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Spezzano L, Cortese MD, Quintieri M, Pignolo L, Tonin P, Lucca FL, Tomaiuolo F, Calabrò RS, Morone G, Cerasa A. Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept. Clin Pract 2023; 13:1603-1611. [PMID: 38131689 PMCID: PMC10742110 DOI: 10.3390/clinpract13060140] [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] [Received: 10/16/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Individuals with acquired brain injuries (ABIs) may experience various complications related to poor coughing or impaired cough reflex (including risk of aspiration pneumonia or respiratory infections). For this reason, cough assessment is an important component in the clinical evaluation since patients with ABI are not able to cough voluntarily due to severe motor deficits. When voluntarily coughing is not possible, it is essential for clinical practices to find a quick and minimally invasive way to induce a cough reflex. In the present study, we evaluated the cough reflex in ABI patients using a new method based on a capsaicin spray stimulation test. In total, 150 healthy controls demographically matched with 50 ABI patients were included in this study. Clinical observations demonstrated robust cough response in both healthy controls and ABI patients, as well as the safety and tolerability of capsaicin spray stimulation. ABI patients with dysphagia were characterized by slower and delayed cough responses. Further studies are needed to validate this feasible, less-invasive, and simple-to-comprehend technique in inducing cough reflex. According to this preliminary evidence, we believe that this test might be translated into a simple and effective treatment to improve reflexive cough modulation in ABI patients.
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Affiliation(s)
- Luisa Spezzano
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Maria Daniela Cortese
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Maria Quintieri
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Loris Pignolo
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Paolo Tonin
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Francesca Lucia Lucca
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
| | - Francesco Tomaiuolo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | | | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- San Raffaele Sulmona Institute, 67039 Sulmona, Italy
| | - Antonio Cerasa
- S’Anna Institute, 88900 Crotone, Italy; (L.S.); (M.D.C.); (M.Q.); (L.P.); (P.T.); (F.L.L.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
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Cinelli E, Iovino L, Bongianni F, Pantaleo T, Lavorini F, Mannini C, Mutolo D. Reply to Myslivecek. Am J Physiol Lung Cell Mol Physiol 2023; 325:L92-L93. [PMID: 37405948 DOI: 10.1152/ajplung.00146.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Elenia Cinelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ludovica Iovino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fulvia Bongianni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tito Pantaleo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Claudia Mannini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Donatella Mutolo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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3
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Myslivecek J. Muscarinic receptors in the nucleus tractus solitarii. Am J Physiol Lung Cell Mol Physiol 2023; 325:L91. [PMID: 37405947 DOI: 10.1152/ajplung.00134.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Jaromir Myslivecek
- Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Yoo SD, Park EJ. Assessing the effect of transcranial magnetic stimulation on peak cough flow in patients with supratentorial cerebral infarction: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33689. [PMID: 37115059 PMCID: PMC10145718 DOI: 10.1097/md.0000000000033689] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Respiratory dysfunction following supratentorial cerebral infarction leads to pneumonia and is a major cause of mortality. Decreased voluntary cough function impairs the ability to clear mucus or secretions from the airways and increases the risk of aspiration pneumonia. Peak cough flow (PCF) is one of the objective tools for evaluating voluntary cough function. Repetitive transcranial magnetic stimulation (rTMS) could be applied to the respiratory motor cortex to improve respiratory function. Little is known about the effect of rTMS on PCF in patients with supratentorial cerebral infarction during the subacute period. This study aimed to determine whether rTMS treatment could improve PCF in patients with supratentorial cerebral infarction. We retrospectively recruited patients with subacute supratentorial cerebral infarction who underwent a PCF test. The rTMS group received a combination of rTMS treatment for 2 weeks and conventional rehabilitation for 4 weeks. However, the control group underwent only conventional rehabilitation for 4 weeks. PCF tests were performed before and after treatment and the results were compared between the 2 groups. In total, 145 patients with supratentorial cerebral infarctions were recruited. The PCF parameters before and after treatment increased in both the rTMS and control groups. However, the rTMS group showed a greater increase in PCF values compared with the control group. In patients with supratentorial cerebral infarction, the combination of conventional rehabilitation and rTMS in the subacute period may be helpful in improving voluntary cough function compared with conventional rehabilitation alone.
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Affiliation(s)
- Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul, Republic of Korea
| | - Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Yared M, Headden KW, Barrett WF, Boehmer DO, Britell PE. Superior Laryngeal Nerve Block Attenuates Refractory Cough in a Patient With COVID-19 on Extracorporeal Membrane Oxygenation Awaiting Lung Transplantation. J Cardiothorac Vasc Anesth 2022; 36:3212-3215. [PMID: 35618590 PMCID: PMC9026958 DOI: 10.1053/j.jvca.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Maria Yared
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC.
| | - Kendall W Headden
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
| | - William F Barrett
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
| | - Drew O Boehmer
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
| | - Patrick E Britell
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC
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Papadopoulou A, Mermiri DZT, Gritzelas G, Tsouridi O, Dimara E, Yapijakis C, Chrousos GP. Increased Incidence of Stress-related Tic Habit Cough in Children During the Recent Greek Financial Crisis. In Vivo 2021; 35:1811-1820. [PMID: 33910867 DOI: 10.21873/invivo.12442] [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] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Tic habit cough (THC) is not easily recognized and requires a high index of suspicion. Since there is evidence for stress-related etiology, the study presents our experience during the eight-year period of the recent Greek financial crisis. PATIENTS AND METHODS This is a descriptive prospective cross-sectional clinical study using a consistent approach to diagnosis, possible triggers and treatment options. RESULTS Fifty-one children (26 girls, age 9.5±3.1y) from a total of 3,793 new referrals for chronic cough fulfilled the criteria of THC (1.34%). Incidence rates per 1,000 person-years were 1.34 (95%CI=0.34-5.40), 3.91 (95%CI=1.86-8.19), 4.03 (95%CI=2.01-8.06) and 14.60 (95%CI=10.43-20.44) for every two years. Poisson analysis showed an increased trend during the four time periods with an incidence rate ratio equal to 2.21 (95%CI=1.58-3.09, p<0.001). THC was mainly attributed to learning difficulties, as well as stress-related impact of peer or family bullying, family financial problems and child anxiety disorders. CONCLUSION The incidence of THC is associated with the negative aspects of stressors during a period of financial crisis. The potential underlining psycho-physiological mechanisms are discussed as well as the fact that prompt diagnosis may result in successful interventions.
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Affiliation(s)
- Athina Papadopoulou
- Allergology and Pulmunology Unit, Penteli's Children Hospital, Athens, Greece;
| | | | | | | | - Eleni Dimara
- Allergology and Pulmunology Unit, Penteli's Children Hospital, Athens, Greece
| | - Christos Yapijakis
- Unit of Orofacial Genetics, 1 Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Athens, Greece
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Rasijeff AMP, Garcia-Zermeno K, Carrington EV, Knowles C, Scott SM. Systematic evaluation of cough-anorectal pressure responses in health and in fecal incontinence: A high-resolution anorectal manometry study. Neurogastroenterol Motil 2021; 33:e13999. [PMID: 33150700 DOI: 10.1111/nmo.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/31/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anorectal manometry is the most commonly performed test of anorectal function. The cough-anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined anorectal pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements. METHODS High-resolution anorectal manometry (HR-ARM) traces from nulliparous (n = 25) and parous (n = 25) healthy volunteers (HV: aged 41, range 18-64), and 57 parous patients with FI (age 47, range 28-72) were retrospectively reviewed. Cough-anorectal pressure responses were analyzed between groups by qualitative and quantitative approaches. KEY RESULTS In health, traditional anal pressure measurements ("rest" and "squeeze") were similar between nulliparous and parous women. In contrast, incremental anal-rectal pressure difference during cough significantly differed: nulliparous 42 mm Hg (95% CI: 21-64) vs. parous 6 mm Hg (-14-25), P < 0.036). This measure also differed significantly between nulliparous HVs and patients with FI (-2 mm Hg (95% CI: -15-12), P < 0.001), but not between parous HVs and FI. Qualitatively, a color-contour trace resembling a "spear" in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%. CONCLUSIONS AND INFERENCES Novel HR-ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough-anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.
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Affiliation(s)
- Annika M P Rasijeff
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Karla Garcia-Zermeno
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - Emma V Carrington
- Colorectal Unit, Surgical Professorial Unit, St Vincent's University Hospital, Dublin, Ireland
| | - Charles Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
| | - S Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, UK
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Lee S, Han EH, Lim MK, Lee SH, Yu HJ, Lim YH, Kang S. Fermented Platycodon grandiflorum Extracts Relieve Airway Inflammation and Cough Reflex Sensitivity In Vivo. J Med Food 2020; 23:1060-1069. [PMID: 32758004 DOI: 10.1089/jmf.2019.4595] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Platycodon grandiflorum (PG) has been extensively utilized as an herb to relieve phlegm. In this study, the effects of PG root extracts on airway inflammation and cough reflex were investigated, especially using fermented PG extracts (FPE) to increase an active compound, platycodin D by fermentation. FPE significantly reduced the numbers of eosinophils and total cells in the bronchoalveolar lavage fluid (BALF) obtained from lipopolysaccharide/ovalbumin (LPS/OVA)-induced asthma mice versus those of vehicle control. Moreover, in the BALF and the serum, FPE significantly reduced the concentration of IL-17E, a proinflammatory cytokine that causes TH2 immunity, including eosinophil amplification. It was also demonstrated that FPE might relieve inflammations through histological analysis of the lung separated from each mouse. Furthermore, in cough reflex guinea pigs induced by citric acid treatment, FPE treatment significantly reduced the number of coughs versus that of vehicle control, and consequently decreased cough reflex sensitivity. In addition, the total cell number and eosinophils significantly decreased in the BALF obtained from each guinea pig versus that of vehicle control. In in vitro study, pretreatment with FPE in LPS-stimulated RAW264.7 cells significantly reduced the levels of proinflammatory cytokines such as TNF-α, IL-6, and IL-1β, and inducible nitric oxide synthases (iNOS). Therefore, we demonstrated that FPE relieved airway inflammation and cough reflex sensitivity in vivo, and exhibited anti-inflammatory effects through suppression of iNOS and several proinflammatory cytokines. These findings suggest that FPE might have a beneficial effect on respiratory health, and may be useful as a functional food to prevent respiratory diseases.
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Affiliation(s)
- Soyeon Lee
- Division of Life Sciences, College of Life Sciences and Biotechnology, Korea University, Seoul, Korea.,Department of Research & Development, Koreaeundan Healthcare Co. Ltd., Ansan, Gyeonggido, Korea
| | - Eun Hye Han
- Department of Research & Development, Koreaeundan Healthcare Co. Ltd., Ansan, Gyeonggido, Korea.,Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, Korea
| | - Mi-Kyung Lim
- Department of Research & Development, Koreaeundan Co., Seongnam, Gyeonggido, Korea
| | - Sang-Ho Lee
- Department of Research & Development, Koreaeundan Healthcare Co. Ltd., Ansan, Gyeonggido, Korea.,Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, Korea
| | - Heui Jong Yu
- Research & Development Center, SKbioland Co., Ltd., Ansan, Gyeonggido, Korea
| | - Young Hee Lim
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, Korea
| | - Seongman Kang
- Division of Life Sciences, College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
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Valentin S, Chenuel B, Demoulin-Alexikova S, Demoulin B, Gérard D, Foucaud L, Poussel M. Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise. Front Physiol 2020; 11:466. [PMID: 32528305 PMCID: PMC7247830 DOI: 10.3389/fphys.2020.00466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/16/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims and Objectives The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids (CS) in ovalbumin (OVA) sensitized rabbits during artificial limb exercise. Materials and Methods Seventeen OVA sensitized rabbits were studied. Among them, 9 were treated with CS delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically induced hindlimb muscular contractions (EMC). Results Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during artificial limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusion Corticosteroids appear to restore the desensitization of the CR in OVA sensitized rabbits during artificial limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
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Affiliation(s)
- Simon Valentin
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Department of Pneumology, CHRU Nancy, Nancy, France
| | - Bruno Chenuel
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | | | - Laurent Foucaud
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Mathias Poussel
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
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Higashi E, Hirayama S, Nikaido J, Shibasaki M, Kono T, Honjo A, Ikeda H, Kamei J, Fujii H. Development of Novel δ Opioid Receptor Inverse Agonists without a Basic Nitrogen Atom and Their Antitussive Effects in Mice. ACS Chem Neurosci 2019; 10:3939-3945. [PMID: 31397148 DOI: 10.1021/acschemneuro.9b00368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/06/2023] Open
Abstract
Our previous results showed that naltrindole (NTI) derivatives with certain types of electron-withdrawing groups as an N-substituent showed δ opioid receptor (DOR) inverse agonistic activities. We therefore synthesized N-acylated NTI derivatives 3a-e and observed that N-benzoyl and N-cyclopropanecarbonyl derivatives SYK-736 (3b) and SYK-623 (3c) were DOR full inverse agonists and the N-acryloyl derivative 3d was a DOR partial inverse agonist. SKY-623 was over 110-fold more potent than the reference compound ICI-174,864. Both naltriben (NTB) and 7-benzylidenenaltrexone (BNTX) derivatives with N-benzoyl and N-cyclopropanecarbonyl groups were also DOR full inverse agonists. These N-acylated inverse agonists are interesting compounds because they have no basic nitrogen atom, which has been demonstrated to be an important pharmacophore. NTI and BNTX-type DOR inverse agonists SYK-623 and SYK-723 (12c) showed dose-dependent antitussive effects in a mouse cough model induced by citric acid exposure. The antitussive effects by SYK-623 and SYK-723 were significantly attenuated by pretreatment with DOR agonist SNC80.
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Affiliation(s)
- Eika Higashi
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
| | - Shigeto Hirayama
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
- Medicinal Research Laboratories, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
| | - Jun Nikaido
- Department of Pathophysiology and Therapeutics, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Marie Shibasaki
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
| | - Tomomi Kono
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
| | - Ayaka Honjo
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
| | - Hiroko Ikeda
- Department of Pathophysiology and Therapeutics, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Junzo Kamei
- Department of Pathophysiology and Therapeutics, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
- Global Research Center for Innovative Life Science, Hoshi University School of Pharmacy and Pharmaceutical Sciences, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Hideaki Fujii
- Laboratory of Medicinal Chemistry, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
- Medicinal Research Laboratories, School of Pharmacy, Kitasato University, 5-9-1, Shirokane,
Minato-ku, Tokyo 108-8641, Japan
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Lai HC, Huang TW, Tseng WC, Lin WL, Chang H, Wu ZF. Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery. Medicine (Baltimore) 2018; 97:e12927. [PMID: 30335029 PMCID: PMC6211903 DOI: 10.1097/md.0000000000012927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS. METHODS Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated. RESULTS Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33). CONCLUSION Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
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Affiliation(s)
| | - Tsai-Wang Huang
- Division of Chest Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | | | | | - Hung Chang
- Division of Chest Surgery, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
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Kondo E, Jinnouchi O, Nakano S, Ohnishi H, Kawata I, Okamoto H, Takeda N. Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study. Clin Interv Aging 2017; 12:1921-1928. [PMID: 29180855 PMCID: PMC5691921 DOI: 10.2147/cia.s138357] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective The aim of this study was to assess whether aural stimulation with ointment containing capsaicin improves swallowing function in elderly patients with dysphagia. Study design A randomized, placebo-controlled, double-blind, comparative study. Settings Secondary hospital. Patients and methods Twenty elderly dysphagic patients with a history of cerebrovascular disorder or Parkinson’s disease were randomly divided into two groups: 10 receiving aural stimulation with 0.025% capsaicin ointment and 10 stimulated with placebo. The ointments were applied to the external auditory canal with a cotton swab. Then, swallowing of a bolus of blue-dyed water was recorded using transnasal videoendoscopy, and the swallowing function was evaluated according to both endoscopic swallowing scoring and Sensory-Motor-Reflex-Clearance (SMRC) scale. Results The sum of endoscopic swallowing scores was significantly decreased 30 and 60 min after a single administration in patients treated with capsaicin, but not with placebo. Reflex score, but not Sensory, Motion and Clearance scores, of the SMRC scale was significantly increased 5, 30 and 60 min after single administration in patients treated with capsaicin, but not with placebo. No patient showed signs of adverse effects. Conclusion As capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1), these findings suggest that improvement of the swallowing function, especially glottal closure and cough reflexes, in elderly dysphagic patients was due to TRPV1-mediated aural stimulation of vagal Arnold’s nerve with capsaicin, but not with a nonspecific mechanical stimulation with a cotton swab.
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Affiliation(s)
- Eiji Kondo
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima.,Department of Otolaryngology, Kochi National Hospital, Kochi
| | - Osamu Jinnouchi
- Department of Otolaryngology, Anan Kyoei Hospital, Tokushima
| | - Seiichi Nakano
- Department of Otolaryngology, Kochi National Hospital, Kochi
| | - Hiroki Ohnishi
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima
| | - Ikuji Kawata
- Department of Otolaryngology, Anan Kyoei Hospital, Tokushima
| | - Hidehiko Okamoto
- Department of Sensori-Motor Integration, National Institute for Physiological Sciences, Okazaki, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima
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Suntrup-Krueger S, Kemmling A, Warnecke T, Hamacher C, Oelenberg S, Niederstadt T, Heindel W, Wiendl H, Dziewas R. The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia. Eur J Neurol 2017; 24:867-874. [PMID: 28449405 DOI: 10.1111/ene.13307] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. METHODS In all, 200 acute stroke cases were investigated applying flexible endoscopic evaluation of swallowing within 96 h from admission. Lesions were mapped using patients' computed tomography/magnetic resonance images and these were registered to a standard space. The percentage of lesioned volume of 137 anatomically defined brain regions was determined on a voxel basis (FSL5.0). Region-specific odds ratios (ORs) were calculated with respect to the presence of oropharyngeal residue, delayed swallow response, insufficient cough reflex and occurrence of pneumonia during hospital stay. Colour-coded lesion location maps of brain regions with significant ORs were created (P < 0.05). RESULTS Lesion maps for residue and impaired swallow response depicted parietal-temporal areas of the right hemisphere. Limbic structures in the right hemisphere and sensory regions on the left were associated with cough reflex disturbance. There was no overlap of lesion maps for impaired swallow response and insufficient cough reflex or pneumonia, but substantial overlap between the last two conditions. CONCLUSIONS This study gives new insights on the cortical representation of single components of swallowing and airway protection behaviours. The lesion model may help to risk-stratify patients for dysphagia and pneumonia based on their brain scan.
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Affiliation(s)
| | - A Kemmling
- Institute of Neuroradiology, University Hospital Lübeck, Lübeck, Germany
| | - T Warnecke
- Department of Neurology, University of Münster, Münster, Germany
| | - C Hamacher
- Department of Neurology, University of Münster, Münster, Germany
| | - S Oelenberg
- Department of Neurology, University of Münster, Münster, Germany
| | - T Niederstadt
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - W Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - H Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - R Dziewas
- Department of Neurology, University of Münster, Münster, Germany
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14
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Cinelli E, Iovino L, Bongianni F, Pantaleo T, Mutolo D. GABAA- and glycine-mediated inhibitory modulation of the cough reflex in the caudal nucleus tractus solitarii of the rabbit. Am J Physiol Lung Cell Mol Physiol 2016; 311:L570-80. [PMID: 27402692 DOI: 10.1152/ajplung.00205.2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/20/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023] Open
Abstract
Cough-related sensory inputs from rapidly adapting receptors (RARs) and C fibers are processed by second-order neurons mainly located in the caudal nucleus tractus solitarii (NTS). Both GABAA and glycine receptors have been proven to be involved in the inhibitory control of second-order cells receiving RAR projections. We investigated the role of these receptors within the caudal NTS in the modulation of the cough reflex induced by either mechanical or chemical stimulation of the tracheobronchial tree in pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bilateral microinjections (30-50 nl) of the receptor antagonists bicuculline and strychnine as well as of the receptor agonists muscimol and glycine were performed. Bicuculline (0.1 mM) and strychnine (1 mM) caused decreases in peak abdominal activity and marked increases in respiratory frequency due to decreases in both inspiratory time (Ti) and expiratory time (Te), without concomitant changes in arterial blood pressure. Noticeably, these microinjections induced potentiation of the cough reflex consisting of increases in the cough number associated with decreases either in cough-related Ti after bicuculline or in both cough-related Ti and Te after strychnine. The effects caused by muscimol (0.1 mM) and glycine (10 mM) were in the opposite direction to those produced by the corresponding antagonists. The results show that both GABAA and glycine receptors within the caudal NTS mediate a potent inhibitory modulation of the pattern of breathing and cough reflex responses. They strongly suggest that disinhibition is one important mechanism underlying cough regulation and possibly provide new hints for novel effective antitussive strategies.
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Affiliation(s)
- Elenia Cinelli
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze, Florence, Italy
| | - Ludovica Iovino
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze, Florence, Italy
| | - Fulvia Bongianni
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze, Florence, Italy
| | - Tito Pantaleo
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze, Florence, Italy
| | - Donatella Mutolo
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze, Florence, Italy
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15
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Demoulin-Alexikova S, Plevkova J, Mazurova L, Zatko T, Alexik M, Hanacek J, Tatar M. Impact of Air Pollution on Age and Gender Related Increase in Cough Reflex Sensitivity of Healthy Children in Slovakia. Front Physiol 2016; 7:54. [PMID: 26941651 PMCID: PMC4763033 DOI: 10.3389/fphys.2016.00054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/04/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Numerous studies show higher cough reflex sensitivity (CRS) and cough outcomes in children compared to adults and in females compared to males. Despite close link that exists between cough and environment the potential influence of environmental air pollution on age- and gender -related differences in cough has not been studied yet. PURPOSE The purpose of our study was to analyse whether the effects of exposure to environmental tobacco smoke (ETS) from parental smoking and PM10 from living in urban area are implied in age- and gender-related differences in cough outcomes of healthy, non-asthmatic children. Assessment of CRS using capsaicin and incidence of dry and wet cough was performed in 290 children (mean age 13.3 ± 2.6 years (138 females/152 males). RESULTS CRS was significantly higher in girls exposed to ETS [22.3 μmol/l (9.8-50.2 μmol/l)] compared to not exposed girls [79.9 μmol/l (56.4-112.2 μmol/l), p = 0.02] as well as compared to exposed boys [121.4 μmol/l (58.2-253.1 μmol/l), p = 0.01]. Incidence of dry cough lasting more than 3 weeks was significantly higher in exposed compared to not exposed girls. CRS was significantly higher in school-aged girls living in urban area [22.0 μmol/l (10.6-45.6 μmol/l)] compared to school-aged girls living in rural area [215.9 μmol/l (87.3-533.4 μmol/l); p = 0.003], as well as compared to teenage girls living in urban area [108.8 μmol/l (68.7-172.9 μmol/l); p = 0.007]. No CRS differences were found between urban and rural boys when controlled for age group. No CRS differences were found between school-aged and teenage boys when controlled for living area. CONCLUSIONS Our results have shown that the effect of ETS on CRS was gender specific, linked to female gender and the effect of PM10 on CRS was both gender and age specific, related to female gender and school-age. We suggest that age and gender related differences in incidence of cough and CRS might be, at least partially, ascribed to the effect of environmental pollutants. The role of age and gender in the effect of air pollution on cough strongly suggest some interplay of development with biological and behavioral factors.
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Affiliation(s)
- Silvia Demoulin-Alexikova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in BratislavaBratislava, Slovakia; Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de NancyVandœuvre-lès-Nancy, France; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université de LorraineVandœuvre-lès-Nancy, France
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava Bratislava, Slovakia
| | - Lenka Mazurova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava Bratislava, Slovakia
| | - Tomas Zatko
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava Bratislava, Slovakia
| | - Mikulas Alexik
- Department of Ophthalmology, Faculty Hospital of Žilina Žilina, Slovakia
| | - Jan Hanacek
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava Bratislava, Slovakia
| | - Milos Tatar
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava Bratislava, Slovakia
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16
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Ruoppolo G, Schettino I, Frasca V, Giacomelli E, Prosperini L, Cambieri C, Roma R, Greco A, Mancini P, De Vincentiis M, Silani V, Inghilleri M. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 2013; 128:397-401. [PMID: 23668293 DOI: 10.1111/ane.12136] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. MATERIALS AND METHODS A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. RESULTS Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. CONCLUSIONS Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS.
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Affiliation(s)
- G. Ruoppolo
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - I. Schettino
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Frasca
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - E. Giacomelli
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - L. Prosperini
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - C. Cambieri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
| | - R. Roma
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - A. Greco
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - P. Mancini
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - M. De Vincentiis
- Department of Sensorial Organs; Otorhinolaryngology Section; Sapienza University of Rome; Rome Italy
| | - V. Silani
- Department of Neurological Sciences; University of Milan; Milan Italy
| | - M. Inghilleri
- Department of Neurology and Psychiatry; Sapienza University of Rome; Rome Italy
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17
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Cinelli E, Bongianni F, Pantaleo T, Mutolo D. Suppression of the cough reflex by α 2-adrenergic receptor agonists in the rabbit. Physiol Rep 2013; 1:e00122. [PMID: 24400133 PMCID: PMC3871446 DOI: 10.1002/phy2.122] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 01/26/2023] Open
Abstract
The α2-adrenergic receptor agonist clonidine has been shown to inhibit citric acid-induced cough responses in guinea pigs when administered by aerosol, but not orally. In contrast, oral or inhaled clonidine had no effect on capsaicin-induced cough and reflex bronchoconstriction in humans. In addition, intravenous administration of clonidine has been shown to depress fentanyl-induced cough in humans. We investigated the effects of the α2-adrenergic receptor agonists, clonidine and tizanidine, on cough responses induced by mechanical and chemical (citric acid) stimulation of the tracheobronchial tree. Drugs were microinjected (30–50 nL) into the caudal nucleus tractus solitarii (cNTS) and the caudal ventral respiratory group (cVRG) as well as administered intravenously in pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bilateral microinjections of clonidine into the cNTS or the cVRG reduced cough responses at 0.5 mmol/L and abolished the cough reflex at 5 mmol/L. Bilateral microinjections of 0.5 mmol/L tizanidine into the cNTS completely suppressed cough responses, whereas bilateral microinjections of 5 mmol/L into the cVRG only caused mild reductions in them. Depressant effects on the cough reflex of clonidine and tizanidine were completely reverted by microinjections of 10 mmol/L yohimbine. Intravenous administration of clonidine (80–120 μg/kg) or tizanidine (150–300 μg/kg) strongly reduced or completely suppressed cough responses. These effects were reverted by intravenous administration of yohimbine (300 μg/kg). The results demonstrate that activation of α2-adrenergic receptors in the rabbit exerts potent inhibitory effects on the central mechanism generating the cough motor pattern with a clear action at the level of the cNTS and the cVRG.
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Affiliation(s)
- Elenia Cinelli
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze Viale G.B. Morgagni 63, 50134, Firenze, Italy
| | - Fulvia Bongianni
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze Viale G.B. Morgagni 63, 50134, Firenze, Italy
| | - Tito Pantaleo
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze Viale G.B. Morgagni 63, 50134, Firenze, Italy
| | - Donatella Mutolo
- Dipartimento di Medicina Sperimentale e Clinica, Sezione Scienze Fisiologiche, Università degli Studi di Firenze Viale G.B. Morgagni 63, 50134, Firenze, Italy
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18
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Cinelli E, Bongianni F, Pantaleo T, Mutolo D. Modulation of the cough reflex by GABA(A) receptors in the caudal ventral respiratory group of the rabbit. Front Physiol 2012; 3:403. [PMID: 23087651 PMCID: PMC3475209 DOI: 10.3389/fphys.2012.00403] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022] Open
Abstract
We have previously shown that the caudal ventral respiratory group (cVRG) is a possible site of action of some antitussive drugs and plays a crucial role in determining both the expiratory and inspiratory components of the cough motor pattern. In addition, it has been reported that medullary expiratory neurons of the cVRG are subject to potent GABAergic gain modulation. This study was devoted to investigate the role of cVRG GABAA receptors in the control of baseline respiratory activity and cough responses to mechanical and chemical (citric acid) stimulation of the tracheobronchial tree. To this purpose, bilateral microinjections (30–50 nl) of bicuculline or muscimol were performed into the cVRG of pentobarbital sodium-anesthetized, spontaneously breathing rabbits. Bicuculline (1 mM) increased peak abdominal activity and respiratory frequency due to decreases in TE. Cough responses were potentiated mainly owing to increases in the cough number. The recovery was observed within ~2 h. On the contrary, muscimol (0.3 mM) abolished abdominal activity and decreased respiratory frequency due to increases in TE. In addition, cough responses were progressively reduced and completely suppressed within ~20 min. Partial recovery of cough responses was achieved after ~3 h or within ~5 min following bicuculline microinjections at the same locations. The sneeze reflex induced by mechanical stimulation of the nasal mucosa persisted following bicuculline and muscimol microinjections. However, the number and intensity of expiratory thrusts were enhanced by bicuculline and suppressed by muscimol. The results provide evidence that a potent GABAA-mediated inhibitory modulation is exerted at the level of the cVRG not only on respiratory activity, but also on cough and sneeze reflex responses.
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Affiliation(s)
- Elenia Cinelli
- Dipartimento di Scienze Fisiologiche, Università degli Studi di Firenze Firenze, Italy
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Koudounarakis E, Chatzakis N, Papadakis I, Panagiotaki I, Velegrakis G. Nasal packing aspiration in a patient with Alzheimer's disease: a rare complication. Int J Gen Med 2012; 5:643-5. [PMID: 22879779 PMCID: PMC3413305 DOI: 10.2147/ijgm.s34676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Indexed: 11/23/2022] Open
Abstract
Nasal bleeding is a frequent problem for patients receiving anticoagulant agents.
Most cases are successfully managed with anterior or posterior nasal packing.
However, the complications of nasal packing should be always considered. We
report the case of a 78-year-old man with Alzheimer’s disease who was
treated for anterior epistaxis with anterior nasal packing using three pieces of
antibiotic-soaked gauze. Two days later, the patient was admitted to the
emergency department in respiratory distress. A chest x-ray demonstrated
atelectasis of the right lung. During an examination of the nasal cavities, the
nasal packing was removed, and one of the gauze pieces was missing. The patient
underwent rigid bronchoscopy, and the missing gauze was found to be obstructing
the right main bronchus. The patient’s respiratory function improved
considerably after removal of the foreign body. It is assumed that gauze packs
should be used with caution in patients with an impaired level of consciousness
and neurodegenerative diseases.
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Abstract
OBJECTIVE Respiratory complications account for a major cause of morbidity and mortality in subjects with spinal cord injury (SCI) due to paralysis of the expiratory muscles and the consequent inability to generate effective cough. We demonstrated previously that effective cough can be restored in SCI via spinal cord stimulation (SCS) with disc leads positioned on the lower thoracic and upper lumbar spinal cord via laminotomy incisions. In this study, the effectiveness of wire leads, which can be placed using minimally invasive techniques, to activate the expiratory muscles was evaluated. DESIGN Animal study. SETTING Research laboratory. ANIMALS Dogs (n = 8). INTERVENTIONS In separate trials, disc and wire leads were inserted onto the dorsal epidural space at the T9, T11, and L1 spinal cord levels. Effects of electrical stimulation with disc, single wire, and two wire leads placed in parallel were compared. OUTCOME MEASURES Airway pressure generation following stimulation with disc and various configurations of wire leads were compared. RESULTS Several different configurations of wire leads resulted in airway pressures that were similar to those generated with monopolar stimulation with disc leads (MSDLs). For example, combined monopolar stimulation with parallel wire leads at the T9 + T11 and T9 + L1 levels resulted in airway pressures that were 103.5 ± 6.4 and 101.9 ± 7.0%, respectively, of those achieved with MSDL. Bipolar stimulation with parallel wire leads at T9-T11 and T9-L1 resulted in airway pressures that were 94.2 ± 3.4 and 96.8 ± 5.0%, respectively, of the pressures achieved with MSDL. Other wire configurations were also evaluated, but were generally less effective. CONCLUSION These results suggest that specific configurations of wire leads, which can be placed via minimally invasive techniques, result in comparable activation of the expiratory muscles compared to disc leads and may be a useful technique to restore cough in persons with SCI.
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Affiliation(s)
- Krzysztof E. Kowalski
- Departments of Physiology & Biophysics and Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Anthony F. DiMarco
- Departments of Physiology & Biophysics and Medicine, Case Western Reserve University, Cleveland, OH, USA,Department of Physical Medicine & Rehabilitation, Case Western Reserve University and MetroHealth Medical Center, Cleveland, OH, USA,Correspondence to: Anthony F. DiMarco, MetroHealth Medical Center, Rammelkamp Center, 2500 MetroHealth Drive, Cleveland, OH, USA.
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21
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Lee BB, Boswell-Ruys C, Butler JE, Gandevia SC. Surface functional electrical stimulation of the abdominal muscles to enhance cough and assist tracheostomy decannulation after high-level spinal cord injury. J Spinal Cord Med 2008; 31:78-82. [PMID: 18533416 PMCID: PMC2435038 DOI: 10.1080/10790268.2008.11753985] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Evaluation of noninvasive stimulation modalities to augment cough and assist tracheostomy decannulation in high-level tetraplegia. STUDY DESIGN Single case study. METHODS A 65-year-old man with C4 ASIA C tetraplegia had delayed rehabilitation due to a tracheostomy and recurrent pneumonia primarily resulting from ineffective cough. Anterior surface electrical stimulation (SES) of the abdominal musculature was conducted to train an effective cough and enable decannulation. Training occurred daily for 4 weeks. The patient was tested 1 year later with posterolateral SES to determine the relative clinical effect of this delivery method. RESULTS At baseline, the addition of anterior SES increased maximal expiratory pressure (80%), maximal expiratory cough pressure (67%), and peak expiratory flow rate (11%). Three weeks after training began, the patient was decannulated following a program of SES and assisted and voluntary coughing. Upon testing 1 year later, SES with posterolaterally placed electrodes also produced an enhancement of voluntary cough attempts. CONCLUSIONS Noninvasive SES can potentially assist decannulation of tracheostomies.
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Affiliation(s)
- Bonsan B Lee
- Prince of Wales Spinal Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.
| | - Claire Boswell-Ruys
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
| | - Jane E Butler
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- 2Prince of Wales Medical Research Institute, Sydney, New South Wales, Australia
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