than in classic asthma patients. CONCLUSION CVA patients are on average more depressed and anxious than classic asthma outpatients. Though CVA appears pathologically to be just an early stage of typical asthma, the psychological stress may often be more serious than in asthma controlled by medication, which may explain why CVA cannot be controlled by a bronchodilator alone and patients often require no less intense therapy than for severe asthma.
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Affiliation(s)
- Norihiro Saito
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan; Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan.
| | - Masamichi Itoga
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mami Tamaki
- Department of Allergy and Respiratory Medicine, Yokote Municipal Hospital, Akita, Japan
| | - Ayako Yamamoto
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroyuki Kayaba
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
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Morice AH, Millqvist E, Belvisi MG, Bieksiene K, Birring SS, Chung KF, Dal Negro RW, Dicpinigaitis P, Kantar A, McGarvey LP, Pacheco A, Sakalauskas R, Smith JA. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J 2014; 44:1132-48. [PMID: 25142479 DOI: 10.1183/09031936.00218613] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions. There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough. The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.
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Affiliation(s)
- Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, Respiratory Medicine, Hull York Medical School, University of Hull, Cottingham, UK
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, University of Gothenburg, Gothenburg, Sweden
| | - Maria G Belvisi
- Respiratory Pharmacology Group, Pharmacology and Toxicology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kristina Bieksiene
- Dept of Pulmonology and Immunology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London and Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Roberto W Dal Negro
- Centro Nazionale Studi di Farmacoeconomia e Farmacoepidemiologua Respiratoria CESFAR, Verona, Italy
| | - Peter Dicpinigaitis
- Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, New York, , NY, USA
| | - Ahmad Kantar
- Paediatric Cough and Asthma Centre, Istituti Ospedalieri Bergamaschi, Bergamo, Italy
| | - Lorcan P McGarvey
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, UK
| | - Adalberto Pacheco
- Chronic Cough Unit, Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - Raimundas Sakalauskas
- Dept of Pulmonology and Immunology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - Jaclyn A Smith
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, UK
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Nilius B, Szallasi A. Transient Receptor Potential Channels as Drug Targets: From the Science of Basic Research to the Art of Medicine. Pharmacol Rev 2014; 66:676-814. [DOI: 10.1124/pr.113.008268] [Citation(s) in RCA: 348] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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28
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Roth R, Schatz M. Allergic bronchopulmonary aspergillosis presenting as chronic cough in an elderly woman without previously documented asthma. Perm J 2013; 17:e103-8. [PMID: 23704852 DOI: 10.7812/tpp/12-051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A nonsmoking woman in her mid-70s presents to the allergist for consultation of a chronic cough of almost 3-years' duration without a specific diagnosis as to etiology in spite of numerous diagnostic tests and therapeutic trials. This is a case report from a specialist point of view that includes a comprehensive review of her clinical course pre- and postconsultation along with a brief but pertinent review of the literature as it relates to this particular unusual and protracted case, which was ultimately successfully diagnosed and treated.
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Affiliation(s)
- Richard Roth
- Southern California Permanente Medical Group Orange County Service Area, USA.
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