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Song WJ, Dupont L, Birring SS, Chung KF, Dąbrowska M, Dicpinigaitis P, Ribas CD, Fontana G, Gibson PG, Guilleminault L, Hull JH, Idzko M, Kardos P, Kim HJ, Lai K, Lavorini F, Millqvist E, Morice AH, Niimi A, Parker SM, Satia I, Smith JA, van den Berg JW, McGarvey LP. Consensus goals and standards for specialist cough clinics: the NEUROCOUGH international Delphi study. ERJ Open Res 2023; 9:00618-2023. [PMID: 38020564 PMCID: PMC10658629 DOI: 10.1183/23120541.00618-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background Current guidelines on the management of chronic cough do not provide recommendations for the operation of specialist cough clinics. The objective of the present study was to develop expert consensus on goals and standard procedures for specialist cough clinics. Methods We undertook a modified Delphi process, whereby initial statements proposed by experts were categorised and presented back to panellists over two ranking rounds using an 11-point Likert scale to identify consensus. Results An international panel of 57 experts from 19 countries participated, with consensus reached on 15 out of 16 statements, covering the aims, roles and standard procedures of specialist cough clinics. Panellists agreed that specialist cough clinics offer optimal care for patients with chronic cough. They also agreed that history taking should enquire as to cough triggers, cough severity rating scales should be routinely used, and a minimum of chest radiography, spirometry and measurements of type 2 inflammatory markers should be undertaken in newly referred patients. The importance of specialist cough clinics in promoting clinical research and cough specialty training was acknowledged. Variability in healthcare resources and clinical needs between geographical regions was noted. Conclusions The Delphi exercise provides a platform and guidance for both established cough clinics and those in planning stages.
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Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lieven Dupont
- Department of Respiratory Diseases, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Surinder S. Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Kian Fan Chung
- Experimental Studies Unit, National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Dąbrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center Bronx, Bronx, NY, USA
| | - Christian Domingo Ribas
- Servicio de Neumología, Hospital Parc Taulí, Sabadell, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Giovanni Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Peter G. Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Laurent Guilleminault
- Service de Pneumologie-Allergologie, Pôle des Voies Respiratoires, Hôpital Larrey and Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
| | - James H. Hull
- Royal Brompton Hospital, Guy's and St Thomas’ NHS Trust, London, UK
| | - Marco Idzko
- Department of Pneumology, University Hospital Vienna AKH, Medical University of Vienna, Vienna, Austria
| | - Peter Kardos
- Centre of Allergy, Respiratory and Sleep Medicine, Maingau Clinic of the Red Cross, Frankfurt am Main, Germany
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kefang Lai
- The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alyn H. Morice
- Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Akio Niimi
- School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | - Imran Satia
- Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Jaclyn A. Smith
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester and Manchester University NHS Trust, Manchester, UK
| | | | - Lorcan P. McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Millqvist E, Janson C, Bredin C. [New ICD-10 code for refractory and unexplained chronic cough]. Lakartidningen 2023; 120:22163. [PMID: 36942650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Chronic cough is a common disease, causing distress and impaired quality of life [2]. In the Western world, cough is the most common reason for seeking medical attention [3]. The prevalence of chronic cough is about 10 percent in the adult population but of course hides several subgroups, and the numbers vary greatly [1]. A subgroup of chronic cough is Refractory Chronic Cough (RCC) or Unexplained Chronic Cough (UCC) where no »certain« underlying medical explanation can be found. Until January 2023, the diagnosis of chronic, refractory cough is not included in the ICD-10 codes applied in Sweden. In September 2022, an announcement came from the Swedish National Board of Health and Welfare that from January 1 2023 »Chronic Cough« including refractory and unexplained chronic cough will get its own code under R05 also in Sweden: R05.7.
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Affiliation(s)
- Eva Millqvist
- överläkare, avd för lungmedicin och allergologi, Sahlgrenska universitetssjukhuset, Göteborg
| | - Christer Janson
- överläkare, överläkare, lung- och allergimottagningen, Akademiska sjukhuset, Uppsala; ordförande, Svensk förening för allergologi
| | - Cecilia Bredin
- överläkare, ME lung- och allergisjukdomar, Karolinska universitetssjukhuset, Stockholm: avgående ordförande, Svensk lungmedicinsk förening
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3
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Lee JH, Song WJ, Millqvist E, Morice AH. Objective cough frequency monitoring in real-world practice. ERJ Open Res 2021; 7:00545-2021. [PMID: 34616837 PMCID: PMC8488337 DOI: 10.1183/23120541.00545-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022] Open
Abstract
There are possibilities and obstacles to the use of objective cough monitoring in real-world practice. Advances in technology will overcome the difficulties and continuous real-time cough monitoring will then provide a valuable tool in cough management. https://bit.ly/3lu5cfk.
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Affiliation(s)
- Ji-Hyang Lee
- Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Alyn H. Morice
- Respiratory Medicine, Institute for Clinical and Applied Health Research, Hull York Medical School, Hull, UK
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Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, Hilton Boon M, Kantar A, Lai K, McGarvey L, Rigau D, Satia I, Smith J, Song WJ, Tonia T, van den Berg JWK, van Manen MJG, Zacharasiewicz A. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55:1901136. [PMID: 31515408 PMCID: PMC6942543 DOI: 10.1183/13993003.01136-2019] [Citation(s) in RCA: 354] [Impact Index Per Article: 88.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/01/2019] [Indexed: 01/07/2023]
Abstract
These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
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Affiliation(s)
- Alyn H Morice
- Respiratory Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Bieksiene
- Dept of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Dept of Respiratory Medicine, King's College Hospital, London, UK
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Christian Domingo Ribas
- Pulmonary Service, Corporació Sanitària Parc Taulí (Sabadell), Dept of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Michele Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ahmad Kantar
- Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Kefang Lai
- Dept of Clinical Research, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Representing the Chinese Thoracic Society
| | - Lorcan McGarvey
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Imran Satia
- Dept of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Science Centre, Manchester, UK
| | - Jacky Smith
- University of Manchester, Division of Infection, Immunity and Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Woo-Jung Song
- Airway Sensation and Cough Research Laboratory, Dept of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Representing the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI)
| | | | | | - Mirjam J G van Manen
- Dept of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Angela Zacharasiewicz
- Dept of Pediatrics, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Vienna, Austria
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Song WJ, Millqvist E, Morice AH. New ERS cough guidelines: A clinical framework for refining the patient management strategy. Asia Pac Allergy 2019; 9:e36. [PMID: 31720247 PMCID: PMC6826112 DOI: 10.5415/apallergy.2019.9.e36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alyn H Morice
- Respiratory Research Group, University of Hull, Hull York Medical School, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom
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Affiliation(s)
| | - Simon Hart
- 1 University of Hull Hull, United Kingdom and
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McGarvey L, Dupont L, Birring SS, Boyd J, Chung KF, Dabrowska M, Domingo C, Fontana G, Guilleminault L, Kardos P, Millqvist E, Morice AH, Smith JA, van den Berg JW, Van de Kerkhove C. New understanding in the treatment of cough (NEUROCOUGH) ERS Clinical Research Collaboration: improving care and treatment for patients with cough. Eur Respir J 2019; 53:53/5/1900787. [PMID: 31147424 DOI: 10.1183/13993003.00787-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/05/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Lorcan McGarvey
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lieven Dupont
- Dept of Respiratory Diseases, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | | | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Christian Domingo
- Servicio de Neumología, Hospital Parc Taulí, Sabadell, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Giovanni Fontana
- Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laurent Guilleminault
- Service de pneumologie-allergologie, pôle des voies respiratoires, hôpital Larrey, and Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
| | - Peter Kardos
- Centre for Allergy, Respiratory and Sleep Medicine at Red Cross Maingau Hospital, Frankfurt, Germany
| | - Eva Millqvist
- Dept of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Alyn H Morice
- Hull York Medical School, Castle Hill Hospital, Hull, UK
| | - Jaclyn A Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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8
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Johansson EL, Gustafsson P, Millqvist E, Ternesten-Hasséus E. Small and large airways' reactions to inhaled capsaicin in patients with chronic idiopathic cough, or asthma and in healthy control subjects. Exp Lung Res 2019; 45:55-64. [PMID: 31088165 DOI: 10.1080/01902148.2019.1611971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Cough is a common medical problem, and when it persists for more than 8 weeks it is arbitrarily defined as chronic. While spirometry assesses the large airways, impulse oscillometry system (IOS) measures peripheral airway function. The present study investigated whether provocation with inhaled capsaicin affects the large and small airways in patients with chronic idiopathic cough (CIC) or asthma and in healthy controls. Materials and methods: Twenty-one patients with CIC, 18 patients with asthma, and 22 healthy controls were subjected to a provocation with capsaicin, and lung function was assessed by IOS and spirometry. Results: At baseline, before the capsaicin provocation, the CIC group had significantly increased airway resistance compared to the controls. After capsaicin provocation, the CIC group exhibited a significant increase in total airway resistance. The asthma group showed a small but significant reduction in spirometry, increased airway resistance, and reactance after capsaicin provocation. Capsaicin inhalation affected neither the spirometry nor the IOS of the healthy controls. Conclusions: The present study demonstrates that inhaled capsaicin induces changes in lung function, both in patients with CIC and in patients with asthma, when IOS, which measures changes also in the peripheral airways, is used. IOS appears to be a more sensitive tool than spirometry for the detection of airway impairment in airway provocation studies. In patients with CIC, higher peripheral resistance at baseline may have clinical significance.
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Affiliation(s)
- Ewa-Lena Johansson
- a Department of Clinical Neuroscience, Rehabilitation and Physiotherapy , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Per Gustafsson
- b Department of Pediatrics , Central Hospital , Skövde , Sweden
| | - Eva Millqvist
- c Department of Internal Medicine/Respiratory Medicine and Allergology , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Ewa Ternesten-Hasséus
- c Department of Internal Medicine/Respiratory Medicine and Allergology , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Abstract
Background This is an explorative study of growth-related nasal geometry in healthy children. Methods A total of 88 girls and boys between the ages of 4 and 16 years were followed over a period of 2 years by acoustic rhinometry. The registrations were correlated to height at each occasion. Results Although both the minimal cross-sectional area and the nasal volume increased in all age groups over 7 years, large individual variations in nasal geometry led to a weak relationship with growth. Conclusion In the undecongested nasal cavity in children, correlation of nasal geometry makes sense for height but not for age.
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Affiliation(s)
- Eva Millqvist
- Asthma and Allergy Research Group, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Bende
- Allergy Center, Central Hospital, Skövde, Sweden
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10
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Abstract
Nasal geometry measured by acoustic rhinometry was compared with the subjective sensation of nasal stuffiness in healthy subjects before and after provocation with histamine. The correlation was poor at rest, but it was significant after histamine provocation in children and adults. It is easier to find a relationship between subjective and objective nasal obstruction after inducing congestion.
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Affiliation(s)
| | | | - Mats Bende
- Allergy Center, Central Hospital, Skövde, Sweden
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11
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Johansson EL, Ternesten-Hasséus E, Gustafsson P, Pullerits T, Arvidsson M, Millqvist E. Small and large airway reactions to osmotic stimuli in asthma and chronic idiopathic cough. Pulm Pharmacol Ther 2018; 49:112-118. [PMID: 29438818 DOI: 10.1016/j.pupt.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic cough is a common symptom and related to several pulmonary, airway and heart diseases. When all likely medical explanations for the coughing are excluded, there remains a large group of patients with chronic coughing, which is mostly a cough reflex easily triggered by environmental irritants and noxious stimuli. The main aim of this study was to improve the diagnostic ability to differentiate chronic idiopathic cough (CIC) from asthma. METHODS Twenty-three patients with CIC, 16 patients with mild asthma and 21 control participants were included. The study consisted of three randomised bronchial provocations with osmotic stimuli: mannitol, eucapnic dry air and hypertonic saline. At each provocation lung function was assessed by spirometry and impulse oscillometry (IOS). RESULTS In a comparison of the groups, while the FEV1 measurements did not differ, the CIC group had increased airway resistance and reactance after provocation with hypertonic saline compared to the control subjects. After mannitol provocation the patients with asthma had significantly increased airway resistance compared to the controls and from eucapnic dry air provocations these patients had a significant reduction in spirometry values and increased airway resistance compared to both the patients with CIC and the controls. CONCLUSION The asthma group reacted in a predictable way with impaired lung function from osmotic provocations, whereas the patients with CIC demonstrated peripheral airway changes from hypertonic saline, also known to be a noxious stimulus. The IOS method uncovers differences between patients with CIC and control participants that contribute to our ability to provide a correct diagnosis.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Ewa Ternesten-Hasséus
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Per Gustafsson
- Department of Paediatrics, Central Hospital, Skovde, Sweden.
| | - Teet Pullerits
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Monica Arvidsson
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy, University of Gothenburg, Sweden.
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Bohman A, Oscarsson M, Holmberg K, Johansson L, Millqvist E, Nasic S, Bende M. Relative frequencies of symptoms and risk factors among patients with chronic rhinosinusitis with nasal polyps using a case-control study. Acta Otolaryngol 2018; 138:46-49. [PMID: 28826302 DOI: 10.1080/00016489.2017.1366052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relative frequency of important symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), the link between CRSwNP and the lower airways and the importance of smoking in CRSwNP. METHOD Three hundred and sixty-eight patients with CRSwNP and 1349 controls were recruited to the study and underwent a structured interview about symptoms from the upper and lower airways, and about smoking habits. Furthermore, all participants were clinically examined using nasal endoscopy. RESULTS Due to interactions between the outcome variables, a multiple logistic regression model was fitted to the data. Nasal secretions, nasal blockage and impaired sense of smell were symptoms associated with CRSwNP. Furthermore, male gender, increasing age and asthma were also associated with the disease. Current smoking was less frequent among patients with CRSwNP. CONCLUSION By comparing symptoms and risk factors of patients with CRSwNP with those of a large population-based control group and testing them in a multiple logistic regression model, we have been able to generate data that address key research interests in CRSwNP.
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Affiliation(s)
- Anton Bohman
- Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Oscarsson
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
| | - Kenneth Holmberg
- Department of Otorhinolaryngology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Mats Bende
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
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13
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Frieberg OP, Millqvist E, Nilsson J, From I. Development and validation of the self-administered Falun health instrument (SAFHI) using data from health promoted workplaces in Sweden. Scand J Public Health 2017; 46:735-743. [PMID: 29027502 DOI: 10.1177/1403494817728668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study was to develop and to validate the self-administered Falun health instrument. An additional aim was to test its applicability in measuring people's lifestyles linked to health. METHODS In 2002, an instrument was constructed containing questions regarding the hazardous use of alcohol, tobacco, unhealthy diets and insufficient physical activity. A pilot study using the instrument was assessed between 2002 and 2006. In Sweden, it was further expanded and tested during the years 2004-2014 among a total of 1295 people. RESULTS Face validity was evaluated among colleagues and experts for clarity and completeness resulting in minor adjustments of some questions. With the test-retest method, the self-administered Falun health questionnaire showed a positive and high reproducibility and high compliance. Cronbach's alpha showed a high level of consistency (average 0.86). Factor analysis demonstrated the choice of questions correlated highly to the measured lifestyle. CONCLUSIONS This study showed that the self-administered Falun health questionnaire is a valid and reliable instrument, useful for detecting individuals at risk of developing diseases that are related to individual choice of lifestyle.
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Affiliation(s)
- Otto-Patrik Frieberg
- 1 Health Centre Läkarhuset Unicare, Borlänge, Sweden; Centre of Clinical Research (CKF), Dalarna, Sweden
| | - Eva Millqvist
- 2 Department of Internal Medicine/Respiratory Medicine and Allergology, University of Gothenburg, Sweden
| | - Jan Nilsson
- 3 Department of Medical Science, Sophiahemmet University, Sweden.,4 Department of Health Sciences, Karlstad University, Sweden
| | - Ingrid From
- 5 The School of Education, Health and Social Studies, Dalarna University, Sweden
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Abstract
Chronic cough is common in the population, and among some there is no evident medical explanation for the symptoms. Such a refractory or idiopathic cough is now often regarded as a neuropathic disease due to dysfunctional airway ion channels, though the knowledge in this field is still limited. Persistent coughing and a cough reflex easily triggered by irritating stimuli, often in combination with perceived dyspnea, are characteristics of this disease. The patients have impaired quality of life and often reduced work capacity, followed by social and economic consequences. Despite the large number of individuals suffering from such a persisting cough, there is an unmet clinical need for effective cough medicines. The cough treatment available today often has little or no effect. Adverse effects mostly follow centrally acting cough drugs comprised of morphine and codeine, which demands the physician's awareness. The possibilities of modulating airway transient receptor potential (TRP) ion channels may indicate new ways to treat the persistent cough "without a reason". The TRP ion channel vanilloid 1 (TRPV1) and the TRP melastin 8 (TRPM8) appear as two candidates in the search for cough therapy, both as single targets and in reciprocal interaction.
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Affiliation(s)
- Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, The Sahlgrenska Academy at University of Gothenburg, 413 45 Gothenburg, Sweden.
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15
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Affiliation(s)
- Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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Johansson EL, Ternestén-Hasseus E, Olsén MF, Millqvist E. Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity. Physiother Res Int 2016; 22. [PMID: 26847527 DOI: 10.1002/pri.1658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. METHODS Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. RESULTS Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p < 0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p < 0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p < 0.001). CONCLUSION Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients with SHR and signs of dysfunctional breathing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Ewa Ternestén-Hasseus
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
BACKGROUND Nasal polyps is a common disease but little is known about its` pathogenesis. Our hypothesis was that there are genetic factors involved in the development of this disease. The aim of this study was to examine close relatives of patients with nasal polyps and comparing them with a general population with regard to prevalence of polyps. METHODOLOGY Patients with nasal polyps who attended the clinic were recruited to the study and were asked whether they had any close adult relatives (siblings, parents or children). We intended to recruit two relatives per patient, one of each gender, for nasal endoscopy. The prevalence of nasal polyps in these relatives was compared with the prevalence of nasal polyps in a general population. RESULTS During a 4-year period, 368 patients and 410 relatives were recruited to the study. Although we were unable to recruit two close relatives for every patient, we were able to calculate nasal polyp prevalence within families as being 19.2%. Compared with the prevalence of nasal polyps among individuals in a general Swedish population from the same geographical area, the relative risk for polyps among relatives was almost five times higher. CONCLUSION This study strongly indicates that heredity is a factor of importance for development of nasal polyps.
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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. Cough hypersensitivity syndrome: clinical measurement is the key to progress. Eur Respir J 2015; 45:1509-10. [PMID: 25931492 DOI: 10.1183/09031936.00014215] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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Lind N, Nordin M, Palmquist E, Claeson AS, Millqvist E, Nordin S. Coping and social support in asthma and allergy: the Västerbotten Environmental Health Study. J Asthma 2015; 52:622-9. [PMID: 25428769 DOI: 10.3109/02770903.2014.991970] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Asthma and allergy are stressful conditions that require coping strategies and social support to reduce stress and enhance health-promoting behavior. However, research is limited regarding coping and social support in asthma and allergy. The aim was to better understand the use of different coping strategies and perceived social support in low and high severity (exacerbation frequency) of asthma and allergy. METHODS Population-based data were used to provide ratings of coping strategies (Study I) and social support (Study II) from 124 and 94 participants, respectively, with asthma and/or allergy, categorized as low or high in severity. Problem- and emotion-focused coping strategies were assessed as well as emotional, instrumental and informative social support from seven sources. RESULTS Study I showed that avoiding certain environments (problem-based coping) and trying to accept one's situation (emotion-based) were the most commonly used coping strategies. These behaviors did not differ due to severity. Study II showed that more emotional than instrumental and informative support was perceived. The highest rated support sources were the partner, family members and the healthcare system. More social support was reported in low asthma/allergy severity compared to high asthma/allergy severity. CONCLUSION The most commonly used coping strategies in the population of persons with these four types of asthma and allergy are avoiding certain environments and trying to accept one's situation. More emotional support than instrumental and informative is perceived to be received, and most of the support is received from one's partner and other family members and least from authorities and patient associations/support groups.
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Affiliation(s)
- Nina Lind
- a Department of Psychology , Umeå University , Umeå , Sweden and
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Ternesten-Hasseus E, Johansson EL, Millqvist E. Reply to correspondence regarding the paper "Ternesten-Hasséus E, Johansson EL, Millqvist E. Cough reduction using capsaicin. Respir Med. 2015 Jan;109(1):27-37.". Respir Med 2015; 109:927. [PMID: 25962647 DOI: 10.1016/j.rmed.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Millqvist E. TRP channels and temperature in airway disease-clinical significance. Temperature (Austin) 2015; 2:172-7. [PMID: 27227021 PMCID: PMC4843868 DOI: 10.1080/23328940.2015.1012979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/24/2015] [Accepted: 01/26/2015] [Indexed: 11/16/2022] Open
Abstract
Temperatures above and below what is generally regarded as “comfortable” for the human being have long been known to induce various airway symptoms, especially in combination with exercise in cold climate with temperatures below 0°C, which is naturally since exercise is followed by enhanced ventilation and thus greater amounts of inhaled cold air. The aim was to highlight the knowledge we have today on symptoms from the airways (here also including the eyes) arisen from various temperatures; the mechanisms, the pathophysiology and their clinical significance. The most common eye and airway conditions related to temperature changes are dry eye disease, rhinitis, laryngeal dysfunction, asthma, chronic obstructive pulmonary disease and chronic cough. Transient receptor potential (TRP) ion channels are probably involved in all temperature induced airway symptoms but via different pathways, which are now beginning to be mapped out. In asthma, the most persuasive hypothesis today is that cold-induced asthmatic bronchoconstriction is induced by dehydration of the airway mucosa, from which it follows that provocations with osmotic stimuli like hypertonic saline and mannitol can be used as a surrogate for exercise provocation as well as dry air inhalation. In chronic unexplained cough there seems to be a direct influence of cold air on the TRP ion channels followed by coughing and increased cough sensitivity to inhaled capsaicin. Revelations in the last decades of the ability of several airway TRP ion channels to sense and react to ambient air temperature have opened new windows for the understanding of the pathogenesis in a diversity of airway reactions appearing in many common respiratory diseases.
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Affiliation(s)
- Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology; The Sahlgrenska Academy; University of Gothenburg ; Gothenburg, Sweden
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Ternesten-Hasséus E, Johansson EL, Millqvist E. Cough reduction using capsaicin. Respir Med 2015; 109:27-37. [DOI: 10.1016/j.rmed.2014.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 12/20/2022]
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Morice AH, Jakes AD, Faruqi S, Birring SS, McGarvey L, Canning B, Smith JA, Parker SM, Chung KF, Lai K, Pavord ID, van den Berg J, Song WJ, Millqvist E, Farrell MJ, Mazzone SB, Dicpinigaitis P. A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response. Eur Respir J 2014; 44:1149-55. [PMID: 25186267 DOI: 10.1183/09031936.00217813] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reports from individual centres suggest a preponderance of females with chronic cough. Females also have heightened cough reflex sensitivity. Here we have reviewed the age and sex of unselected referrals to 11 cough clinics. To investigate the cause of any observed sex dimorphism, functional magnetic resonance imaging of putative cough centres was analysed in normal volunteers. The demographic profile of consecutive patients presenting with chronic cough was evaluated. Cough challenge with capsaicin was undertaken in normal volunteers to construct a concentration-response curve. Subsequent functional magnetic resonance imaging during repeated inhalation of sub-tussive concentrations of capsaicin observed areas of activation within the brain and differences in the sexes identified. Of the 10,032 patients presenting with chronic cough, two-thirds (6591) were female (mean age 55 years). The patient profile was largely uniform across centres. The most common age for presentation was 60-69 years. The maximum tolerable dose of inhaled capsaicin was lower in females; however, a significantly greater activation of the somatosensory cortex was observed. Patients presenting with chronic cough from diverse racial and geographic backgrounds have a strikingly homogeneous demographic profile, suggesting a distinct clinical entity. The preponderance of females may be explained by sex-related differences in the central processing of cough sensation.
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Affiliation(s)
- Alyn H Morice
- Respiratory Medicine, Castle Hill Hospital, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Cottingham, UK
| | - Adam D Jakes
- Respiratory Medicine, Castle Hill Hospital, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Cottingham, UK
| | - Shoaib Faruqi
- Respiratory Medicine, Castle Hill Hospital, Centre for Cardiovascular and Metabolic Research, Hull York Medical School, Cottingham, UK
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Lorcan McGarvey
- Dept of Medicine, Institute of Clinical Science, The Queen's University of Belfast, Belfast, UK
| | - Brendan Canning
- Dept of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
| | - Jaclyn A Smith
- Centre for Respiratory and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, UK
| | - Sean M Parker
- Dept of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHSFT, North Shields, UK
| | - Kian Fan Chung
- Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, Imperial College, London, UK
| | - Kefang Lai
- Dept of Clinical Research, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Ian D Pavord
- Nuffield Dept of Medicine Research Building, University of Oxford, Oxford, UK
| | | | - Woo-Jung Song
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eva Millqvist
- Dept of Internal Medicine/Respiratory Medicine and Allergology, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael J Farrell
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Stuart B Mazzone
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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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: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Ternesten-Hasséus E, Larsson C, Larsson S, Millqvist E. Capsaicin sensitivity in patients with chronic cough- results from a cross-sectional study. Cough 2013; 9:5. [PMID: 23448366 PMCID: PMC3598875 DOI: 10.1186/1745-9974-9-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/18/2013] [Indexed: 11/26/2022]
Abstract
Background A subgroup of patients with chronic cough is recognised as having airway symptoms resulting exposure to chemicals and scents related to enhanced cough sensitivity to inhaled capsaicin. Sensory hyperreactivity, which has an estimated prevalence of more than 6%, is one possible explanation for the symptoms experienced by these patients. We hypothesized that a number of patients diagnosed with chronic unexplained cough also have coughing provoked by chemical irritants associated with augmented capsaicin cough reaction, but the extent of such a relation is not known. One aim of the present study was to analyse cough sensitivity to inhaled capsaicin in patients with chronic unexplained cough. Another aim was to compare capsaicin sensitivity in individuals with chemically induced coughing (the chemical-sensitive group) to capsaicin sensitivity in those without such chemical sensitivity (non-sensitive group). Methods Fifty-six participants from an earlier cross-sectional study of 62 patients with chronic unexplained cough were asked to participate in this study: 33 were chemical-sensitive and 23 were non-sensitive. Each participant visited the clinic once and performed a capsaicin inhalation test with one of two inhalation devices. The number of coughs, induced airway symptoms, and spirometry results were recorded. Results Thirty-nine of the invited patients participated in the study, with 32 in the chemical-sensitive group (21 women, 11 men), and 7 in the non-sensitive group (4 women, 3 men). The chemical-sensitive patients coughed significantly more on inhaling capsaicin, and had significantly more other airway symptoms compared to those in the non-sensitive group. Women coughed significantly more than men after receiving the higher concentration of capsaicin. Conclusions Environmental irritants often trigger chronic unexplained cough. The current findings confirm that this sensitivity is related to enhanced capsaicin cough sensitivity and indicates more involvement of airway sensory nerves in the pathophysiology of the disease than in cough without evident trigger factors.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Department of Allergology, Institution of Internal Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Millqvist E, Ternesten-Hasséus E, Bende M. Inhalation of menthol reduces capsaicin cough sensitivity and influences inspiratory flows in chronic cough. Respir Med 2012; 107:433-8. [PMID: 23266255 DOI: 10.1016/j.rmed.2012.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/13/2012] [Accepted: 11/16/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Chronic cough is a common clinical problem and there is a shortage of effective treatments for it. Within the group of transient receptor potential ion channels a receptor for the cooling substance menthol has been identified. This study aimed to assess whether pre-inhalation of dissolved, nebulised menthol could increase capsaicin cough thresholds and influence spirometric values. METHODS Fourteen patients with chronic cough and airway sensitivity to environmental irritants and 15 control subjects were tested on three occasions. Each one inhaled a 1 mL of nebulised menthol solution of 0.5% or 1% or placebo (saline with 0.05% menthol) at each visit in a randomized and double-blind order. They were then provoked by capsaicin inhalation. RESULTS Patients' cough thresholds differed significantly from the controls' on all three provocations (P < 0.0001). After inhalation of 1% menthol, the patients' cough thresholds were significantly higher (P < 0.02) compared to after placebo inhalation and to after 0.5% menthol inhalation (P < 0.05). The patients' peak inspiratory flows were significantly reduced after inhalation of the placebo (saline) (P < 0.05) but not after inhalation of 0.5% or 1% menthol. Forced inspiratory flows 50% were lowered after inhalation of placebo and of 0.5% menthol (P < 0.05) but not after 1% menthol. Among the controls, forced inspiratory flows 50% were lowered after only placebo inhalation (P < 0.05). CONCLUSIONS In patients with chronic cough, pre-inhalation of menthol reduces cough sensitivity to inhaled capsaicin and influences inspiratory flows. The findings may provide scientific support for the common practice of using menthol as a reliever for variant airway discomfort. The use of menthol in different cigarette brands could be questioned since it could conceal the natural irritation following smoking.
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Affiliation(s)
- Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
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Nordin S, Palmquist E, Bende M, Millqvist E. Normative data for the chemical sensitivity scale for sensory hyperreactivity: the Västerbotten environmental health study. Int Arch Occup Environ Health 2012; 86:749-53. [PMID: 22918527 DOI: 10.1007/s00420-012-0812-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 08/09/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The chemical sensitivity scale for sensory hyperreactivity (CSS-SHR) is used to quantify affective reactions to and behavioral disruptions by odorous/pungent substances in the environment and has documented good metric properties. However, normative data have not been available. The main objective of the present study was therefore to establish normative data for reference by means of a large-scale population-based study. MATERIALS AND METHODS From a random sample of 8,520 reachable inhabitants in the county of Västerbotten in Sweden, aged 18-79 years, stratified for age and gender, 3,406 individuals agreed to participate. RESULTS The results show fairly high internal consistency (Cronbach's α = 0.78-0.83) of the CSS-SHR and that it generates scores with approximately normal distributions (skewness: 0.045-0.454; kurtosis: -0.314 to 0.230), irrespective of age group and gender. Mean scores, standard deviations, confidence intervals, and proportions of individuals who met the diagnostic cutoff score for the CSS-SHR were obtained for reference of normality. CONCLUSIONS CSS-SHR can be recommended for quantification of affective reactions to and behavioral disruptions by odorous/pungent environmental substances, and with the advantage of comparing scores with normality.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, 901 87, Umeå, Sweden,
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Bende M, Millqvist E. Prevalence of chronic cough in relation to upper and lower airway symptoms; the Skövde population-based study. Front Physiol 2012; 3:251. [PMID: 22934008 PMCID: PMC3429028 DOI: 10.3389/fphys.2012.00251] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/18/2012] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to determine the prevalence of chronic cough in relation to upper airway symptoms, in a cross-sectional, population-based epidemiological study. Another aim was to relate coughing to other explanatory variables and risk factors. A random sample of 1900 inhabitants from the age of 20, stratified for age and gender, was recruited. Subjects were invited for clinical examinations that included questions about general odor intolerance, respiratory symptoms, and smoking habits, and a smell identification test. In total, 1387 volunteers (73% of the sample) were investigated. The overall prevalence of self-reported chronic cough was 6.3% [95% confidence interval (CI): 5.0-7.6%]. Female gender, age, height, BMI, and smoking were significantly related to cough. Furthermore, nasal blockage, nasal secretion, sneezing, asthma, odor and cold air sensitivity, and aspirin intolerance also related to cough with statistical significance, indicating a close connection between chronic cough and upper airway symptoms. In keeping with other studies, this study demonstrates that chronic cough is a widespread problem in society, and is about twice as common in women than in men.
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Affiliation(s)
- Mats Bende
- Department of Otorhinolaryngology, Central Hospital Skövde, Sweden
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Johansson EL, Ternesten-Hasséus E, Olsén MF, Millqvist E. Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD. Respir Med 2012; 106:1006-13. [PMID: 22510540 DOI: 10.1016/j.rmed.2012.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/01/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with "sensory hyperreactivity" (SHR) have airway environmental sensitivity, chronic cough and dyspnoea. Cough, chest discomfort and sense of difficulties getting air are some of the symptoms these patients seek medical attendance for. The patients have increased cough sensitivity to inhaled capsaicin, mediated by ion channel receptors on sensory nerves also known to react to pain stimuli. Whether a link exists between capsaicin airway sensitivity and pain sensitivity has not yet been evaluated. The aim was to investigate chest mobility, respiratory movement and pain sensitivity in SHR patients compared with patients with asthma, chronic obstructive pulmonary disease (COPD) and alleged healthy control subjects. METHODS Thirty-five patients diagnosed with SHR, 19 with COPD, 32 with asthma and 28 control subjects were included. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using a pressure algometer. RESULTS Groups differed significantly in lung function, respiratory rate and pain sensitivity but also in chest expansion and abdominal breathing movement. In comparison with the control and asthma groups but not the COPD patients, SHR patients had an increased respiratory rate and reduced abdominal movement during deep breathing. All patient groups showed lower pain thresholds than the controls. CONCLUSION Patients with SHR have evident signs of dysfunctional breathing and appeared to be most similar to the COPD group except for lung function. Lower pain thresholds among the patients indicate a general up-regulation of the sensory nerve system.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, the Sahlgrenska Academy, University of Gothenburg, Sweden
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Ternesten-Hasséus E, Larsson S, Millqvist E. Sensitivity to environmental irritants and quality of life in COPD. Int J Chron Obstruct Pulmon Dis 2011; 6:685-91. [PMID: 22259245 PMCID: PMC3257954 DOI: 10.2147/copd.s25839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
It is a common clinical experience that patients with chronic obstructive pulmonary disease (COPD) complain of airway symptoms provoked by environmental irritants like chemicals and scents, although few studies can confirm such connections. The aim was to study the prevalence of airway symptoms induced by chemicals and scents in a group of patients with newly diagnosed CPOD and to analyze any relation to illness severity and quality of life. Eighty-one patients with COPD were recruited to the study. By mail they were asked to answer three questionnaires regarding symptoms, quality of life, and social and emotional influence of airway symptoms induced by environmental irritants. A majority (62%) of the COPD patients claimed to be hyperreactive to chemicals and scents. As a group they scored higher on a questionnaire measuring social and emotional influences of such environmental irritants compared to healthy control subjects. Further, high scores were more common among patients with a very severe form of COPD and among patients with regular use of β(2)-stimulants. High scores were also associated with significantly more airway symptoms and, in some aspects, with impaired quality of life. In conclusion, the results of this study show that airway symptoms induced by environmental irritants are common in patients with COPD and that this increased airway sensitivity follows the impairment of lung capacity. The mechanisms behind this remain unclear.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven Larsson
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/ Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Emilsson M, Berndtsson I, Lötvall J, Millqvist E, Lundgren J, Johansson A, Brink E. The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Prim Care Respir J 2011; 20:141-7. [PMID: 21311839 DOI: 10.4104/pcrj.2011.00005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM To explore the influence of personality traits and beliefs about medicines on adherence to treatment with asthma medication. METHODS Respondents were 35 asthmatic adults prescribed controller medication. They answered questionnaires about medication adherence, personality traits, and beliefs about medicines. RESULTS In gender comparisons, the personality traits "Neuroticism" in men and "adherence to medication" were associated with lower adherent behaviour. Associations between personality traits and beliefs in the necessity of medication for controlling the illness were identified. Beliefs about the necessity of medication were positively associated with adherent behaviour in women. In the total sample, a positive "necessity-concern" differential predicted adherent behaviour. CONCLUSION The results imply that personality and beliefs about medicines may influence how well adults with asthma adhere to treatment with asthma medication.
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Affiliation(s)
- Maria Emilsson
- Department of Nursing, Health and Culture, University of West, Trollhättan, Sweden.
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Ternesten-Hasséus E, Larsson S, Millqvist E. Symptoms induced by environmental irritants and health-related quality of life in patients with chronic cough - A cross-sectional study. Cough 2011; 7:6. [PMID: 21981855 PMCID: PMC3212888 DOI: 10.1186/1745-9974-7-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/07/2011] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Chronic cough is a common condition, but some patients have no evident medical explanation for their symptoms. A group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin. Chronic cough is usually a prominent symptom in these patients, and it has been suggested that they suffer from sensory hyperreactivity.Our main aim was to analyse, in a group of patients with chronic cough, the presence of symptoms induced by environmental factors such as chemicals, scents, and cold air, and to measure the social and emotional influences of these symptoms in relation to quality of life. A second aim was to pilot-test a Swedish translation of a cough-specific questionnaire. METHODS A total of 119 patients with chronic cough were asked to answer three different questionnaires: a local symptom questionnaire, the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), and the Nottingham Health Profile (NHP). In addition, a Swedish version of the Hull Airway Reflux Questionnaire (HARQ) was developed and answered by a subgroup of patients and healthy controls. RESULTS Sixty-two patients (52%) with mean cough duration of 10.6 years answered the local symptom questionnaire, the CSS-SHR, and the NHP. Of these, 39 (63%) claimed to have cough and other symptoms induced by chemicals and scents. Compared to population-based findings, the patients scored higher on the CSS-SHR, and the CSS-SHR score was significantly higher among chemical-sensitive individuals (p < 0.001). The NHP showed that the patients had a significantly reduced quality of life, which was most pronounced among chemical-sensitive individuals. The 31 patients who answered the HARQ had significantly higher scores (p < 0.0001) than 59 healthy controls. CONCLUSIONS Among patients with chronic cough, a majority claimed that environmental factors induced coughing. Both the CSS-SHR and the HARQ score systems seem to be valuable instruments in the mapping of cough patients, supporting the novel paradigm of a cough hypersensitivity syndrome. Our results emphasize that cough is a substantial burden to the patient, influencing daily living and quality of life.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Department of Allergology, Institution of Internal Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden, S-413 45 Gothenburg, Sweden
| | - Sven Larsson
- Department of Respiratory Medicine, Institution of Internal Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Eva Millqvist
- Department of Allergology, Institution of Internal Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden, S-413 45 Gothenburg, Sweden
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Ekstrand Y, Ternesten-Hasséus E, Arvidsson M, Löfdahl K, Palmqvist M, Millqvist E. Sensitivity to environmental irritants and capsaicin cough reaction in patients with a positive methacholine provocation test before and after treatment with inhaled corticosteroids. J Asthma 2011; 48:482-9. [PMID: 21486197 DOI: 10.3109/02770903.2011.570405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Increasing evidence points to a potential role for members of the transient receptor potential family of cation channels on several features of asthmatic disease. The cough sensitivity to inhaled capsaicin is known to reflect the reactivity of these airway sensory nerves. OBJECTIVE The aim was to study, among patients having a positive methacholine provocation and diagnosed with asthma, capsaicin cough sensitivity, sensitivity to methacholine, and levels of exhaled nitric oxide before and after treatment with inhaled steroids, and further, to measure the self-reported impact from environmental irritants. METHODS Eighteen steroid-naïve patients with a positive methacholine test underwent capsaicin inhalation provocation on two occasions, before and after regular use of inhaled steroids over at least 3 months. Comparisons were made to 21 healthy controls. Sensitivity to methacholine and levels of exhaled nitric oxide were measured before and after the treatment. The participants also answered a validated questionnaire regarding environmental irritants. RESULTS The patients displayed higher capsaicin cough sensitivity than the controls before the treatment period, but not afterward. Before treatment, capsaicin cough answer correlated significantly with levels of exhaled nitric oxide, but not with methacholine sensitivity. After treatment with inhaled corticosteroids, the capsaicin cough sensitivity and the inflammatory parameters were normalized. In comparison to the control group, the patients reported more affective reactions to and behavioral disruptions induced by environmental irritants. CONCLUSIONS In steroid-naïve patients with a positive methacholine test, there is a link between that part of the airway inflammation that is reflected by exhaled nitric oxide and that followed by an augmented reactivity of capsaicin-sensitive sensory nerves. This association disappears after steroid treatment.
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Affiliation(s)
- Ylva Ekstrand
- Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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Abstract
After exclusion of diverse pulmonary illnesses, the remaining explanations for chronic cough include medication with angiotensin-converting enzyme (ACE) inhibitor, gastroesophageal reflux disease (GERD), and post-nasal drip. Different clinics report shifting frequencies for both the causes of chronic cough and the success of treatment. However, after all evaluations, differential diagnosis still leaves a group of patients with unexplained cough. This unexplained cough is also known as chronic idiopathic cough (CIC), though there are widely varying opinions as to its existence. Among patients previously diagnosed with CIC, a subgroup has been identified with both upper and lower airway symptoms, including cough induced by odours and chemicals, and with increased cough sensitivity to inhaled capsaicin, which is known to stimulate the airway sensory nerves. A suggested explanation for this condition is a hyperreactivity of the sensory nerves of the entire airways, and hence the condition is known as sensory hyperreactivity (SHR). SHR affects more than 6% of the adult population in Sweden. It is a longstanding condition, and is clearly associated with significant social and psychological impacts.
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Affiliation(s)
- Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, Bruna stråket 11 B, SE 413 45 Gothenburg, Sweden.
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Abstract
BACKGROUND Patients with airway symptoms induced by chemicals and odors are common in allergy clinics, but the problems cannot be explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity; a diagnosis of airway sensory hyperreactivity (SHR) has been suggested for this condition. OBJECTIVES To examine the relationship between asthma and SHR and to investigate whether patients with SHR show signs of increased psychiatric morbidity. METHODS This study included 724 patients who were attending an allergy center because of suspected allergy or asthma. All the patients completed a quantitative questionnaire on self-reported affective reactions and behavioral disruptions caused by odorous/pungent substances. A standardized capsaicin inhalation test was performed and a questionnaire to assess psychiatric morbidity was administered in patients with pronounced chemical sensitivity to identify those with SHR. RESULTS The prevalence of SHR was approximately 6% in asthmatic patients in the allergy center population, which is in accordance with the prevalence in a general population. There was no significant indication that SHR was related to either depression or anxiety. CONCLUSION There is no strong relationship between SHR and either asthma or psychiatric morbidity.
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Affiliation(s)
- Ake Johansson
- Department of Respiratory Medicine, Central Hospital, Skövde, Sweden
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Johansson EL, Ternesten-Hasséus E, Millqvist E. Down-regulation of cough sensitivity after eucapnic dry air provocation in chronic idiopathic cough. Pulm Pharmacol Ther 2009; 22:543-7. [PMID: 19646543 DOI: 10.1016/j.pupt.2009.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 07/17/2009] [Accepted: 07/21/2009] [Indexed: 12/17/2022]
Abstract
Down-regulation of cough sensitivity in humans is rarely discussed in terms other than pharmacological treatment of cough or hypersensitive cough reflex. Chronic cough and increased cough sensitivity could be due to a number of airway and other diseases. When such conditions are excluded, there still remains a group of patients with no evident medical explanation for persistent coughing; such patients are often described as having "chronic idiopathic cough". The aim of this study was to use a standardized eucapnic dry air provocation among patients with chronic idiopathic cough in order to study physiological parameters and measure their possible influence on capsaicin cough sensitivity. Fourteen female patients with chronic idiopathic cough and ten healthy controls underwent a capsaicin inhalation provocation on two occasions. In all patients, irritating environmental factors were known to induce cough and airway symptoms. One of the two capsaicin provocations was preceded by a eucapnic dry air provocation. Number of coughs, spirometry, respiratory rate, pulse rate, end-tidal CO(2), and oxygen saturation by pulse oximetry (PSaO(2)) were registered and compared. The patients showed increased capsaicin sensitivity compared with the control subjects. This sensitivity was decreased when the capsaicin test was preceded by a eucapnic dry air provocation. Before the dry air provocation and after the capsaicin provocations, end-tidal CO(2) was decreased among the patients in comparison with the controls. After dry air provocation, spirometry values remained unchanged. The results suggest that in patients with chronic idiopathic cough, physiological down-regulation of the cough sensitivity is possible with a eucapnic dry air provocation.
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Affiliation(s)
- Ewa-Lena Johansson
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy, Gothenburg University, Sweden
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Abstract
In the absence of other explanations, exercise-induced dyspnea is often labeled as a manifestation of asthma. The aim of this study was to use exercise provocation in cold air among patients with exercise-induced dyspnea, but without any bronchoconstriction, in order to study induced symptoms and different physiological parameters and to measure the possible influence of exercise in cold air on capsaicin cough sensitivity. Eleven patients with exercise-induced dyspnea but no asthma, along with 11 healthy controls, performed a capsaicin inhalation provocation on two occasions. One of these provocations was preceded by an exercise provocation in a cold chamber. Number of coughs, airway symptoms, spirometry, respiratory rate, pulse rate, end-tidal CO(2), and PSaO(2) were registered. During exercise, the patients coughed more than the controls and also had more airway symptoms. After exercise provocation, spirometry values remained unchanged, but capsaicin cough sensitivity was increased and end-tidal CO(2) decreased among the patients, both in comparison to the controls and in comparison to the patients themselves prior to exercise. Exercise-induced dyspnea may be associated with hypocapnia from hyperventilation and increased capsaicin cough sensitivity. The diagnosis of exercise-induced asthma should be questioned when the patient has no signs of bronchoconstriction.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy at Göteborg University, Goteborg, Sweden.
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Brämerson A, Millqvist E, Ydse B, Larsson C, Olofsson JK, Bende M. Event-related potentials in patients with olfactory loss. Acta Otolaryngol 2008; 128:1126-31. [PMID: 18607946 DOI: 10.1080/00016480801891702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION The olfactory event-related potential (OERP) method provides a means of objectively assessing olfactory function. However, further validation is needed before OERPs can be routinely applied in clinical assessment of olfactory dysfunction. OBJECTIVE To assess OERPs in patients with olfactory impairment and in healthy controls to investigate possible dose-response effects of odor concentration on OERP parameters in these groups, thereby exploring possibilities and limitations regarding the clinical utility of the OERP method. SUBJECTS AND METHODS Twenty-three patients with a history of impaired olfactory function and 24 controls participated in the study. Olfactory function was assessed with psychophysical tests, i.e. assessment of the odor threshold, and odor identification. OERPs were obtained in response to the olfactory stimulant butanol at two different concentrations, presented via an olfactometer. RESULTS The OERP amplitudes increased and the latencies shortened with increasing stimulus concentration. Furthermore, a difference between the groups was found, with higher OERP amplitudes and shorter latencies in healthy subjects compared with patients.
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Ternesten-Hasséus E, Larsson C, Bende M, Millqvist E. Capsaicin provocation using two different inhalation devices. Respir Med 2008; 102:1784-90. [PMID: 18703328 DOI: 10.1016/j.rmed.2008.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 06/03/2008] [Accepted: 06/27/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sensory hyperreactivity (SHR) has been suggested as one explanation for chemically induced airway symptoms; it can be diagnosed with a capsaicin inhalation test. Previous capsaicin inhalation studies of SHR have used a Pari Boy device. This model of inhalator device has become outdated, hence it is necessary to abandon it in favour of a new device. The aim of this study was to transfer the capsaicin inhalation test using the Pari Boy device to a corresponding model using the Maxin MA3 device. METHODS Twenty-one patients with SHR and 44 healthy controls visited the clinic twice and underwent a randomised protocol. The participants were provoked with saline and capsaicin using one of two devices, Pari Boy and Maxin MA3. Eight patients also underwent two additional capsaicin provocations with Maxin MA3. A new series of capsaicin concentrations was chosen for Maxin MA3. The results from each device were analysed, the agreement between the two devices and the repeatability of the Maxin MA3 were evaluated. RESULTS Among all participants, the mean number of coughs with the Pari Boy was 5.5 (95% CI: 2.7; 8.2) after inhalation of 0.4 micromol/L capsaicin and 20.0 (95% CI: 14.1; 25.9) after 2.0 micromol/L. With the Maxin MA3, the mean number of coughs was 3.6 (95% CI: 1.3; 4.0) after 0.06 micromol/L capsaicin, and 17.8 (95% CI: 12.0; 23.6) after 0.3 micromol/L. The Maxin MA3 showed good repeatability and the agreement between the devices with the capsaicin concentrations chosen for each device was considered to be good.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
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Millqvist E, Ternesten-Hasséus E, Bende M. Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity. Pulm Pharmacol Ther 2008; 21:794-7. [PMID: 18621137 DOI: 10.1016/j.pupt.2008.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/16/2008] [Accepted: 06/18/2008] [Indexed: 12/31/2022]
Abstract
A suggested explanation for airway symptoms induced by chemicals and scents is sensory hyperreactivity (SHR) of airway mucosal nerves. Patients with SHR have increased cough sensitivity to inhaled capsaicin, mediated by transient receptor potential (TRP) ion channels. In animal experiments, some TRP receptors are potentiated by ethanol, which is why in this study, the aim was to evaluate whether a pre-inhalation of ethanol could influence the capsaicin cough response in patients with SHR. Fifteen patients with SHR and 15 healthy controls were provoked on three occasions with two concentrations of inhaled capsaicin. Before each capsaicin provocation, a pre-inhalation of saline or one of two concentrations of ethanol was given in a double-blind, randomized fashion. The participants reacted in a dose-dependent way with cough on the capsaicin inhalations. Among the patients, but not in the control group, pre-inhalation of ethanol increased the cough response dose-dependently. The results suggest that the pathophysiology of SHR is related to airway mucosal TRP receptors in the sensory nerves. In scented products, the combination of ethanol as a solvent and perfume may augment an airway reaction in sensitive individuals.
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Affiliation(s)
- Eva Millqvist
- Department of Respiratory Medicine and Allergology, Asthma and Allergy Research Group, The Sahlgrenska Academy at University of Gothenburg, S-413 45 Gothenburg, Sweden.
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Andersson L, Johansson A, Millqvist E, Nordin S, Bende M. Prevalence and risk factors for chemical sensitivity and sensory hyperreactivity in teenagers. Int J Hyg Environ Health 2008; 211:690-7. [PMID: 18403259 DOI: 10.1016/j.ijheh.2008.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 01/25/2008] [Accepted: 02/04/2008] [Indexed: 11/16/2022]
Abstract
The prevalence of chemical sensitivity (CS) and sensory hyperreactivity (SHR) was assessed in a teenage population. Among a random sample of 401 teenagers, 326 (81.3%) answered questionnaires assessing sensitivity to chemicals and noise, anxiety and depression. A subgroup of 85 teenagers conducted a capsaicin inhalation test. The estimated prevalence was 15.6% for general self-reported CS, 3.7% for CS with affective and behavioral consequences, about 1% for SHR. Sensitivity variables were positively intercorrelated. Risk factors for general CS were noise sensitivity (OR: 2.1), probable anxiety (OR: 2.5) and female sex (OR: 2.0). CS problems seem to be present also in teenagers, although less so than in adults. Furthermore, CS seems to be related to other environmental sensitivities.
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Millqvist E, Johansson A, Månsson T, Bende M. A prospective study of allergy development in 158 children and 128 adults with new extensive exposure to furred animals. Clin Exp Allergy 2007; 37:948-53. [PMID: 17517109 DOI: 10.1111/j.1365-2222.2007.02731.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is still controversy over whether exposure to furred animals increases or decreases the risk of developing sensitization and allergic symptoms to such animals, and there is a need for further knowledge on this subject. OBJECTIVE The aim of this study was to follow allergy development in relation to new extensive exposure to furred animals in adults and children. METHODS A total of 286 individuals, 128 parents and 158 children, were recruited from 68 families who intended to buy a dog or a cat, or where one child of the family intended to start riding a horse. Subjects were examined before the new allergen exposure and once a year thereafter for 5 years, in all at six occasions, and they also completed questionnaires covering allergy symptoms. Serum IgE antibodies to cat, dog and horse were determined each year, and fur allergens from beds and living rooms were analysed. RESULTS Two-hundred and fifty-six study subjects remained for evaluation, 37 of whom showed signs of allergic sensitization at the start of the study. Four children (11%) in this pre-sensitized group developed IgE antibodies to their new animal and six (16%) to another animal. Among the 219 participants who were not sensitized when entering the study, one male adult (0.4%) developed a sensitization to his new animal, and nobody developed sensitization to other animals. Pre-sensitized individuals had significantly more allergic symptoms at the study start, but the symptom scores did not change over time. CONCLUSIONS When the first year of a human's life has passed, we have no strong evidence to recommend avoidance of a domestic animal in order to prevent new allergy development, even if there are known allergies in the family or if the individual is sensitized and has allergic symptoms to another allergen. Five years exposure to new fur allergens does not seem to influence sensitization to these animals in either sensitized or non-sensitized children and adults.
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Affiliation(s)
- E Millqvist
- The Allergy Centre of the Central Hospital, Skövde, Sweden
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Abstract
Voice problems are seldom reported in pollen allergy, although the allergic reaction involves the entire airways. The objective of this study was to investigate voice dysfunction during the pollen season in patients with allergic rhinitis. Thirty patients with verified birch pollen allergy and 30 controls were investigated twice, during the pollen season and outside the pollen season. Both times they scored respiratory and voice symptoms, the latter with the validated questionnaire Voice Handicap Index (VHI), and performed standardized voice recordings. These recordings were analyzed in a controlled manner by a professional voice therapist. During the allergy season, patients reported more respiratory and voice symptoms compared with controls. Those with blinded scored voice dysfunction scored their voice quality during springtime as 31 mm (95% confidence interval [CI] 20-42 mm), compared with 13 mm (95% CI 6-21 mm for participants without voice dysfunction (P<0.01). Furthermore, the group with experienced voice dysfunction scored significantly higher on the VHI in the functional and physical domains and in the total VHI score. Although voice problems during the pollen season are rarely discussed, in allergic rhinitis the larynx may also be involved. These findings support that some patients experience voice change, an experience which can be objectively confirmed.
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Affiliation(s)
- Eva Millqvist
- Department of Otorhinolaryngology and Allergy Centre, Central Hospital, Skövde, Sweden
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Ternesten-Hasséus E, Lowhagen O, Millqvist E. Quality of life and capsaicin sensitivity in patients with airway symptoms induced by chemicals and scents: a longitudinal study. Environ Health Perspect 2007; 115:425-9. [PMID: 17431493 PMCID: PMC1849925 DOI: 10.1289/ehp.9624] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 12/19/2006] [Indexed: 05/09/2023]
Abstract
OBJECTIVE It is common in asthma and allergy clinics to see patients presenting with upper and lower airway symptoms that are induced by chemicals and scents and not explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased cough sensitivity to inhaled capsaicin; such sensitivity is known to reflect the airway sensory reactivity. The aim of this study was to evaluate the duration of symptoms induced by chemicals and scents and to measure health-related quality of life (HRQL) in patients with chemically induced airway symptoms. We also wished to determine and compare repeatability of the cough response to capsaicin inhalation, and to evaluate the patients' airway sensory reactivity in a long-term perspective. PARTICIPANTS Seventeen patients with a history of at least 12 months of airway symptoms induced by chemicals and scents were followed over 5 years with repeated questionnaires, measurements of HRQL, and capsaicin inhalation tests. RESULTS The symptoms persisted and did not change significantly over time, and the patients had a reduced HRQL that did not change during the 5-year period. The capsaicin sensitivity was increased at the start of the study, the cough sensitivity was long-lasting, and the repeatability of the capsaicin inhalation test was considered to be good in a long-term perspective. CONCLUSIONS Upper and lower airway symptoms induced by chemicals and scents represent an entity of chronic diseases, different from asthma or chronic obstructive pulmonary disease, with persistent symptoms, a reduced HRQL, and unchanged sensory hyperreactivity.
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Affiliation(s)
- Ewa Ternesten-Hasséus
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Nordin S, Brämerson A, Millqvist E, Bende M. Prevalence of parosmia: the Skövde population-based studies. Rhinology 2007; 45:50-3. [PMID: 17432070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM Parosmia can be defined as a qualitative odor distortion. Despite the consequences of this condition for quality of life, the scientific literature lacks information about the prevalence of parosmia in the general population, which was the objective of the present study. METHODS Random samples of 1,900 adult and 401 teenage inhabitants, stratified for age and gender, were drawn from the municipal population register of Skövde, Sweden. In total, 1,713 individuals (74% of the samples) agreed to participate, of which 1,387 (73%) were adults and 326 (81%) were teenagers. They responded to a question about parosmia by means of either a structured interview (adults) or a questionnaire (teenagers). RESULTS The overall prevalence of parosmia was 3.9% (4.0% in adults and 3.4% in teenagers), which was stable across gender, but differed somewhat between age groups, with highest prevalence in the age group 20-29 years. CONCLUSIONS The rather high overall prevalence, 3.9%, does indeed suggest that parosmia deserves attention when attempting to better understand olfactory dysfunction in clinical settings and in the general population of both adults and teenagers.
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Millqvist E. Rhinitis as a part of sensory hyperreactivity characterized by increased capsaicin cough sensitivity. Clin Allergy Immunol 2007; 19:401-10. [PMID: 17153030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Eva Millqvist
- Department of Respiratory, Asthma and Allergy Research Group, Medicine and Allergy, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
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Abstract
PURPOSE OF THE REVIEW Chronic cough can be caused by a number of factors, including infections, rhinosinusitis, asthma and environmental stimuli. This paper reviews recent findings and opinions regarding the role played by the upper airways in chronic cough. RECENT FINDINGS Chronic cough has a significant impact on quality of life, which is more pronounced in women. In Western countries, the reported occurrence of rhinosinusitis in patient groups with chronic cough ranges from 8% to 81%. Allergic rhinitis is a risk factor for later development of asthma. In children, bronchiectasis is combined with upper airway abnormalities in the majority of cases. Increased expression of the capsaicin receptor subtype named 'transient receptor potential vanilloid-1', which correlates with capsaicin cough response, has been identified in patients with chronic cough. Patients with airway chemical sensitivity and chronic cough as one symptom have augmented capsaicin cough sensitivity that is related to changed levels of nerve growth factor in nasal lavage. SUMMARY Involvement of the upper airways in chronic cough has been confirmed in several studies. However, there are considerable differences between different health centres in the occurrence of rhinosinusitis as a cause of chronic cough. In patients with chronic cough of various causes, a neurochemical alteration in both the upper and the lower airways appears to have taken place, followed by increased cough sensitivity.
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Affiliation(s)
- Eva Millqvist
- Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergy, Sahlgrenska University Hospital, Göteborg, Sweden.
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49
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Abstract
STUDY OBJECTIVES The aim of this study was to investigate the relationship between the behavioral consequences of self-reported odor sensitivity with the chemical sensitivity scale for sensory hyperreactivity (CSS-SHR) and cough sensitivity to inhaled capsaicin. We also wanted to estimate the prevalence of airway sensory hyperreactivity (SHR), which was defined as a positive CSS-SHR score in combination with a positive capsaicin inhalation test result. DESIGN A general population-based study with randomly selected individuals after stratification for age and gender. SETTING Skövde Central Hospital, Departments of Lung Medicine and Otorhinolaryngology, Sweden. PARTICIPANTS A total of 693 randomly selected individuals from a population-based study in which 595 persons (86%) responded to the CSS-SHR questionnaire. INTERVENTIONS The individuals were divided into four groups with different odor sensitivity according to their CSS-SHR score. Of these, 137 individuals were randomly recruited for the capsaicin inhalation test. Capsaicin inhalation was performed with concentrations of 0.4 and 2.0 mumol/L in a randomized order. The number of coughs were registered and counted for 10 min from the start of each inhalation. MEASUREMENTS AND RESULTS Of the 137 individuals who were recruited for the capsaicin inhalation test, 103 (75%) participated. Sixteen individuals had increased cough sensitivity and fulfilled the criteria for a positive capsaicin inhalation test result. Of the individuals with a positive capsaicin inhalation test result, > 80% also had a positive CSS-SHR score. Only 5% of the individuals with a negative CSS-SHR score had a positive capsaicin inhalation test result. The order of inhaled capsaicin concentration was found to influence the results. The prevalence of SHR with the definition given above was estimated to be 6.3% in this general population. CONCLUSIONS A high CSS-SHR score was found to be directly related to the sensitivity for inhaled capsaicin, which made it possible to relate subjective data to objective findings.
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Affiliation(s)
- Ake Johansson
- Department of Otorhinolaryngology, Central Hospital, SE-541 85 Skövde, Sweden
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50
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Abstract
CONCLUSION This study was able to present representative data from Sweden as a whole and illuminates the epidemiological background of symptoms of the upper and lower airways. Current regular smokers, compared with non-smokers, had more problems with nasal blockage, cough and asthma. The relationship between the upper and lower airways was confirmed as regards airway symptoms. BACKGROUND Epidemiology of common respiratory symptoms is basic information in health care. This study has focused on the prevalence of upper and lower airway symptoms. PATIENTS AND METHODS A random sample of 1900 age- and gender-stratified adults was recruited from a general population for this study, which included a structured interview about symptoms of nasal secretions and blockage, cough and asthma, and a clinical examination with nasal endoscopy, and peak nasal-inspiratory flow (PNIF). Smoking habits were evaluated by a questionnaire for current and previous smoking. RESULTS A response rate of 73% was achieved. The prevalence of various symptoms varied between age strata and gender. There was a statistically significant relationship between subjectively experienced nasal blockage and objectively observed nasal congestion. PNIF was negatively related to age and height and was increased in male gender. Smoking was most common among females and related to nasal blockage, cough and asthma, but not to nasal secretions. Significant relationships between the upper and lower airways were found.
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