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Barata, Filipe, Peter Tinschert, Frank Rassouli, Claudia Steurer-Stey, Elgar Fleisch, Milo Alan Puhan, Martin Brutsche, David Kotz, and Tobias Kowatsch. "Automatic Recognition, Segmentation, and Sex Assignment of Nocturnal Asthmatic Coughs and Cough Epochs in Smartphone Audio Recordings: Observational Field Study." Journal of Medical Internet Research 22, no. 7 (July 14, 2020): e18082. http://dx.doi.org/10.2196/18082.
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Background Asthma is one of the most prevalent chronic respiratory diseases. Despite increased investment in treatment, little progress has been made in the early recognition and treatment of asthma exacerbations over the last decade. Nocturnal cough monitoring may provide an opportunity to identify patients at risk for imminent exacerbations. Recently developed approaches enable smartphone-based cough monitoring. These approaches, however, have not undergone longitudinal overnight testing nor have they been specifically evaluated in the context of asthma. Also, the problem of distinguishing partner coughs from patient coughs when two or more people are sleeping in the same room using contact-free audio recordings remains unsolved. Objective The objective of this study was to evaluate the automatic recognition and segmentation of nocturnal asthmatic coughs and cough epochs in smartphone-based audio recordings that were collected in the field. We also aimed to distinguish partner coughs from patient coughs in contact-free audio recordings by classifying coughs based on sex. Methods We used a convolutional neural network model that we had developed in previous work for automated cough recognition. We further used techniques (such as ensemble learning, minibatch balancing, and thresholding) to address the imbalance in the data set. We evaluated the classifier in a classification task and a segmentation task. The cough-recognition classifier served as the basis for the cough-segmentation classifier from continuous audio recordings. We compared automated cough and cough-epoch counts to human-annotated cough and cough-epoch counts. We employed Gaussian mixture models to build a classifier for cough and cough-epoch signals based on sex. Results We recorded audio data from 94 adults with asthma (overall: mean 43 years; SD 16 years; female: 54/94, 57%; male 40/94, 43%). Audio data were recorded by each participant in their everyday environment using a smartphone placed next to their bed; recordings were made over a period of 28 nights. Out of 704,697 sounds, we identified 30,304 sounds as coughs. A total of 26,166 coughs occurred without a 2-second pause between coughs, yielding 8238 cough epochs. The ensemble classifier performed well with a Matthews correlation coefficient of 92% in a pure classification task and achieved comparable cough counts to that of human annotators in the segmentation of coughing. The count difference between automated and human-annotated coughs was a mean –0.1 (95% CI –12.11, 11.91) coughs. The count difference between automated and human-annotated cough epochs was a mean 0.24 (95% CI –3.67, 4.15) cough epochs. The Gaussian mixture model cough epoch–based sex classification performed best yielding an accuracy of 83%. Conclusions Our study showed longitudinal nocturnal cough and cough-epoch recognition from nightly recorded smartphone-based audio from adults with asthma. The model distinguishes partner cough from patient cough in contact-free recordings by identifying cough and cough-epoch signals that correspond to the sex of the patient. This research represents a step towards enabling passive and scalable cough monitoring for adults with asthma.
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Vally, M., and M. O. E. Irhuma. "Management of Cough: a practical approach." South African Family Practice 58, no. 4 (August 4, 2016): 35–39. http://dx.doi.org/10.4102/safp.v58i4.4486.
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On a regular day, healthcare providers will be contacted by one or more health seekers presenting with cough as a symptom. Cough has been considered an important physiological reflex that protects the airways from aspiration of foreign materials. Cough is one of the most common symptoms for which people seek medical attention from their healthcare practitioners. The common classifications for cough include acute, subacute and chronic cough. Such classification is time dependant. Acute cough is generally self-limiting, while subacute and chronic coughs have various different causes. There are many different causes of cough, and the common causes of persistent coughs include: upper airway cough syndrome, asthma, gastroesophageal reflux disease (GORD) and even pharmacological therapy. There are other important causes of chronic cough especially in the Southern African region that include: pulmonary tuberculosis (TB), environmental diseases, and others, which will not be covered by this article. Management of subacute and chronic coughs should be individualised according to their cause. Currently, there is no evidence to suggest acute coughs need to be treated. Moreover, there is poor evidence to recommend the use of over the counter (OTC) cough syrups in the management of acute coughs.
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Cho, Peter S. P., Hannah V. Fletcher, Richard D. Turner, Caroline J. Jolley, and Surinder S. Birring. "Impaired cough suppression in chronic refractory cough." European Respiratory Journal 53, no. 5 (February 28, 2019): 1802203. http://dx.doi.org/10.1183/13993003.02203-2018.
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Functional brain imaging in individuals with chronic cough demonstrates reduced activation in cortical regions associated with voluntary cough suppression. Little is known about the ability of patients with chronic cough to suppress cough. This study aimed to compare the ability to voluntarily suppress cough during inhaled capsaicin challenge in participants with chronic refractory cough with that in healthy controls. In addition, this study aimed to assess the repeatability of capsaicin challenge test with voluntary cough suppression.Participants with chronic refractory cough and healthy controls underwent inhaled capsaicin challenge tests while attempting to suppress their cough responses. After 5 days, either a conventional capsaicin challenge test with no cough suppression attempt, or a repeat test with an attempt at cough suppression was performed. Threshold capsaicin concentrations required to elicit one, two and five coughs were calculated by interpolation. Objective 24-h cough frequency was measured in individuals with chronic refractory cough.Healthy controls were able to suppress capsaicin-evoked cough while participants with chronic refractory cough were not. Geometric mean±sd capsaicin dose thresholds for five coughs with (CS5) and without (C5) suppression attempts were 254.40±3.78 versus 45.89±3.95 µmol·L−1, respectively, in healthy controls (p=0.033) and 3.34±5.04 versus 3.86±5.13 µmol·L−1, respectively, in participants with chronic refractory cough (p=0.922). Capsaicin dose thresholds for triggering five coughs with self-attempted cough suppression were significantly lower in participants with chronic refractory cough than in healthy controls; geometric mean±sd 4.94±4.43 versus 261.10±4.34 µmol·L−1, respectively; mean difference (95% CI) 5.72 (4.54–6.91) doubling doses (p<0.001). Repeatability of cough suppression test in both patients and healthy controls was high; intraclass correlation coefficients of log(CS5) values 0.81 and 0.87, respectively. CS5 was associated with objective cough frequency (ρ=−0.514, p=0.029).Participants with chronic refractory cough were less able to voluntarily suppress capsaicin-evoked cough compared to healthy controls. This may have important implications for the pathophysiology and treatment of chronic cough.
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Yang, Bennett E., and Joel Moss. "Cough, Cough." Chest 163, no. 4 (April 2023): 746–48. http://dx.doi.org/10.1016/j.chest.2022.12.009.
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Xiang, Anbo, Yoshiyuki Uchida, Akihiro Nomura, Hiroaki Iijima, Fang Dong, Min-Jie Zhang, and Shizuo Hasegawa. "Effects of airway inflammation on cough response in the guinea pig." Journal of Applied Physiology 85, no. 5 (November 1, 1998): 1847–54. http://dx.doi.org/10.1152/jappl.1998.85.5.1847.
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We have developed a guinea pig model for cough related to allergic airway inflammation. Unanesthetized animals were exposed to capsaicin aerosols for 10 min, and cough frequency was counted during this period. The cough evaluation was performed by the following three methods: visual observation, acoustic analysis, and monitoring of pressure changes in the body chamber. These analyses clearly differentiated a cough from a sneeze. To elucidate the relationship between cough response and airway inflammation, animals were immunosensitized and multiple challenged. Sensitized guinea pigs presented no specific changes microscopically, but multiple-challenged animals showed an increased infiltration of inflammatory cells into the airway. Cough number in response to capsaicin increased significantly from 4.7 ± 1.4 coughs/10 min in normal animals to 10.6 ± 2.0 coughs/10 min in sensitized animals and further to 22.8 ± 1.3 coughs/10 min in multiple-challenged animals. This augmented cough frequency was significantly inhibited by the inhalation of tachykinin-receptor antagonists and by oral ingestion, but not inhalation, of codeine phosphate. The results suggest that airway inflammation potentiates an elevation of cough sensitivity in this model.
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Barry, P. W., N. P. Mason, M. Riordan, and C. O'Callaghan. "Cough Frequency and Cough-Receptor Sensitivity are Increased in Man at Altitude." Clinical Science 93, no. 2 (August 1, 1997): 181–86. http://dx.doi.org/10.1042/cs0930181.
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1. Travellers to high altitude often complain of paroxysmal cough, which has not been previously investigated. We recorded overnight cough frequency and cough-receptor sensitivity to inhaled citric acid in a group of climbers travelling to 5300 m or higher. 2. Cough frequency, monitored in ten subjects, increased from a median of 0 coughs at sea level (range 0–1) to 5 coughs at 5000 m (range 0–13) and to over 60 coughs in subjects ascending to 7000 m. Citric acid cough threshold, measured in 42 subjects, was unchanged on arrival at 5300 m compared with sea level (geometric mean difference 1.26, 95% confidence intervals 0.84–1.89, P = 0.25), but was significantly reduced after 6 days, or more, at altitude compared with sea level (geometric mean difference 2.2, 95% confidence intervals 1.54–3.15, P = 0.0002). Cough threshold was not related to symptoms of acute mountain sickness, oxygen saturation, carbon dioxide tension or lung function. 3. These results indicate an increase in cough and cough-receptor sensitivity after some days at altitude. This may be due to respiratory tract damage from breathing cold dry air at increased ventilatory rates. Other explanations, such as sub-clinical pulmonary oedema or an effect on the cough centre of acclimatization to altitude, cannot be excluded.
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Hee, Hwan Ing, BT Balamurali, Arivazhagan Karunakaran, Dorien Herremans, Onn Hoe Teoh, Khai Pin Lee, Sung Shin Teng, Simon Lui, and Jer Ming Chen. "Development of Machine Learning for Asthmatic and Healthy Voluntary Cough Sounds: A Proof of Concept Study." Applied Sciences 9, no. 14 (July 16, 2019): 2833. http://dx.doi.org/10.3390/app9142833.
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(1) Background: Cough is a major presentation in childhood asthma. Here, we aim to develop a machine-learning based cough sound classifier for asthmatic and healthy children. (2) Methods: Children less than 16 years old were randomly recruited in a Children’s Hospital, from February 2017 to April 2018, and were divided into 2 cohorts—healthy children and children with acute asthma presenting with cough. Children with other concurrent respiratory conditions were excluded in the asthmatic cohort. Demographic data, duration of cough, and history of respiratory status were obtained. Children were instructed to produce voluntary cough sounds. These clinically labeled cough sounds were randomly divided into training and testing sets. Audio features such as Mel-Frequency Cepstral Coefficients and Constant-Q Cepstral Coefficients were extracted. Using a training set, a classification model was developed with Gaussian Mixture Model–Universal Background Model (GMM-UBM). Its predictive performance was tested using the test set against the physicians’ labels. (3) Results: Asthmatic cough sounds from 89 children (totaling 1192 cough sounds) and healthy coughs from 89 children (totaling 1140 cough sounds) were analyzed. The sensitivity and specificity of the audio-based classification model was 82.81% and 84.76%, respectively, when differentiating coughs from asthmatic children versus coughs from ‘healthy’ children. (4) Conclusion: Audio-based classification using machine learning is a potentially useful technique in assisting the differentiation of asthmatic cough sounds from healthy voluntary cough sounds in children.
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Poliacek, Ivan, Kendall F. Morris, Bruce G. Lindsey, Lauren S. Segers, Melanie J. Rose, Lu Wen-Chi Corrie, Cheng Wang, Teresa E. Pitts, Paul W. Davenport, and Donald C. Bolser. "Blood pressure changes alter tracheobronchial cough: computational model of the respiratory-cough network and in vivo experiments in anesthetized cats." Journal of Applied Physiology 111, no. 3 (September 2011): 861–73. http://dx.doi.org/10.1152/japplphysiol.00458.2011.
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We tested the hypothesis, motivated in part by a coordinated computational cough network model, that alterations of mean systemic arterial blood pressure (BP) influence the excitability and motor pattern of cough. Model simulations predicted suppression of coughing by stimulation of arterial baroreceptors. In vivo experiments were conducted on anesthetized spontaneously breathing cats. Cough was elicited by mechanical stimulation of the intrathoracic airways. Electromyograms (EMG) of inspiratory parasternal, expiratory abdominal, laryngeal posterior cricoarytenoid (PCA), and thyroarytenoid muscles along with esophageal pressure (EP) and BP were recorded. Transiently elevated BP significantly reduced cough number, cough-related inspiratory, and expiratory amplitudes of EP, peak parasternal and abdominal EMG, and maximum of PCA EMG during the expulsive phase of cough, and prolonged the cough inspiratory and expiratory phases as well as cough cycle duration compared with control coughs. Latencies from the beginning of stimulation to the onset of cough-related diaphragm and abdominal activities were increased. Increases in BP also elicited bradycardia and isocapnic bradypnea. Reductions in BP increased cough number; elevated inspiratory EP amplitude and parasternal, abdominal, and inspiratory PCA EMG amplitudes; decreased total cough cycle duration; shortened the durations of the cough expiratory phase and cough-related abdominal discharge; and shortened cough latency compared with control coughs. Reduced BP also produced tachycardia, tachypnea, and hypocapnic hyperventilation. These effects of BP on coughing likely originate from interactions between barosensitive and respiratory brainstem neuronal networks, particularly by modulation of respiratory neurons within multiple respiration/cough-related brainstem areas by baroreceptor input.
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Sanchez-Olivieri, Isabel, Matthew Rudd, Juan Carlos Gabaldon-Figueira, Francisco Carmona-Torre, Jose Luis Del Pozo, Reid Moorsmith, Lola Jover, et al. "Performance evaluation of human cough annotators: optimal metrics and sex differences." BMJ Open Respiratory Research 10, no. 1 (November 2023): e001942. http://dx.doi.org/10.1136/bmjresp-2023-001942.
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IntroductionDespite its high prevalence and significance, there is still no widely available method to quantify cough. In order to demonstrate agreement with the current gold standard of human annotation, emerging automated techniques require a robust, reproducible approach to annotation. We describe the extent to which a human annotator of cough sounds (a) agrees with herself (intralabeller or intrarater agreement) and (b) agrees with other independent labellers (interlabeller or inter-rater agreement); we go on to describe significant sex differences in cough sound length and epochs size.Materials and methods24 participants wore an audiorecording smartwatch to capture 6–24 hours of continuous audio. A randomly selected sample of the whole audio was labelled twice by an expert annotator and a third time by six trained annotators. We collected 400 hours of audio and analysed 40 hours. The cough counts as well as cough seconds (any 1 s of time containing at least one cough) from different annotators were compared and summary statistics from linear and Bland-Altman analyses were used to quantify intraobserver and interobserver agreement.ResultsThere was excellent intralabeller (less than two disagreements per hour monitored, Pearson’s correlation 0.98) and interlabeller agreement (Pearson’s correlation 0.96), using cough seconds as the unit of analysis decreased annotator discrepancies by 50% in comparison to coughs. Within this data set, it was observed that the length of cough sounds and epoch size (number of coughs per bout or attach) differed between women and men.ConclusionGiven the decreased interobserver variability in annotation when using cough seconds (vs just coughs) we propose their use for manually annotating cough when assessing of the performance of automatic cough monitoring systems. The differences in cough sound length and epochs size may have important implications for equality in the development of cough monitoring tools.Trial registration numberNCT05042063.
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Gavliakova, S., T. Dolak, H. Licha, S. Krizova, and J. Plevkova. "Cineole, Thymol and Camphor Nasal Challenges and their Effect on Nasal Symptoms and Cough in an Animal Model." Acta Medica Martiniana 13, no. 2 (November 1, 2013): 5–13. http://dx.doi.org/10.2478/acm-2013-0012.
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Abstract Inhalation of aromatic vapours suppressed coughing induced by citric acid (CA) in naive animals. No data are available about their effects in an animal model with primarily up-regulated cough reflex. New data indicate that aromatic vapours suppress cough via effect on nasal sensory nerves. The aim of our study was to ascertain the efficacy of nasal application of 1,8-cineole, thymol and camphor on nasal symptoms and CA induced cough in validated model of up-regulated cough reflex. Guinea pigs (n=13) were sensitized by intraperitoneal administration of ovalbumin (OVA) and sensitization was confirmed 21 days later by skin tests. Sensitized animals were repeatedly challenged with nasal OVA to induce rhinitis, and further experiments (cough challenges) were performed during the early phase of allergic inflammation. Cough was induced by CA in plethysmograph for 10 minutes after nasal pre-treatment with aromatic substances (10-3M) in rhinitis model. Cough was recognized from record of sudden airflow changes interrupting breathing pattern and cough sound. Final count of coughs was established by blind analysis using SonicVisualiser Software. Dose responses curves, total cough count and cough latency were analyzed. Repeated intranasal challenge with OVA induces progressively worsening symptoms, and cough induced by CA during acute phase of allergic rhinitis was enhanced. Nasal pre-treatment with 1,8-cineole, thymol and camphor did not prevent onset of nasal symptoms, and the magnitude of symptoms was comparable to those without pretreatment. Camphor had the most potent antitussive effects (number of coughs 25±3 vs. 7±2, p<0.05) followed by thymol (number of coughs 25±3 vs. 14±2, p<0.05). The data for nasal 1,8-cineole challenge did not reach statistical significance. Cough latency followed this trend. Although the magnitude of nasal symptoms is not influenced, the effect on cough is in case of camphor and thymol significant. Our data showed that nasal application of aromatic substances suppress citric acid induced cough in animals with up-regulated cough reflex.
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Stafford, Ryan E., Stuart Mazzone, James A. Ashton-Miller, Christos Constantinou, and Paul W. Hodges. "Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs." Journal of Applied Physiology 116, no. 8 (April 15, 2014): 953–60. http://dx.doi.org/10.1152/japplphysiol.01225.2013.
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Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28–42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.
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Ewig, Jeffrey M. "Chronic Cough." Pediatrics In Review 16, no. 2 (February 1, 1995): 72–73. http://dx.doi.org/10.1542/pir.16.2.72.
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Cough is a reflex that protects the lungs from aspirating food or inhaling irritants. It is a key component of the nonimmune pulmonary defense system. The cough that accompanies most common respiratory infections usually resolves in 7 to 10 days and rarely is a cause of concern. The patient who has frequent viral infections may complain of a "chronic" cough, but a careful history will reveal a shorter duration of repetitive episodes with coughs resolving completely in between infections. Chronic cough usually is defined as lasting for more than 3 to 4 weeks. Chronic cough is a symptom, not a diagnosis, and the underlying cause should be ascertained.
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Thorpe, CW, LJ Toop, and KP Dawson. "Towards a quantitative description of asthmatic cough sounds." European Respiratory Journal 5, no. 6 (June 1, 1992): 685–92. http://dx.doi.org/10.1183/09031936.93.05060685.
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This study describes a method of quantitatively characterizing cough sounds using digital signal processing techniques. Differences between asthmatic and non-asthmatic cough sounds are presented. Coughs from 12 asthmatic and 5 non-asthmatic subjects were analysed. Cough sounds and flows were digitized, at a sampling rate of 5 kHz, before and after a free-running exercise test. Individual coughs were divided into two or three phases, corresponding to the initial glottal opening burst, the quieter middle phase, and (sometimes) the final closing burst. Standard signal processing techniques were then invoked to characterize the spectral and temporal shapes of the first two phases. Factor analysis indicated that the spectral shapes of the two phases are independent, with each being largely described by the degree of "peakedness" in the spectrum, and by the balance of energy between low and high frequencies. Both the duration of the initial burst and zero-crossing rates of the cough waveform (which indicates the "spectral balance") during each of the first two phases were smaller for asthmatic than for non-asthmatic coughs. Fewer asthmatic coughs contained a final burst. Discriminant analysis between the two groups gave classification error rates of 20-30%. The peak flow recorded during the cough was significantly smaller for asthmatics, and correlated very well with the peak flow recorded during forced expiration. Thus, significant differences exist between asthmatic and non-asthmatic cough sounds. An effective representation of the temporal structure of the cough sound is required to successfully characterize the cough.
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Romaniuk, Jarosław, Krzysztof Kowalski, and Thomas Dick. "The role of pulmonary stretch receptor activation during cough in dogs." Acta Neurobiologiae Experimentalis 57, no. 1 (March 31, 1997): 21–29. http://dx.doi.org/10.55782/ane-1997-1207.
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The role of pulmonary stretch receptors in the modulation of expiratory muscle activity during cough is controversial. To evaluate their potential influence on expiratory effort during cough, we compared expiratory muscle activity during unobstructed cough to that during obstructed cough in which the trachea was occluded at the end-inspiration and maintained throughout the subsequent expiration. Cough was evoked by mechanical stimulation of the intrathoracic trachea in 9 anesthetized, tracheotomized dogs. Peak triangularis sterni (TS), internal intercostal (IIC) and transversus abdominis (TA) muscle EMG were monitored to assess both rib cage and abdominal muscle activation during expiration. During cough, expiratory activity increased and peak activity shifted from Stage II to Stage I expiration. Peak expiratory muscle activation during unobstructed and occluded coughs were not significantly different: during unobstructed coughs, peak EMG's (mean +/- SE as percent of resting breathing) were TS, 212 +/- 18; IIC, 425 +/- 72; TA, 406 +/- 66; and during obstructed cough: TS, 188 +/- 24; IIC, 365 +/- 44; TA, 387 +/- 77 (n=9). These data indicate that enhanced vagal stimulation resulting from airway occlusion does not affect expiratory activity during cough. We suggest that during cough, the expiratory muscles are activated in a stereotypical pattern by the neural network generating the cough and this pattern of activation is not affected by phasic vagal input.
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Hilton, Emma, Imran Satia, Kimberley Holt, Ashley A. Woodcock, John Belcher, and Jaclyn A. Smith. "The effect of pain conditioning on experimentally evoked cough: evidence of impaired endogenous inhibitory control mechanisms in refractory chronic cough." European Respiratory Journal 56, no. 6 (July 23, 2020): 2001387. http://dx.doi.org/10.1183/13993003.01387-2020.
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The pathophysiology of refractory chronic cough (RCC) is unclear. We hypothesised that endogenous inhibitory control mechanisms, such as those activated by noxious stimuli inducing pain (conditioned pain modulation) may be capable of inhibiting coughing and urge to cough evoked by inhaled capsaicin. Furthermore, these mechanisms may be impaired in patients with RCC.The objective was to investigate the effects of pain on cough and urge to cough in healthy volunteers and RCC patients. Healthy volunteers and RCC patients underwent a randomised, controlled, four-way crossover study comparing the effect of four interventions on capsaicin-evoked coughing and urge to cough. The interventions comprised immersing a hand in 1) noxious cold water; 2) warm water; 3) warm water, but subjects were instructed to voluntarily supress coughing; and 4) no intervention. The co-primary outcomes were numbers of evoked coughs and urge to cough scores.20 healthy volunteers (mean±sd age 50.1±14.2 years, male:female 10:10) and 20 RCC patients (age 60.1±7.9 years, male:female 9:11) participated. Overall, noxious cold water reduced capsaicin-evoked urge-to-cough scores and cough numbers compared with warm water (1.6 (95% CI 1.3–2.0) versus 2.2 (1.8–2.6), p<0.001 and 4.8 (3.7–6.2) coughs versus 7.9 (6.7–9.5) coughs, p<0.001, respectively). Healthy volunteers and RCC patients demonstrated similar reductions in the urge to cough during noxious cold-water immersion, but noxious cold water and voluntary suppression interventions were less effective at reducing capsaicin-evoked cough in RCC patients than in healthy volunteers (p=0.041).Endogenous inhibitory control mechanisms, specifically those activated by pain, can reduce both coughing and the urge to cough. Impairment of endogenous inhibitory control mechanisms may contribute to excessive coughing in RCC.
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Choudry, NB, and RW Fuller. "Sensitivity of the cough reflex in patients with chronic cough." European Respiratory Journal 5, no. 3 (March 1, 1992): 296–300. http://dx.doi.org/10.1183/09031936.93.05030296.
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Cough may occur in association with excess bronchial secretions and may, therefore, be productive. However, in a proportion of patients the cough is non-productive and a possible association with an enhanced response of the cough reflex has been postulated. Using the irritant capsaicin, the sensitivity of the cough reflex was measured in 363 individuals. A questionnaire was used to divide subjects into three groups: Group A) non-coughing controls; Group B) subjects with non-productive cough; and Group C) subjects with productive cough. The group means (+/- 99% confidence interval (CI)) of the log capsaicin concentration causing two or more coughs (C2) for groups A, B, C were 0.98 (+/- 0.08), 0.64 (+/- 0.09) and 1.04 (+/- 0.23), respectively. The log capsaicin concentration causing five or more coughs (C5) for groups A, B, C were 1.78 (+/- 0.1), 1.16 (+/- 0.12) and 1.54 (+/- 0.25), respectively. Group B was significantly more sensitive to inhaled capsaicin than the other groups (p less than 0.01). No significant difference was observed between groups A and C. Some differences were found when subgroups were examined within groups B and C. In group B, patients with post-nasal drip were found to have a normal sensitivity of the cough reflex and were, therefore, different from the remainder of patients with non-productive cough. In group C, patients with bronchiectasis and current infection showed an increase in the sensitivity of their cough reflex. It is concluded that cough can occur in association with either excess mucus production leading to productive cough or an increase in the sensitivity of the cough reflex, possibly leading to non-productive cough.
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Lalloo, UG, S. Lim, R. DuBois, PJ Barnes, and KF Chung. "Increased sensitivity of the cough reflex in progressive systemic sclerosis patients with interstitial lung disease." European Respiratory Journal 11, no. 3 (March 1, 1998): 702–5. http://dx.doi.org/10.1183/09031936.98.11030702.
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Cough is a common presenting symptom of interstitial lung disease (ILD). The aim of this study was to examine the cough reflex in patients with progressive systemic sclerosis (PSS), with and without associated ILD. The cough reflex to inhalation of chloride deficient solutions and capsaicin was determined in patients with PSS with associated ILD (n=12), compared to patients with PSS without ILD (n=12). In addition, patients with a chronic dry cough (n=12) and healthy subjects (n=10) without cough were studied. Cough responses to inhalation of isotonic solutions containing 150, 75, 37.5 and 0 mM Cl- ions and of capsaicin (0.9-500 mM) were measured. PSS patients with ILD reported a significantly higher cough score than PSS patients without ILD (p<0.03). ILD patients coughed more than those without ILD to Cl- of 37.5 and 0 mM (19.1+/-5.0 vs 6.2+/-1.9 coughs x min(-1) (p<0.03), and 29.2+/-5.0 vs 14.1/-4.1 coughs x min(-1) (p<0.04), respectively). The log concentration of capsaicin causing two or five coughs was lower in PSS with ILD compared to PSS without ILD (0.74+/-0.15 mM vs 2.12+/-0.26 mM; p<0.002). Patients with chronic dry cough had a similar degree of response to low-chloride and capsaicin solutions as patients with PSS and ILD, whilst healthy controls had a similar degrees of response to PSS patients. There is an increased cough reflex in patients with interstitial lung disease, which may represent sensitization of airway sensory nerves. This may be the basis for the chronic dry cough in patients with interstitial lung disease.
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Rissardo, JamirPitton, and AnaLeticia Fornari Caprara. "Cough, cough-induced, and primary cough headache." Matrix Science Medica 6, no. 4 (2022): 117. http://dx.doi.org/10.4103/mtsm.mtsm_6_22.
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Lalloo, U. G., A. J. Fox, M. G. Belvisi, K. F. Chung, and P. J. Barnes. "Capsazepine inhibits cough induced by capsaicin and citric acid but not by hypertonic saline in guinea pigs." Journal of Applied Physiology 79, no. 4 (October 1, 1995): 1082–87. http://dx.doi.org/10.1152/jappl.1995.79.4.1082.
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Acidic solutions mimick many of the effects of capsaicin (Cap), including pain, bronchoconstriction, cough, and sensory neuropeptide release. Evidence from the use of the Cap antagonist capsazepine suggests that in some cases protons act at the Cap receptor. In the present study, we have investigated whether cough evoked by Cap and citric acid (CA) is mediated specifically via the Cap receptor on airway sensory nerves. We have examined the effects of capsazepine on Cap-, CA-, and hypertonic saline-induced cough and also on CA-induced nasal irritation in awake guinea pigs. Capsazepine was nebulized for 5 min before cough challenges with Cap for 5 min and CA for 10 min. Control animals were pretreated with vehicle alone. Capsazepine (100 microM) inhibited the cough response to 30 microM Cap from 0.77 +/- 0.14 coughs/min in control animals to 0.23 +/- 0.08 coughs/min (P < 0.05) and to 80 microM Cap from 1.4 +/- 0.23 to 0.3 +/- 0.11 coughs/min (P < 0.01). There was no effect, however, of lower concentrations of capsazepine (5 and 10 microM) against Cap-evoked cough. At a concentration of 100 microM, capsazepine also inhibited the coughing induced by 0.25 M CA from 1.8 +/- 0.26 to 0.93 +/- 0.31 coughs/min (P < 0.05) but not that induced by 0.5 M CA. Nasal irritation induced by 0.25 M CA, but not by 0.5 M CA, was also inhibited by capsazepine from 2.47 +/- 0.37 to 0.75 +/- 0.31 nose wipes/min (P < 0.05). This inhibitory effect of capsazepine did not appear to reflect a nonspecific suppression of the cough reflex, since cough evoked by exposure to hypertonic (7%) saline for 10 min was unaffected by pretreatment with capsazepine (100 microM). These data show that capsazepine is a specific inhibitor of Cap- and CA-induced cough in guinea pigs. Moreover, they suggest that low pH stimuli evoke cough and nasal irritation by an action at the Cap receptor, either directly or through the release of an intermediate agent.
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Balamurali, B. T., Hwan Ing Hee, Saumitra Kapoor, Oon Hoe Teoh, Sung Shin Teng, Khai Pin Lee, Dorien Herremans, and Jer Ming Chen. "Deep Neural Network-Based Respiratory Pathology Classification Using Cough Sounds." Sensors 21, no. 16 (August 18, 2021): 5555. http://dx.doi.org/10.3390/s21165555.
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Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician’s diagnosis. The chosen model is a bidirectional long–short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs—healthy or pathology (in general or belonging to a specific respiratory pathology)—reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians’ diagnosis. To classify the subject’s respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.
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Cho, Peter S. P., Hannah V. Fletcher, Irem S. Patel, Richard D. Turner, Caroline J. Jolley, and Surinder S. Birring. "Cough hypersensitivity and suppression in COPD." European Respiratory Journal 57, no. 5 (December 10, 2020): 2003569. http://dx.doi.org/10.1183/13993003.03569-2020.
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Cough reflex hypersensitivity and impaired cough suppression are features of chronic refractory cough (CRC). Little is known about cough suppression and cough reflex hypersensitivity in cough associated with chronic obstructive pulmonary disease (COPD). This study investigated the ability of patients with COPD to suppress cough during a cough challenge test in comparison to patients with CRC and healthy subjects. This study also investigated whether cough reflex hypersensitivity is associated with chronic cough in COPD.Participants with COPD (n=27) and CRC (n=11) and healthy subjects (n=13) underwent capsaicin challenge tests with and without attempts to self-suppress cough in a randomised order over two visits, 5 days apart. For patients with COPD, the presence of self-reported chronic cough was documented, and objective 24-h cough frequency was measured.Amongst patients with COPD, those with chronic cough (n=16) demonstrated heightened cough reflex sensitivity compared to those without chronic cough (n=11): geometric mean±sd capsaicin dose thresholds for five coughs (C5) 3.36±6.88 µmol·L−1versus 44.50±5.90 µmol·L−1, respectively (p=0.003). Participants with CRC also had heightened cough reflex sensitivity compared to healthy participants: geometric mean±sd C5 3.86±5.13 µmol·L−1versus 45.89±3.95 µmol·L−1, respectively (p<0.001). Participants with COPD were able to suppress capsaicin-evoked cough, regardless of the presence or absence of chronic cough: geometric mean±sd capsaicin dose thresholds for 5 coughs without self-suppression attempts (C5) and with (CS5) were 3.36±6.88 µmol·L−1versus 12.80±8.33 µmol·L−1 (p<0.001) and 44.50±5.90 µmol·L−1versus 183.2±6.37 µmol·L−1 (p=0.006), respectively. This was also the case for healthy participants (C5 versus CS5: 45.89±3.95 µmol·L−1versus 254.40±3.78 µmol·L−1, p=0.033), but not those with CRC, who were unable to suppress capsaicin-evoked cough (C5 versus CS5: 3.86±5.13 µmol·L−1versus 3.34±5.04 µmol·L−1, p=0.922). C5 and CS5 were associated with objective 24-h cough frequency in patients with COPD: ρ= −0.430, p=0.036 and ρ= −0.420, p=0.041, respectively.Patients with COPD-chronic cough and CRC both had heightened cough reflex sensitivity but only patients with CRC were unable to suppress capsaicin-evoked cough. This suggests differing mechanisms of cough between patients with COPD and CRC, and the need for disease-specific approaches to its management.
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Bennett, W. D., and K. L. Zeman. "Effect of enhanced supramaximal flows on cough clearance." Journal of Applied Physiology 77, no. 4 (October 1, 1994): 1577–83. http://dx.doi.org/10.1152/jappl.1994.77.4.1577.
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Efficiency of cough for clearing mucus from the lungs is believed to be a function of peak airflow velocities in the airways. Initial transient supramaximal flows are characteristic of cough, and these peak flow rates can be enhanced by placing a triggered shutter at the mouth, serving the role of the epiglottis. Using radiolabeled monodispersed aerosols (99mTc-iron oxide) and gamma camera analysis, we measured over a 2-h period the efficacy of 60 voluntary vs. shutter coughs for clearing mucus from the airways of patients (n = 15) with chronic airway obstruction (mean ratio of forced expired volume in 1 s to forced vital capacity = 0.55). In a subset of patients (n = 9), we also measured the efficacy of forced expirations, or huffs, without glottis closure. Peak flow rate was greater for shutter than voluntary coughs [9.4 +/- 2.0 (SD) vs. 4.1 +/- 1.9 l/s; P < 0.001]. Retention at 60 min (as a fraction of initial deposition) was significantly different for the 3 study days (control, 0.83 +/- 0.17; voluntary cough, 0.69 +/- 0.18; shutter cough, 0.75 +/- 0.19; P = 0.01), but only control vs. voluntary cough values were significantly different from each other (P = 0.01). In contrast, retention at 120 min was significantly different for the 3 days, but both voluntary and shutter coughs were significantly different from control (P = 0.01 and P = 0.02, respectively) (control, 0.73 +/- 0.16; voluntary cough, 0.61 +/- 0.20; shutter cough, 0.65 +/- 0.20). Patients studied with buffs showed a clearance rate faster than control and similar to that associated with voluntary cough.(ABSTRACT TRUNCATED AT 250 WORDS)
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AD, Shah, Apoorva BVS, Jain A, and Shah KV. "Cough without a cause: Habit cough / Tic cough." International Journal of Research in Medicine 9, no. 4 (December 31, 2020): 5–8. http://dx.doi.org/10.38174/ijorim/9.4.2020.5-8.
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WALKER, LEWIS H. "Tic Cough μ Habit Cough μ Psychogenic Cough." Pediatric Asthma, Allergy & Immunology 1, no. 2 (January 1987): 123–26. http://dx.doi.org/10.1089/pai.1987.1.123.
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Neuschlová, Martina, and R. Pecova. "Cough Reflex Sensitivity Testing in Asthmatic Patients and Healthy Volunteers." Acta Medica Martiniana 13, Supplement-1 (March 1, 2013): 21–27. http://dx.doi.org/10.2478/acm-2013-0003.
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Abstract Asthma and allergic diseases are complex conditions caused by a combination of genetic and environmental factors. Cough is a major symptom in some people with asthma. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important method for cough studying. Cough reflex sensitivity was defined as the lowest concentration of capsaicin that elicited 2 or more (C2) and 5 or more coughs (C5). The aim of this study was to find out a cough reflex sensitivity in patients with asthma bronchiale and in healthy volunteers. In the present study we conclude that cough reflex sensitivity was significantly increased in asthmatic adult patients compared with healthy adult volunteers.
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Stone, R., P. J. Barnes, and R. W. Fuller. "Contrasting effects of prostaglandins E2 and F2 alpha on sensitivity of the human cough reflex." Journal of Applied Physiology 73, no. 2 (August 1, 1992): 649–53. http://dx.doi.org/10.1152/jappl.1992.73.2.649.
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Prostaglandins have been shown to influence the sensitivity of the cough reflex. To investigate putative mechanisms of this, we examined the effects of inhaled prostaglandins E2 (PGE2) and F2 alpha (PGF2 alpha) on human cough responses elicited by two challenges, low chloride solution and capsaicin, which may activate different neural pathways. Baseline cough challenges were followed after 2 h by five breaths of PGE2, PGF2 alpha, or citric acid as a control. Cough challenges were repeated after 1 min. Potentiation of capsaicin responses occurred after PGE2 (median increase 2 coughs/min, range 0–7, P less than 0.01) and PGF2 alpha (median increase 8 coughs/min, range -3 to 27, P less than 0.01) compared with control. The effect of PGF2 alpha was greater (P less than 0.05) than that of PGE2. Potentiation of low chloride responses also occurred after PGF2 alpha (median increase 7 coughs/2 min, range -1 to 19, P less than 0.01), but effects of PGE2 were insignificant against this challenge (median change -1 coughs/2 min, range -4 to 13). These data suggest that PGE2 and PGF2 alpha have different effects on the sensitivity of the human cough reflex, which may be relevant during airway disease.
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Hara, Akinori, Hiroshi Odajima, Hiroshi Matsuzaki, Masaki Fujimura, Tomoko Toma, Taizo Wada, Noriyuki Ohkura, et al. "Association between Cough and Ambient Polycyclic Aromatic Hydrocarbons in Patients with Chronic Cough: An Observational Study in Two Regions of Japan." Applied Sciences 12, no. 24 (December 7, 2022): 12505. http://dx.doi.org/10.3390/app122412505.
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Ambient polycyclic aromatic hydrocarbons’ (PAHs) specific components are likely involved in respiratory disease development and exacerbation in children and adults. Airborne PAH exposure’s effects on cough symptoms in children and adults with chronic coughs in Kanazawa and Fukuoka, Japan, were investigated in this longitudinal study. A total of 98 patients with chronic coughs were enrolled and followed up between 1 April and 31 May 2020. The enrolled patients were non-smoking adults and children aged 3–83 years. Cough diaries were used to record and collect daily cough symptoms. High-performance liquid chromatography coupled with a fluorescence detector was used to determine the particulate PAH content in daily total suspended particles collected on quartz fiber filters. Ambient concentrations of fine particulate matter, nitrogen dioxide, and sulfur dioxide were obtained from local monitoring sites. Generalized estimated equations were used to estimate the association between daily PAHs and cough symptoms. Among nine PAHs measured, benz[a]anthracene (BaA) was significantly associated with cough symptoms for both lag4 and lag5 PAH exposure. These findings suggest that airborne specific PAHs, especially BaA, affect cough symptoms in children and adults with chronic cough. Further studies are needed to develop effective measures to prevent respiratory diseases against specific PAHs.
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Eni, Marina, Valeria Mordoh, and Yaniv Zigel. "Cough detection using a non-contact microphone: A nocturnal cough study." PLOS ONE 17, no. 1 (January 19, 2022): e0262240. http://dx.doi.org/10.1371/journal.pone.0262240.
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An automatic non-contact cough detector designed especially for night audio recordings that can distinguish coughs from snores and other sounds is presented. Two different classifiers were implemented and tested: a Gaussian Mixture Model (GMM) and a Deep Neural Network (DNN). The detected coughs were analyzed and compared in different sleep stages and in terms of severity of Obstructive Sleep Apnea (OSA), along with age, Body Mass Index (BMI), and gender. The database was composed of nocturnal audio signals from 89 subjects recorded during a polysomnography study. The DNN-based system outperformed the GMM-based system, at 99.8% accuracy, with a sensitivity and specificity of 86.1% and 99.9%, respectively (Positive Predictive Value (PPV) of 78.4%). Cough events were significantly more frequent during wakefulness than in the sleep stages (p < 0.0001) and were significantly less frequent during deep sleep than in other sleep stages (p < 0.0001). A positive correlation was found between BMI and the number of nocturnal coughs (R = 0.232, p < 0.05), and between the number of nocturnal coughs and OSA severity in men (R = 0.278, p < 0.05). This non-contact cough detection system may thus be implemented to track the progression of respiratory illnesses and test reactions to different medications even at night when a contact sensor is uncomfortable or infeasible.
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Kishanrao, Suresh. "Epidemiology & Management of Cough in Smaller Settings-An Indian Case Study." Journal of Quality in Health Care & Economics 6, no. 3 (2023): 1–13. http://dx.doi.org/10.23880/jqhe-16000331.
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Nearly every person experiences at least one episode of cough every year in their lifetime. Most, people seek care outside home only after trying known home remedies, especially when cough disturbs their sleep due to postnasal drip. Available data suggest that an average Indian adult has 3 episodes of cough per year, while an average child has 7-10 such episodes every year. The COVID-19 pandemic has increased the magnitude of cough across the world since early 2020. The most annoying part about a cough is “phlegm or mucus.” Mucus forms a protective lining in certain parts of our body, protects our body from foreign invaders by trapping the irritants and expel them in a cough. Excessive Phlegm or mucus is produced as a response to an irritant from the environment like allergies, smoke, smoking, dust, and infections. Excess phlegm or difficulty to expel phlegm can be tackled as per its cause or origin. No doctor or a health care worker, in his/her clinical practice has a day without seeing a patient with cough. The diagnostic tests are either not available, or unaffordable, if available and used take a long time for definitive diagnosis. Another problem is of self-medication with innumerable number of over-the-counter cough syrups. Most practitioners know about the types of coughs, their symptomatic treatment and over the counter cough syrups and mucolytics, but very few know, the Ideal rationale of managing cough. Having analysed six varieties of coughs namely i) Cough due to postnasal drip in an elderly person ii & iii) Cough of Community acquired Pneumonia in a child and an adult by antibiotics iv) Cough in an elderly person managed by traditional approach of using roasted Guava fruit v) A case of Cough variant Asthma vi) Cough among Covid 19 cases and vii) Cough in COPD case in an elderly, the author is recommending a simple symptoms based logarithmic approach for differentiating various conditions causing cough and managing them empirically. This article highlights the need for a rational approach for small settings or individual practitioners. Materials & Methodology: This review is based on the review of literature on the ideal rationale of managing cough, own learning from personal practice and practices observed among colleagues, in public sector teaching institutes and private sector hospitals. The article addresses the general practitioner’s dilemma of diagnosis and management by simple symptoms based logarithmic approach and managing empirically.
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Bolser, Donald C., John A. Hey, and Richard W. Chapman. "Influence of central antitussive drugs on the cough motor pattern." Journal of Applied Physiology 86, no. 3 (March 1, 1999): 1017–24. http://dx.doi.org/10.1152/jappl.1999.86.3.1017.
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The present study was conducted to determine the effects of administration of centrally active antitussive drugs on the cough motor pattern. Electromyograms of diaphragm and rectus abdominis muscles were recorded in anesthetized, spontaneously breathing cats. Cough was produced by mechanical stimulation of the intrathoracic trachea. Centrally acting drugs administered included codeine, morphine, dextromethorphan, baclofen, CP-99,994, and SR-48,968. Intravertebral artery administration of all drugs reduced cough number (number of coughs per stimulus trial) and rectus abdominis burst amplitude in a dose-dependent manner. Codeine, dextromethorphan, CP-99,994, SR-48,968, and baclofen had no effect on cough cycle timing (CTtot) or diaphragm amplitude during cough, even at doses that inhibited cough number by 80–90%. Morphine lengthened CTtot and inhibited diaphragm amplitude during cough, but these effects were not dose dependent. Only CP-99,994 altered the eupneic respiratory pattern. Central antitussive drugs primarily suppress cough by inhibition of expiratory motor drive and cough number. CTtot and inspiratory motor drive are relatively insensitive to the effects of these drugs. CTtot can be controlled independently from cough number.
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Morice, Alyn H., Michael M. Kitt, Anthony P. Ford, Andrew M. Tershakovec, Wen-Chi Wu, Kayleigh Brindle, Rachel Thompson, Susannah Thackray-Nocera, and Caroline Wright. "The effect of gefapixant, a P2X3 antagonist, on cough reflex sensitivity: a randomised placebo-controlled study." European Respiratory Journal 54, no. 1 (April 25, 2019): 1900439. http://dx.doi.org/10.1183/13993003.00439-2019.
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We evaluated the effect of gefapixant on cough reflex sensitivity to evoked tussive challenge.In this phase 2, double-blind, two-period study, patients with chronic cough (CC) and healthy volunteers (HV) were randomised to single-dose gefapixant 100 mg or placebo in a crossover fashion. Sequential inhalational challenges with ATP, citric acid, capsaicin and distilled water were performed 1, 3 and 5 h after dosing. Mean concentrations evoking ≥2 coughs (C2) and ≥5 coughs (C5) post dose versus baseline were co-primary endpoints. Objective cough frequency (coughs·h−1) over 24 h and a cough severity visual analogue scale (VAS) were assessed in CC patients. Adverse events were monitored.24 CC patients and 12 HV were randomised (mean age 61 and 38 years, respectively). The cough challenge threshold increased for ATP by 4.7-fold (C2, p≤0.001) and 3.7-fold (C5, p=0.007) for gefapixant versus placebo in CC patients; in HV, C2 and C5 increased 2.4-fold (C2, p=0.113; C5, p=0.003). The distilled water C2 and C5 thresholds increased significantly (p<0.001) by a factor of 1.4 and 1.3, respectively, in CC patients. Gefapixant had no effect on capsaicin or citric acid challenge. Median cough frequency was reduced by 42% and the least squares mean cough severity VAS was 18.0 mm lower for gefapixant versus placebo in CC patients. Dysgeusia was the most frequent adverse event (75% of HV and 67% of CC patients).ATP-evoked cough was significantly inhibited by gefapixant 100 mg, demonstrating peripheral target engagement. Cough count and severity were reduced in CC patients. Distilled water may also evoke cough through a purinergic pathway.
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Fraser, Simon D., Susannah Thackray-Nocera, Marica Shepherd, Rachel Flockton, Caroline Wright, Wayne Sheedy, Kayleigh Brindle, et al. "Azithromycin for sarcoidosis cough: an open-label exploratory clinical trial." ERJ Open Research 6, no. 4 (October 2020): 00534–2020. http://dx.doi.org/10.1183/23120541.00534-2020.
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BackgroundChronic cough is a distressing symptom for many people with pulmonary sarcoidosis. Continuous treatment with a macrolide antibiotic may improve cough. We aimed to assess the potential efficacy of azithromycin in patients with sarcoidosis and self-reported cough.MethodsWe conducted a noncontrolled, open-label clinical trial of azithromycin 250 mg once daily for 3 months in patients with pulmonary sarcoidosis who reported a chronic cough. The primary outcome was number of coughs in 24 h. Secondary outcomes were cough visual analogue scales and quality of life measured using the Leicester Cough Questionnaire and King's Sarcoidosis Questionnaire. Safety outcomes included QTc interval on ECG. Measurements were made at baseline and after 1 and 3 months of treatment.ResultsAll 21 patients were white, median age 57 years, 9 males, 12 females, median 3 years since diagnosis. Five were taking oral corticosteroids and none were taking other immunosuppressants. Twenty patients completed the trial. The median (range) number of coughs in 24 h was 228 (43–1950) at baseline, 122 (20–704) at 1 month, and 81 (16–414) at 3 months (p=0.002, Friedman's test). The median reduction in cough count at 3 months was 49.6%. There were improvements in all patient-reported outcomes. Azithromycin was well tolerated.ConclusionIn a noncontrolled open-label trial in people with sarcoidosis who reported a chronic cough, 3 months of treatment with azithromycin led to improvements in a range of cough metrics. Azithromycin should be tested as a treatment for sarcoidosis cough in a randomised placebo-controlled trial.
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Xu, Xuhai, Ebrahim Nemati, Korosh Vatanparvar, Viswam Nathan, Tousif Ahmed, Md Mahbubur Rahman, Daniel McCaffrey, Jilong Kuang, and Jun Alex Gao. "Listen2Cough." Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies 5, no. 1 (March 19, 2021): 1–22. http://dx.doi.org/10.1145/3448124.
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The prevalence of ubiquitous computing enables new opportunities for lung health monitoring and assessment. In the past few years, there have been extensive studies on cough detection using passively sensed audio signals. However, the generalizability of a cough detection model when applied to external datasets, especially in real-world implementation, is questionable and not explored adequately. Beyond detecting coughs, researchers have looked into how cough sounds can be used in assessing lung health. However, due to the challenges in collecting both cough sounds and lung health condition ground truth, previous studies have been hindered by the limited datasets. In this paper, we propose Listen2Cough to address these gaps. We first build an end-to-end deep learning architecture using public cough sound datasets to detect coughs within raw audio recordings. We employ a pre-trained MobileNet and integrate a number of augmentation techniques to improve the generalizability of our model. Without additional fine-tuning, our model is able to achieve an F1 score of 0.948 when tested against a new clean dataset, and 0.884 on another in-the-wild noisy dataset, leading to an advantage of 5.8% and 8.4% on average over the best baseline model, respectively. Then, to mitigate the issue of limited lung health data, we propose to transform the cough detection task to lung health assessment tasks so that the rich cough data can be leveraged. Our hypothesis is that these tasks extract and utilize similar effective representation from cough sounds. We embed the cough detection model into a multi-instance learning framework with the attention mechanism and further tune the model for lung health assessment tasks. Our final model achieves an F1-score of 0.912 on healthy v.s. unhealthy, 0.870 on obstructive v.s. non-obstructive, and 0.813 on COPD v.s. asthma classification, outperforming the baseline by 10.7%, 6.3%, and 3.7%, respectively. Moreover, the weight value in the attention layer can be used to identify important coughs highly correlated with lung health, which can potentially provide interpretability for expert diagnosis in the future.
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Martinek, Jozef, P. Klco, M. Vrabec, T. Zatko, M. Tatar, and M. Javorka. "Cough Sound Analysis." Acta Medica Martiniana 13, Supplement-1 (March 1, 2013): 15–20. http://dx.doi.org/10.2478/acm-2013-0002.
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Abstract Cough is the most common symptom of many respiratory diseases. Currently, no standardized methods exist for objective monitoring of cough, which could be commercially available and clinically acceptable. Our aim is to develop an algorithm which will be capable, according to the sound events analysis, to perform objective ambulatory and automated monitoring of frequency of cough. Because speech is the most common sound in 24-hour recordings, the first step for developing this algorithm is to distinguish between cough sound and speech. For this purpose we obtained recordings from 20 healthy volunteers. All subjects performed continuous reading of the text from the book with voluntary coughs at the indicated instants. The obtained sounds were analyzed using by linear and non-linear analysis in the time and frequency domain. We used the classification tree for the distinction between cough sound and speech. The median sensitivity was 100% and the median specificity was 95%. In the next step we enlarged the analyzed sound events. Apart from cough sounds and speech the analyzed sounds were induced sneezing, voluntary throat and nasopharynx clearing, voluntary forced ventilation, laughing, voluntary snoring, eructation, nasal blowing and loud swallowing. The sound events were obtained from 32 healthy volunteers and for their analysis and classification we used the same algorithm as in previous study. The median sensitivity was 86% and median specificity was 91%. In the final step, we tested the effectiveness of our developed algorithm for distinction between cough and non-cough sounds produced during normal daily activities in patients suffering from respiratory diseases. Our study group consisted from 9 patients suffering from respiratory diseases. The recording time was 5 hours. The number of coughs counted by our algorithm was compared with manual cough counts done by two skilled co-workers. We have found that the number of cough analyzed by our algorithm and manual counting, as well, were disproportionately different. For that reason we have used another methods for the distinction of cough sound from non-cough sounds. We have compared the classification tree and artificial neural networks. Median sensitivity was increasing from 28% (classification tree) to 82% (artificial neural network), while the median specificity was not changed significantly. We have enlarged our characteristic parameters of the Mel frequency cepstral coefficients, the weighted Euclidean distance and the first and second derivative in time. Likewise the modification of classification algorithm is under our interest
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Keen, Eric M., Emily J. True, Alyssa R. Summers, Everett Clinton Smith, Joe Brew, and Simon Grandjean Lapierre. "High-throughput digital cough recording on a university campus: A SARS-CoV-2-negative curated open database and operational template for acoustic screening of respiratory diseases." DIGITAL HEALTH 8 (January 2022): 205520762210975. http://dx.doi.org/10.1177/20552076221097513.
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Objective Respiratory illnesses have information-rich acoustic biomarkers, such as cough, that can potentially play an important role in screening populations for disease risk. To realize that potential, datasets of paired acoustic-clinical samples are needed for the development and validation of acoustic screening models, and protocols for collecting acoustic samples must be efficient and safe. We collected cough acoustic signatures at a high-throughput SARS-CoV-2 testing site on a college campus. Here, we share logistical details and the dataset of acoustic cough signatures paired with the gold standard in SARS-CoV-2 testing of SARS-CoV-2 genomic sequences using qRT-PCR. Methods Cough recordings were collected in winter-spring 2021 at a rural residential college (Sewanee, TN, USA), where approximately 2000 students were tested for SARS-CoV-2 on a weekly basis. Cough collection was managed by student volunteers using custom software. Results 4302 coughs were recorded from 960 participants over 11 weeks. All coughs were COVID-19 negative. Approximately 30 s were required to check-in a participant and collect their cough. Conclusion The value of acoustic screening tools depends upon our ability to develop and implement them reliably and quickly. For that to happen, high-quality datasets and logistical insights must be collected and shared on an ongoing basis.
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Donnelly, Deirdre, and Mark L. Everard. "‘Dry’ and ‘wet’ cough: how reliable is parental reporting?" BMJ Open Respiratory Research 6, no. 1 (April 2019): e000375. http://dx.doi.org/10.1136/bmjresp-2018-000375.
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IntroductionChronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of ‘wheeze’ is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child’s cough is likely to be accurate.MethodsParents of 48 ‘new’ patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child’s cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video.ResultsIn a quarter of cases, the parents chose a video clip of a ‘dry’ or ‘wet’ cough having given the opposite description. In a further 20% parents chose examples of both ‘dry’ and ‘wet’ coughs despite having used only one descriptor.DiscussionWhile the characteristics of a child’s cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child’s cough with some caution in that one person’s ‘dry’ cough may very well be another person’s ‘wet’ cough.
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Ebihara, Takae, Peijun Gui, Chika Ooyama, Koichi Kozaki, and Satoru Ebihara. "Cough reflex sensitivity and urge-to-cough deterioration in dementia with Lewy bodies." ERJ Open Research 6, no. 1 (January 2020): 00108–2019. http://dx.doi.org/10.1183/23120541.00108-2019.
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Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes.We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer's disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C2) or ≥5 coughs (C5). Subjects were asked to rate the UTC based on the threshold concentrations (Cu) using the modified Borg scale.C2, C5 and Cu were negatively correlated with cognitive function in female participants but not in males (p<0.01). The cough reflex sensitivities expressed as C2 and C5 were significantly higher in the DLB group than in the AD and control groups (p<0.01 adjusted for gender). The UTC threshold expressed as Cu was also significantly higher in the DLB group, while the UTC log–log slope was less responsive in the DLB group than in the other groups.The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB.
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Ikawati, Zullies, Poppy Firzani Arifin, Severinus Nugraha Krisma Sandy, Raphael Aswin Susilowidodo, and Rosalina Wisastra. "Antitussive Activity of Herbal Cough Medicine on Guinea Pigs (Cavia porvellus)." Majalah Obat Tradisional 26, no. 1 (April 7, 2021): 59. http://dx.doi.org/10.22146/mot.56620.
Full textAbstract:
This study aims to investigate the antitussive activity of herbal cough medicine containing combined herbal extracts of Echinacea purpurea, Sambucus nigra (Black Elderberry), Glycyrrhiza glabra (licorice), Vitex trifolia (Indian wild pepper), and Zingiber officinale (ginger). Antitussive assays were conducted on male Dunkin-Hartley albino guinea pigs (Cavia cobaya), which are divided into 5 groups, each with 8 individuals. These 5 groups were assigned for negative control group (treated with CMC-Na 0.5%), a positive control group (treated with Dextromethorphan 20 mg/kg BW), and three groups receiving herbal medicine with 3 different doses (Group I: 145 mg/kg BW, Group II: 290 mg/kg BW; Group III: 580 mg/kg BW, respectively). The antitussive activity was evaluated by using a citric acid-induced cough assay. For baseline level, 20 % m/v liquid citric acid was exposed using a nebulizer for 10 min, then the number of coughs in 15 min was counted. Sixty (60) minutes after oral administration of the tested herbal cough medicine, the number of citric acid-induced coughs was counted again to see the effect of herbal cough medicine to reduce cough. The number of coughs before and after herbal administration was calculated to obtain antitussive activity, represented by the percentage of cough suppression (PCS). Average PCS for each treatment group is then compared to control positive Dextromethorphan 20 mg/kg BW and control negative CMC-Na 0.5%. Data are analyzed by applying the one-way ANOVA method, which is followed by conducting a Tukey’s Test to discover differences between groups at 95% level of confidence. In terms of the percentage of cough suppression (PCS), treatment doses at 145mg/kg BW, 290 mg/kg BW and 580 mg/kg BW result in 58.48% ± 8.60% (Group I); 58.69% ± 7.96% (Group II); 59.21% ± 8.79% (Group III) PCS, respectively, which insignificantly differ to treatment with Dextromethorphan dose (66.99% ± 9.63 with p > 0.05, implicating that the herbal cough medicine has comparable effect with dextromethorphan in the doses used in this study.
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Hammersla, Margaret, Shannon Idzik, Alicia Williams, Veronica Quattrini, Brenda Windemuth, Nancy Culpepper, Elizabeth Galik, Maranda Jackson-Parkin, and Laura W. Koo. "An Innovative Strategy for Teaching Diagnostic Reasoning: Cough, Cough, Cough." Journal for Nurse Practitioners 19, no. 9 (October 2023): 104743. http://dx.doi.org/10.1016/j.nurpra.2023.104743.
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Xiang, Anbo, Yoshiyuki Uchida, Akihiro Nomura, Hiroaki Iijima, Tohru Sakamoto, Yukio Ishii, Yuko Morishima, et al. "Involvement of thromboxane A2 in airway mucous cells in asthma-related cough." Journal of Applied Physiology 92, no. 2 (February 1, 2002): 763–70. http://dx.doi.org/10.1152/jappl.2002.92.2.763.
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The aim of this study was to elucidate the role of thromboxane A2 (TxA2) on asthma-related cough in guinea pigs. Animals were immunosensitized and repeatedly challenged with ovalbumin as an antigen. Coughs were induced by the inhalation of 10−5 M capsaicin solution for 10 min. Thromboxane synthetase (TxS) inhibitor OKY-046 and thromboxane-receptor antagonist AA-2414 significantly inhibited cough responses in repeatedly challenged animals. Inhalation of TxA2 mimic STA-2- potentiated cough responses in normal and immunosensitized animals but not in repeatedly challenged ones. Moreover, STA-2-potentiated coughs were inhibited by administration of neurokinin-receptor antagonist FK-224. In repeatedly challenged animals, concentration of TxB2 in airway lavage fluid, expression of TxS mRNA in tracheal epithelia, and the immunostaining intensity against TxS in mucous cells of the epithelium significantly increased compared with normal and sensitized animals. These results suggest that TxA2 derived from mucous cells potentiated cough responses to capsaicin in allergic airway inflammation.
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Bolser, D. C. "Fictive cough in the cat." Journal of Applied Physiology 71, no. 6 (December 1, 1991): 2325–31. http://dx.doi.org/10.1152/jappl.1991.71.6.2325.
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Experiments were performed to determine whether cough could be elicited in paralyzed cats ventilated on a respiratory cycle-triggered pump. Midcollicular decerebrate cats were paralyzed and artificially ventilated on a phrenic-triggered pump. Phrenic and cranial iliohypogastric nerve efferent activities were recorded. Cough was elicited by electrical stimulation of the superior laryngeal nerve (SLN) or probing the intrathoracic trachea. Fictive coughs induced by electrical stimulation of the SLN or mechanical stimulation of the intrathoracic trachea consisted of large-amplitude bursts in phrenic discharge immediately followed by large bursts in cranial iliohypogastric discharge. During fictive cough, phrenic postinspiratory discharge was reduced relative to control cycles. Codeine (0.03–1 mg/kg iv) decreased both SLN- and probe-induced fictive cough. I conclude that fictive cough can be produced in paralyzed cats ventilated on a phrenic-triggered pump. Furthermore, fictive cough can be produced in the absence of afferent feedback associated with active expiration.
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Galvosas, Mindaugas, Juan C. Gabaldón-Figueira, Eric M. Keen, Virginia Orrillo, Isabel Blavia, Juliane Chaccour, Peter M. Small, et al. "Performance evaluation of the smartphone-based AI cough monitoring app - Hyfe Cough Tracker against solicited respiratory sounds." F1000Research 11 (June 9, 2023): 730. http://dx.doi.org/10.12688/f1000research.122597.2.
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Background: Emerging technologies to remotely monitor patients’ cough show promise for various clinical applications. Currently available cough detection systems all represent a trade-off between convenience and performance. The accuracy of such technologies is highly contingent on the clinical settings in which they are intended to be used. Moreover, establishing gold standards to measure this accuracy is challenging. Objectives: We present the first performance evaluation study of the Hyfe Cough Tracker app, a passive cough monitoring smartphone application. We evaluate performance for cough detection using continuous audio recordings obtained within a controlled environment and cough counting by trained individuals as the gold standard. We propose standard procedures to use multi-observer cough sound annotation from continuous audio recordings as the gold standard for evaluating automated cough detection devices. Methods: This study was embedded in a larger digital acoustic surveillance study (clinicaltrial.gov NCT04762693). Forty-nine participants were included and instructed to produce a diverse series of solicited sounds in 10-minute sessions. Simultaneously, continuous audio recording was performed using a MP3 recorder and two smartphones running Hyfe Cough Tracker app monitored and identified cough events. All continuous audio recordings were independently labeled by three medically-trained researchers. Results: Hyfe Cough Tracker app showed sensitivity of 91% and specificity of 98% with a very high correlation between the cough rate measured by Hyfe and that of human annotators (Pearson correlation of 0.968). A standardized approach to establish an acoustic gold standard for identifying cough sounds with multiple observers is presented. Conclusion: This is the first performance evaluation of a new smartphone-based cough monitoring system. Hyfe Cough Tracker can detect, record and count coughs from solicited cough-like explosive sounds in controlled acoustic environments with very high accuracy. Additional steps are required to validate the system in clinical and community settings.
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Majumder, Samir C., MA Hossain, MR Hasan, AM Mahmud, ASMM Rahman, MM Hiron, and M. Rahman. "Aetiological Approach to Patient with Non- Specific Chronic Cough." TAJ: Journal of Teachers Association 25 (November 28, 2018): 1–7. http://dx.doi.org/10.3329/taj.v25i0.37549.
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Chronic cough is a problem commonly encountered by the practicing physicians. Definitive treatment depends upon identifying the cause of cough4.To develop an appropriate algorithm for diagnosis of non-specific chronic cough a Prospective case-control study was carried out in Asthma Centre,NIDCH, Mohakhali, Dhaka during the period of January,2000 to December,2001. Eighty two patients with history of cough for 3 weeks or more duration were taken in group A.The ages ranged from 11 to 68 years with mean age 35.5 ± 12.0 years. There were 43 males and 39 females. Equal number of subjects having no cough were taken as control (group B).The age of control subjects ranged from 11 to 68 years with mean age 35.6 ± 11.9 years. Diagnosis was made in all patients. PNDS was found in 41(50%), PNDS with cough variant asthma in 19(23.2%),cough variant asthma alone in 10(12.2%),GERD singly in 2(2.4%).In control group, only 5 (6.1%) persons were diagnosed as PNDS who had almost all features of PNDS except cough. In this studuy, PNDS alone and in combination with cough variant asthma were common causes of chronic cough.TAJ 2012; 25: 1-7
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Lin, Kwan-Hwa, Yih-Loong Lai, Huey-Dong Wu, Tyng-Quey Wang, and Yen-Ho Wang. "Cough Threshold in People With Spinal Cord Injuries." Physical Therapy 79, no. 11 (November 1, 1999): 1026–31. http://dx.doi.org/10.1093/ptj/79.11.1026.
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Abstract Background and Purpose. The purpose of this study was to compare the cough threshold between people with and without spinal cord injury (SCI). The effect of smoking on cough threshold was also investigated. Subjects. The participants were 26 people with SCI (15 smokers, 11 nonsmokers) and 18 people without SCI (9 smokers, 9 nonsmokers). Methods. Aerosols of citric acid were delivered with incremental doubling concentration from 62.5 mmol to 2 mol. Cough threshold was defined as the first concentration of citric acid that induced at least 2 coughs, which is associated with large chest excursion and concurrently acoustic response. Results. The mean cough thresholds of smokers and nonsmokers with SCI (209 and 417 mmol, respectively) were lower than those of smokers and nonsmokers without SCI (467 and 1,072 mmol, respectively). The mean citric acid cough thresholds decreased in smokers with and without SCI when compared with nonsmokers with and without SCI. Conclusion and Discussion. The cough sensitivity increased in subjects with SCI, and smoking could also increase the cough sensitivity. Training about the frequency and technique of cough in patients with SCI should be carefully monitored.
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Smith, CA, DL Adamson, NB Choudry, and RW Fuller. "The effect of altering airway tone on the sensitivity of the cough reflex in normal volunteers." European Respiratory Journal 4, no. 9 (October 1, 1991): 1078–79. http://dx.doi.org/10.1183/09031936.93.04091078.
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Cough is frequently the presenting symptom of bronchial asthma, although cough can result from a wide variety of other respiratory disease. Treatment of chronic cough has proved extremely difficult. It has been suggested that treatment with bronchodilators may reduce the symptom of cough. In this study the effect of altering airway tone on the sensitivity of the cough reflex was determined. Twelve normal, healthy volunteers took part. The number of coughs following inhalations of single breaths of doubling concentrations of capsaicin (1.95-500 microM) was recorded before and after doses of salbutamol, methacholine and saline which altered forced expiratory volume in one second (FEV1) by 6.2 +/- 2.6%, -8.8 +/- 3.2% and -0.18 +/- 1.38%, respectively. In a further study the cough response was recorded before and after doses of salbutamol and ipratropium bromide, both of which reduced baseline respiratory resistance and resistance measured after capsaicin. Ipratropium bromide, salbutamol and methacholine, despite having significant effects on airway tone, did not change the sensitivity of capsaicin-induced cough. Thus, if bronchodilator drugs are antitussive in non-asthmatic patients, then this is unlikely to be due to an effect on the sensitivity of the cough reflex.
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Fujimura, M., Y. Kamio, K. Kasahara, T. Bando, T. Hashimoto, and T. Matsuda. "Prostanoids and cough response to capsaicin in asthma and chronic bronchitis." European Respiratory Journal 8, no. 9 (September 1, 1995): 1499–505. http://dx.doi.org/10.1183/09031936.95.08091499.
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Cyclooxygenase products are released by chronic airway inflammation. Our working hypothesis for the present study was that prostanoids augment airway cough sensitivity. The effects of a cyclooxygenase inhibitor, indomethacin (100 mg.day-1 for 4 days), and a thromboxane synthesis inhibitor, OKY-046 (400 mg.day-1 for 4 days), on cough response to inhaled capsaicin were examined in eight patients with asthma, 10 patients with chronic bronchitis, and 10 normal subjects. Capsaicin cough threshold, the lowest concentration of capsaicin eliciting five or more coughs, was measured as an index of airway cough sensitivity. In asthmatics, the cough thresholds with indomethacin treatment (15.7 (GSEM 1.38) microM) and OKY-046 (10.2 (GSEM 1.20) microM) were significantly greater than the value with placebo (6.05 (GSEM 1.25) microM). In patients with chronic bronchitis, the cough threshold was significantly greater with indomethacin (5.94 (GSEM 1.50) microM) than with placebo (3.41 (GSEM 1.33) microM and OKY-046 2.97 (GSEM 1.43) microM). In normal subjects, the capsaicin cough threshold was not altered by indomethacin or OKY-046 treatment. These results support our hypothesis and suggest that thromboxane A2 may be one of the cyclooxygenase products augmenting airway cough sensitivity in asthma, but not in chronic bronchitis.
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Panda, Pratikeswar, and Arpita Sahu. "Formulation and Evaluation of Herbal Cough Syrup." Asian Journal of Pharmaceutical Research and Development 11, no. 2 (April 14, 2023): 28–33. http://dx.doi.org/10.22270/ajprd.v11i2.1234.
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The most common problem suffered by individuals everywhere over many centuries is cough. Coughing is the protective mechanism of the body. Coughs are classified further accordingly which are depending upon factors such as signs and symptoms, duration, type, character, etc. Most commonly used, prepared and popular dosage form to cure cough and cold is syrup. The most preferred dosage form to cure cough is herbal syrup, which is used mostly due to its benefits over synthetic syrups. Medicinal plants are used as primary health care agents, mostly in Asian countries. Ingredients showing expectorant antitussive activity are used. Hereby cough and herbal treatments associated with cough are studied briefly. The herbal cough syrup is studied which is liquid dosage form, it is easy to administer than solid dosage form and is more effective and fast acting in order to cure cough. Method of preparation of cough syrups were discussed. The material and quantity used in preparation were listed. Here honey based three batches were performed having concentration such as 35%, 40%, 45% w/v. the quality of final syrup was evaluated for post formulation studies.
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Frohnhofen, Helmut. "Hustenreflex bei Demenz: Differenzierte Medikamentenstrategie zur Vermeidung von Pneumonien nutzen." Kompass Pneumologie 8, no. 4 (2020): 208–9. http://dx.doi.org/10.1159/000509166.
Full textAbstract:
Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes. We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer’s disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C2) or ≥5 coughs (C5). Subjects were asked to rate the UTC based on the threshold concentrations (Cu) using the modified Borg scale. C2, C5 and Cu were negatively correlated with cognitive function in female participants but not in males (p < 0.01). The cough reflex sensitivities expressed as C2 and C5 were significantly higher in the DLB group than in the AD and control groups (p < 0.01 adjusted for gender). The UTC threshold expressed as Cu was also significantly higher in the DLB group, while the UTC log-log slope was less responsive in the DLB group than in the other groups. The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB.
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Mazzone, Stuart B. "Neurobiology of Coughing in Children." Journal of Clinical Medicine 12, no. 23 (November 24, 2023): 7285. http://dx.doi.org/10.3390/jcm12237285.
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A cough is one of several defensive responses that protect and clear the airways of inhaled, aspirated or locally produced chemicals and matter. The neural components needed to initiate a cough begin to develop in utero, and at birth the airways and lungs already have a rich supply of sensory and motor-neural innervation. However, a cough is not always the primary defensive response to airway challenge in very young infants, but instead develops in the first postnatal months and matures further into puberty. Consequently, the clinical presentation of a troublesome cough in children may not be the same as in adults, exemplified by important differences in cough sensitivity and hypersensitivity between children and adults. This review will summarise key anatomical and functional concepts in airway neurobiology that may improve understanding of coughs in children.
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Fowles, Helen Elizabeth, Tim Rowland, Caroline Wright, and Alyn Morice. "Tussive challenge with ATP and AMP: does it reveal cough hypersensitivity?" European Respiratory Journal 49, no. 2 (February 2017): 1601452. http://dx.doi.org/10.1183/13993003.01452-2016.
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Recent studies have demonstrated that blockade of P2X3 ATP receptors can profoundly inhibit chronic cough. We have considered whether inhaled ATP produces a tussive response and whether chronic cough patients are hypersensitive to inhaled ATP compared to healthy volunteers.A standardised inhalational cough challenge was performed with ATP and AMP. We randomised 20 healthy volunteers and 20 chronic cough patients as to the order of challenges. The concentration of challenge solution causing at least five coughs (C5) was compared for ATP and AMP.The study population consisted of six male and 14 female volunteers in each group. Two out of 19 healthy volunteers coughed with AMP (one volunteer could not take part in this challenge) and none reached C5. Eight out of 20 chronic cough patients coughed with AMP and two reached C5. Of the 20 healthy volunteers, 18 coughed with ATP, with 15 reaching C5. All 19 chronic cough patients completing the ATP challenge coughed with ATP and 18 reached C5. The chronic cough patients had a greater cough response at lower concentrations of ATP.The greater potency of ATP versus AMP in the inhalational challenge suggests that tussive responses are mediated through members of the P2X purinergic receptor family. This acute effect was, however, not sufficient to explain cough hypersensitivity syndrome.