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Llor C, Moragas A, Ouchi D, Monfà R, Garcia-Sangenís A, Gómez-Lumbreras A, Pera H, Pujol J, Morros R. Effectiveness of antitussives, anticholinergics, and honey versus usual care in adults with uncomplicated acute bronchitis: a multiarm randomized clinical trial. Fam Pract 2022; 40:407-413. [PMID: 36239199 PMCID: PMC9619792 DOI: 10.1093/fampra/cmac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Despite the frequent use of symptomatic therapies in cough, evidence of their benefits is lacking. OBJECTIVE We compared the effectiveness of 3 symptomatic therapies and usual care in acute bronchitis. METHODS Multicenter, pragmatic, multiarm parallel group, open randomized trial in primary care (ClinicalTrials.gov, Identifier: NCT03738917) was conducted in Catalonia. Patients ≥18 with uncomplicated acute bronchitis, with cough<3 weeks as the main symptom, scoring ≥4 in either daytime or nocturnal cough (7-point Likert scale), were randomized to usual care, dextromethorphan 15 mg t.i.d., ipratropium bromide inhaler 20 µg 2 puffs t.i.d, or 30 mg of honey t.i.d., all taken for up to 14 days. The main outcome measure was the number of days with moderate-to-severe cough. A symptom diary was given. A second visit was scheduled at days 2-3 for assessing evolution, with 2 more visits at days 15 and 29 for clinical assessment, evaluation of adverse effects, re-attendance, and complications. RESULTS We failed to achieve the sample size scheduled due to the COVID-19 pandemic. We finally recruited 194 patients. The median number of days with moderate-to-severe cough (score ≥ 3) in the usual care arm was 5 (interquartile range [IQR], 4, 8.75), 5 in the ipratropium bromide arm (IQR, 3, 8), 5 in the dextromethorphan arm (IQR, 4, 9.75), and 6 in the honey arm (IQR, 3.5, 7). The same results were obtained in the Kaplan-Meier survival analysis for the median survival time of each arm with the usual care as the reference group. CONCLUSION The symptomatic treatment evaluated has shown to be ineffective against cough.
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Affiliation(s)
- Carl Llor
- Department of Public Health, General Practice. University of Southern Denmark, Odense, Denmark.,Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.,Via Roma Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Ana Moragas
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.,Jaume I Health Centre, Institut Català de la Salut, Tarragona, Spain.,University Rovira i Virgili, Reus, Spain
| | - Dan Ouchi
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain
| | - Ramon Monfà
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain
| | - Ana Garcia-Sangenís
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain
| | - Ainhoa Gómez-Lumbreras
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain
| | - Helena Pera
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain
| | - Jesus Pujol
- Balaguer Health Centre, Institut Català de la Salut, Balaguer, Spain
| | - Rosa Morros
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.,Plataforma SCReN, UICEC IDIAPJGol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
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Walther C, Döring K, Schmidtke M. Comparative in vitro analysis of inhibition of rhinovirus and influenza virus replication by mucoactive secretolytic agents and plant extracts. BMC Complement Med Ther 2020; 20:380. [PMID: 33357221 PMCID: PMC7757078 DOI: 10.1186/s12906-020-03173-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/02/2020] [Indexed: 01/23/2023] Open
Abstract
Background Rhinoviruses and influenza viruses cause millions of acute respiratory infections annually. Symptoms of mild acute respiratory infections are commonly treated with over-the-counter products like ambroxol, bromhexine, and N-acetyl cysteine, as well as of thyme and pelargonium extracts today. Because the direct antiviral activity of these over-the-counter products has not been studied in a systematic way, the current study aimed to compare their inhibitory effect against rhinovirus and influenza virus replication in an in vitro setting. Methods The cytotoxicity of ambroxol, bromhexine, and N-acetyl cysteine, as well as of thyme and pelargonium extracts was analyzed in Madin Darby canine kidney (MDCK) and HeLa Ohio cells. The antiviral effect of these over-the-counter products was compared by analyzing the dose-dependent inhibition (i) of rhinovirus A2- and B14-induced cytopathic effect in HeLa Ohio cells and (ii) of influenza virus A/Hong Kong/68 (subtype H3N2)- and A/Jena/8178/09 (subtype H1N1, pandemic)-induced cytopathic effect in MDCK cells at non-cytotoxic concentrations. To get insights into the mechanism of action of pelargonium extract against influenza virus, we performed time-of-addition assays as well as hemagglutination and neuraminidase inhibition assays. Results N-acetyl cysteine, thyme and pelargonium extract showed no or only marginal cytotoxicity in MDCK and HeLa Ohio cells in the tested concentration range. The 50% cytotoxic concentration of ambroxol and bromhexine was 51.85 and 61.24 μM, respectively. No anti-rhinoviral activity was detected at non-cytotoxic concentrations in this in vitro study setting. Ambroxol, bromhexine, and N-acetyl cysteine inhibited the influenza virus-induced cytopathic effect in MDCK cells no or less than 50%. In contrast, a dose-dependent anti-influenza virus activity of thyme and pelargonium extracts was demonstrated. The time-of addition assays revealed an inhibition of early and late steps of influenza virus replication by pelargonium extract whereas zanamivir acted on late steps only. The proven block of viral neuraminidase activity might explain the inhibition of influenza virus replication when added after viral adsorption. Conclusion The study results indicate a distinct inhibition of influenza A virus replication by thyme and pelargonium extract which might contribute to the beneficial effects of these plant extracts on acute respiratory infections symptoms.
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Affiliation(s)
- Christin Walther
- Department Medical Microbiology, Section Experimental Virology, Jena University Hospital, Hans-Knöll-Str. 2, D-07745, Jena, Germany
| | - Kristin Döring
- Department Medical Microbiology, Section Experimental Virology, Jena University Hospital, Hans-Knöll-Str. 2, D-07745, Jena, Germany
| | - Michaela Schmidtke
- Department Medical Microbiology, Section Experimental Virology, Jena University Hospital, Hans-Knöll-Str. 2, D-07745, Jena, Germany.
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Schot MJC, Dekker ARJ, van Werkhoven CH, van der Velden AW, Cals JWL, Broekhuizen BDL, Hopstaken RM, de Wit NJ, Verheij TJM. Burden of disease in children with respiratory tract infections in primary care: diary-based cohort study. Fam Pract 2019; 36:723-729. [PMID: 31166598 PMCID: PMC7006994 DOI: 10.1093/fampra/cmz024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Respiratory tract infections (RTIs) are a common reason for children to consult in general practice. Antibiotics are often prescribed, in part due to miscommunication between parents and GPs. The duration of specific respiratory symptoms has been widely studied. Less is known about illness-related symptoms and the impact of these symptoms on family life, including parental production loss. Better understanding of the natural course of illness-related symptoms in RTI in children and impact on family life may improve GP-parent communication during RTI consultations. OBJECTIVE To describe the general impact of RTI on children and parents regarding illness-related symptoms, absenteeism from childcare, school and work, use of health care facilities, and the use of over-the-counter (OTC) medication. METHODS Prospectively collected diary data from two randomized clinical trials in children with RTI in primary care (n = 149). Duration of symptoms was analysed using survival analysis. RESULTS Disturbed sleep, decreased intake of food and/or fluid, feeling ill and/or disturbance at play or other daily activities are very common during RTI episodes, with disturbed sleep lasting longest. Fifty-two percent of the children were absent for one or more days from childcare or school, and 28% of mothers and 20% of fathers reported absence from work the first week after GP consultation. Re-consultation occurred in 48% of the children. OTC medication was given frequently, particularly paracetamol and nasal sprays. CONCLUSION Appreciation of, and communication about the general burden of disease on children and their parents, may improve understanding between GPs and parents consulting with their child.
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Affiliation(s)
- M J C Schot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A R J Dekker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W L Cals
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - R M Hopstaken
- Star-shl diagnostic centers, Etten-Leur, The Netherlands
| | - N J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Cots JM, Moragas A, García-Sangenís A, Morros R, Gomez-Lumbreras A, Ouchi D, Monfà R, Pera H, Pujol J, Bayona C, de la Poza-Abad M, Llor C. Effectiveness of antitussives, anticholinergics or honey versus usual care in adults with uncomplicated acute bronchitis: a study protocol of an open randomised clinical trial in primary care. BMJ Open 2019; 9:e028159. [PMID: 31101700 PMCID: PMC6530348 DOI: 10.1136/bmjopen-2018-028159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Despite the frequent use of therapies in acute bronchitis, the evidence of their benefit is lacking, since only a few clinical trials have been published, with low sample sizes, poor methodological quality and mainly in children. The objective of this study is to compare the effectiveness of three symptomatic therapies (dextromethorphan, ipratropium or honey) associated with usual care and the usual care in adults with acute bronchitis. METHODS AND ANALYSIS This will be a multicentre, pragmatic, parallel group, open randomised trial. Patients aged 18 or over with uncomplicated acute bronchitis, with cough for less than 3 weeks as the main symptom, scoring ≥4 in either daytime or nocturnal cough on a 7-point Likert scale, will be randomised to one of the following four groups: usual care, dextromethorphan 30 mg three times a day, ipratropium bromide inhaler 20 µg two puffs three times a day or honey 30 mg (a spoonful) three times a day, all taken for up to 14 days. The exclusion criteria will be pneumonia, criteria for hospital admission, pregnancy or lactation, concomitant pulmonary disease, associated significant comorbidity, allergy, intolerance or contraindication to any of the study drugs or admitted to a long-term residence. SAMPLE 668 patients. The primary outcome will be the number of days with moderate-to-severe cough. All patients will be given a paper-based symptom diary to be self-administered. A second visit will be scheduled at day 2 or 3 for assessing evolution, with two more visits at days 15 and 29 for clinical assessment, evaluation of adverse effects, re-attendance and complications. Patients still with symptoms at day 29 will be called 6 weeks after the baseline visit. ETHICS AND DISSEMINATION The study has been approved by the Ethical Board of IDIAP Jordi Gol (reference number: AC18/002). The findings of this trial will be disseminated through research conferences and peer-review journals. TRIAL REGISTRATION NUMBER NCT03738917; Pre-results.
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Affiliation(s)
- Josep M Cots
- Primary Healthcare Centre La Marina, Barcelona, Spain, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Ana Moragas
- Primary Healthcare Centre Jaume I, Universitat Rovira i Virgili, Tarragona, Catalonia
| | - Ana García-Sangenís
- Medicines Research Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Catalonia
- UICEC IDIAP Jordi Gol, Plataforma SCReN, Barcelona, Catalonia
| | - Rosa Morros
- Medicines Research Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Catalonia
- Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Catalonia
| | - Ainhoa Gomez-Lumbreras
- Medicines Research Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Catalonia
| | - Dan Ouchi
- Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Catalonia
| | - Ramon Monfà
- Institut Universitari d’Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Catalonia
| | - Helena Pera
- Medicines Research Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Catalonia
- UICEC IDIAP Jordi Gol, Plataforma SCReN, Barcelona, Catalonia
| | | | | | | | - Carl Llor
- Primary Healthcare Centre Barcelona-2B (via Roma), Barcelona, Catalonia
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Scaglione F, Petrini O. Mucoactive Agents in the Therapy of Upper Respiratory Airways Infections: Fair to Describe Them Just as Mucoactive? CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550618821930. [PMID: 30670922 PMCID: PMC6328955 DOI: 10.1177/1179550618821930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
Abstract
Background Upper and lower respiratory tract infections are common conditions for which medical advice is sought, and their management relies on the use of prescription and over-the-counter (OTC) medicines. Ambroxol, bromhexine, carbocysteine, erdosteine, N-acetyl cysteine (NAC), and sobrerol are mucoactive agents for which clinical trials have been conducted, have been awarded well-established status by regulatory authorities, and are available as OTC or prescription products. Objective To briefly review the evidence-based efficacy and safety of these substances in the therapy of upper respiratory airways infections. Methods We conducted searches in MEDLINE and other databases for clinical trials and reviews done on the efficacy and safety of ambroxol, bromhexine, carbocysteine, erdosteine, NAC, and sobrerol. Results Clinical trials have shown that these mucolytics have an important place in the relief of cough symptoms by easing the elimination of mucus. All drugs have shown comparable efficacy in the symptomatic treatment of productive cough, with some shared characteristics and some specific features. Conclusions and relevance All mucolytics reviewed have a good safety profile, although some precautions should be taken when using ambroxol and bromhexine, and the use of NAC and carbocysteine should be monitored in special patient groups. Overall, however, the available evidence from randomised, controlled, and observational trials, as well as pragmatic, real-life experience, suggests that these products are useful in the therapy of upper respiratory airways infections, including bronchitis, sinusitis, and rhinosinusitis.
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Affiliation(s)
- Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
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Comparison between treatment effects in a randomised controlled trial and an observational study using propensity scores in primary care. Br J Gen Pract 2017; 67:e643-e649. [PMID: 28760739 DOI: 10.3399/bjgp17x692153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although randomised controlled trials (RCTs) are considered 'gold standard' evidence, they are not always feasible or appropriate, and may represent a select population. Observational studies provide a useful alternative to enhance applicability, but results can be biased due to confounding. AIM To explore the utility of propensity scores for causal inference in an observational study. DESIGN AND SETTING Comparison of the effect of amoxicillin on key outcomes in an international RCT and observational study of lower respiratory tract infections. METHOD Propensity scores were calculated and applied as probability weights in the analyses. The adjusted results were compared with the effects reported in the RCT. RESULTS Groups were well balanced in the RCT but significantly imbalanced in the observational study, with evidence of confounding by indication: patients receiving antibiotics tended to be older and more unwell at baseline consultation. In the trial duration of symptoms (hazard ratio 1.06, 95% CI = 0.96 to 1.18) and symptom severity (-0.07, 95% CI = -0.15 to 0.007) did not differ between groups. Weighting by propensity score in the observational study resulted in very similar estimates of effect: duration of symptoms (hazard ratio 1.06, 95% CI = 0.80 to 1.40) and difference for symptom severity (-0.07, 95% CI = -0.34 to 0.20). CONCLUSION The observational study, after conditioning on propensity score, echoed the trial results. Provided that detailed information is available on potential sources of confounding, effects of interventions can probably be assessed reasonably well in observational datasets, allowing them to be more directly compared with the results of RCTs.
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Cazzola M, Rogliani P, Aliberti S, Blasi F, Matera MG. An update on the pharmacotherapeutic management of lower respiratory tract infections. Expert Opin Pharmacother 2017; 18:973-988. [PMID: 28480770 DOI: 10.1080/14656566.2017.1328497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Our knowledge about lower respiratory tract infections (LRTIs) has improved substantially in the last years, but the management of respiratory infections is still a challenge and we are still far from using precision medicine in their treatment. Areas covered: The approaches developed in recent years to improve the pharmacotherapeutic management of LRTIs, such as novel diagnostic assays to facilitate medical decision-making, attempts for selecting an optimal empiric antibiotic regimen, and the role of new and possibly unproven adjunctive therapies, are described. Expert opinion: Early and appropriate antibiotics remain the cornerstone in the treatment of LRTIs. The updated trend is to apply antimicrobial stewardship principles and initiatives to optimize both the management and the outcomes of LTRIs. Biomarkers, mainly C-reactive protein (CRP) and procalcitonin (PCT), can improve the diagnostic and prognostic assessment of LRTIs and aid to guide antibiotic therapy. The widespread use of antimicrobial agents has greatly contributed to faster development of antibiotic resistance and the emergence of opportunistic pathogens, which substitute the indigenous microbiota. However, very few new antibiotics in development to overcome existing resistance and ensure continued success in the treatment of LRTIs have been approved, likely because antibiotic stewardship programs discourage the use of new agents.
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Affiliation(s)
- Mario Cazzola
- a Department of Systems Medicine , Università degli Studi di Roma "Tor Vergata" , Rome , Italy
| | - Paola Rogliani
- a Department of Systems Medicine , Università degli Studi di Roma "Tor Vergata" , Rome , Italy
| | - Stefano Aliberti
- b Department of Pathophysiology and Transplantation , Università degli Studi di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Francesco Blasi
- b Department of Pathophysiology and Transplantation , Università degli Studi di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Maria Gabriella Matera
- c Department of Experimental Medicine , Università degli Studi della Campania "Luigi Vanvitelli" , Naples , Italy
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Cough: impact, beliefs, and expectations from a national survey. Multidiscip Respir Med 2016; 11:34. [PMID: 27708777 PMCID: PMC5037648 DOI: 10.1186/s40248-016-0072-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 11/24/2022] Open
Abstract
Background Cough is one of the most common discomforts affecting general population, which can disrupt subjects’ quality of life due to its physical, social, and psychological effects. Aim of the study was to investigate the impact of cough and related beliefs of general population. Methods A cross-sectional telephone survey was carried out by means of a specific, validated questionnaire on a representative sample of Italian general population. All the interviews were carried out according to the Computer Assisted Telephone Interview (CATI) methodology by expert, professional interviewers. Distributions of all answers were calculated in the overall sample. Results A total of 1,251 subjects (mean age: 49 years; females 44.2 %) completed the interviews. The overall number of telephone calls was 5362, and the corresponding redemption rate was 1/4.3 (23.%). The sample was representative of national population in terms of geographical distribution, age, gender, and smoking habit. The majority of respondents was convinced that cough is merely a symptom of several different diseases, but 46.4 % of respondents affirmed that cough should be regarded as “a disease” per se. Only 29.1 % of subjects say that they usually do not complain of any cough over the year, while 18.4 % reported ≥ 3 episodes of cough/year. These episodes have a duration ranging 10–30 days in 19.9 % of subjects, and > 30 days in 6.9 % of subjects. The majority of respondents is worried about their cough only after 1 week, but 76.9 % of subjects is much more worried if cough affects a child. After a few days of cough, 23.1 % of subjects use domestic remedies; 20.9 % ask their pharmacist, and 33.4 % their doctor, being GPs (69.6 %) and lung physicians (16.2 %) the most asked professionals. The occurrence of bronchitis, pneumonia, upper airway infections, and allergic troubles are the most feared events. The majority of respondents are convinced that antibiotics and steroids should not be regarded as the gold standard for treating persistent cough (61.2 and 58.2 %, respectively), while anti-tussive drugs and aerosols in general are regarded as the most effective strategies (69.1 and 74.1 %, respectively). Moreover, 33.8 % of the sample is in favour of homeopathic drugs, while 23.2 % had already used an homeopathic anti-tussive syrup, and 27.6 % of subjects are really interested in using the homeopathic approach. The willingness to pay for an effective anti-tussive remedy was: 46.3 % up to 10 €; 27.8 % up to 20 €, and 13.3 % more than 20 €. Conclusions Cough confirms its high impact in Italy, and a substantial proportion of individuals regards cough as “a disease”. Only one out of three Italians refers to their doctor, but when cough is already persistent. Cough in children is much more feared than in adults. The majority of Italians have a proper and conservative position versus both antibiotic and the systemic steroid uses against cough. The Italian attitude to aerosol therapy confirms very high. Differently from the cough guidelines, anti-tussive drugs are highly valued among Italian people. The attitude and the interest to homeopathic anti-tussive remedies proves high. Finally, the willingness to pay for an effective anti-tussive remedy is quite high in Italy. Electronic supplementary material The online version of this article (doi:10.1186/s40248-016-0072-1) contains supplementary material, which is available to authorized users.
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Abstract
Pharmacists have a long history of helping Canadians with minor ailments. This often has involved management with over-the-counter medications. If pharmacists felt that the best care required something more robust, they would refer the patient to a physician. In hopes of improving the care of such ailments, Canadian provinces have granted pharmacists the option of selecting medications traditionally under physician control. This review examines the Canadian perspective on pharmacists prescribing for minor ailments and the evidence of value for these programs. It might provide guidance for other jurisdictions contemplating such a move.
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Affiliation(s)
- Jeff Gordon Taylor
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon
| | - Ray Joubert
- Saskatchewan College of Pharmacy Professionals, Regina, SK, Canada
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Wong CKM, Liu Z, Butler CC, Wong SYS, Fung A, Chan D, Yip BHK, Kung K. Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study. NPJ Prim Care Respir Med 2016; 26:15080. [PMID: 26797040 PMCID: PMC5533206 DOI: 10.1038/npjpcrm.2015.80] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/10/2015] [Accepted: 11/24/2015] [Indexed: 12/03/2022] Open
Abstract
Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed
to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care
population. This is a prospective multicentre observational study that included adults
presenting with acute cough. Clinicians recorded patients’ presenting symptoms,
examination findings and medication prescription. Patients completed symptom diaries for
up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic
regression models identified factors independently associated with antibiotic
prescription. Primary care clinicians (n=19) recruited 455 patients. A total of
321 patients (70.5%) returned their completed symptom diaries. Concern about illness
severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather
than obtaining a prescription for antibiotics, were the main reasons for consulting.
Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most
common antimicrobial prescribed (61.3%), as it was associated with clinicians’
perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence
interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1,
95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for
antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory
symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05).
There was a significant difference in antibiotic prescription rates between private
primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00).
Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for
cough and 10 days for all symptoms, which was not significantly associated with antibiotic
treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate
of antibiotic prescribing among private primary care clinicians, which warrants further
exploration and scope for education and intervention.
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Affiliation(s)
- Carmen Ka Man Wong
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaomin Liu
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences Oxford University, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, UK.,Cardiff University, Institute of Primary Care and Public Health, Cardiff, Wales.,Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong, China
| | - Samuel Yeung Shan Wong
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Alice Fung
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Dicken Chan
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- Division of Family Medicine and Primary Health Care, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kenny Kung
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong, China
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Harden LM, Kent S, Pittman QJ, Roth J. Fever and sickness behavior: Friend or foe? Brain Behav Immun 2015; 50:322-333. [PMID: 26187566 DOI: 10.1016/j.bbi.2015.07.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 12/21/2022] Open
Abstract
Fever has been recognized as an important symptom of disease since ancient times. For many years, fever was treated as a putative life-threatening phenomenon. More recently, it has been recognized as an important part of the body's defense mechanisms; indeed at times it has even been used as a therapeutic agent. The knowledge of the functional role of the central nervous system in the genesis of fever has greatly improved over the last decade. It is clear that the febrile process, which develops in the sick individual, is just one of many brain-controlled sickness symptoms. Not only will the sick individual appear "feverish" but they may also display a range of behavioral changes, such as anorexia, fatigue, loss of interest in usual daily activities, social withdrawal, listlessness or malaise, hyperalgesia, sleep disturbances and cognitive dysfunction, collectively termed "sickness behavior". In this review we consider the issue of whether fever and sickness behaviors are friend or foe during: a critical illness, the common cold or influenza, in pregnancy and in the newborn. Deciding whether these sickness responses are beneficial or harmful will very much shape our approach to the use of antipyretics during illness.
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Affiliation(s)
- L M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - S Kent
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Q J Pittman
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada.
| | - J Roth
- Institute of Veterinary-Physiology and -Biochemistry, Justus-Liebig-University of Giessen, Frankfurter Strasse 100, D-35392 Giessen, Germany.
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Can 88% of patients with acute lower respiratory infection all be special? Br J Gen Pract 2015; 64:60-2. [PMID: 24567585 DOI: 10.3399/bjgp14x676636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Chenot JF, Weber P, Friede T. Efficacy of Ambroxol lozenges for pharyngitis: a meta-analysis. BMC FAMILY PRACTICE 2014; 15:45. [PMID: 24621446 PMCID: PMC3975147 DOI: 10.1186/1471-2296-15-45] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 03/03/2014] [Indexed: 11/10/2022]
Abstract
Background Ambroxol has a local anaesthetic action and is marketed for pain relief for sore throat. The objective is to examine the efficacy and safety of ambroxol for the relief of pain associated with acute uncomplicated sore throat. Methods A systematic review of the literature and meta-analysis. Selection criteria consisted of randomized controlled trials which compared ambroxol to placebo or any other treatment for sore throat. Two reviewers independently assessed for relevance, inclusion, and risk of bias. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs). Results and conclusion From 14 potentially relevant citations, five trials reported in three publications met the inclusion criteria, three of them were published twice. Ambroxol lozenges were compared in different dosages (5–30 mg) with mint flavoured lozenges and once with benzocaine. Main outcome was a ratio of pain reduction measured repeatedly over 3 h compared to baseline on 6-item verbal rating scale. A total of 1.772 adult patients participated in the trials. Pain intensity decreased in both study arms. A meta-analysis of the 5 controlled trials resulted in a difference in pain reduction compared to placebo of -0.11 (95% CI [-0.15, -0.07]; p < 0.0001) favouring ambroxol 20 mg. Quality of reporting of the studies was low. Ambroxol is slightly more effective in relieving pain in acute sore throat than mint flavoured lozenges over a period of 3 h. However, the additional benefits of ambroxol beyond three hours, remain unclear given that more than 50% of patients using mint flavoured lozenges for pain relief reported good or very good efficacy after 1 day compared to 69% with ambroxol. Ambroxol is a safe option for individual patients with mainly local symptoms asking for treatment.
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Affiliation(s)
- Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, Ellernholzstr, 1-2, 17487 Greifswald, Germany.
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