Cough Response to High-Dose Inhaled Corticosteroids in Patients with Chronic Cough and Fractional Exhaled Nitric Oxide Levels ≥ 25 ppb: A Prospective Study

Lung, Journal Year: 2024, Volume and Issue: 202(3), P. 275 - 280

Published: May 11, 2024

Language: Английский

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Cough Reflex Hypersensitivity as a Key Treatable Trait

The Journal of Allergy and Clinical Immunology In Practice, Journal Year: 2024, Volume and Issue: 13(3), P. 469 - 478

Published: Nov. 16, 2024

Language: Английский

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Chronic cough: New guidelines, new approaches and new treatments

Respirology, Journal Year: 2024, Volume and Issue: 29(5), P. 366 - 368

Published: Feb. 27, 2024

The end of 2023 brought with it updated national clinical statements on the management chronic cough from both Australia and United Kingdom.1, 2 Both were long in coming, being published 13 17 years since their predecessor documents, respectively. Much has changed intervening time understanding cough, necessitating informing statement updates. Chronic adults (lasting ≥8 weeks) is a common reason for visiting respiratory physician, due not least to associated significant detriment quality life.3 'causes' such coughs however are immediately obvious; medical assessment prior that point should have included simple questioning, examination, chest radiograph rule out acute infection, ACE inhibitor usage, classical presentations asthma, gastroesophageal reflux other contributory factors. Investigations then include spirometry help exclude airways disease, full blood count fractional exhaled nitric oxide specifically eosinophilic airway possibly computed tomography (according 'red flags' risks cancer lung disease).1, Beyond this, rapidly diminishing returns encountered further tests. There may be multiple consultations treatment trials, many futile.4 everyday practice remains heavily influenced by an anatomic protocol, attractive theory now >40 old which posits majority persistent reaching specialist can explained managed as either disease (GORD) or rhinosinusitis.5 This partly explains frequent ongoing use investigations oesophageal manometry sinus imaging investigate absence features GORD respectively.4 With passage time, establishment clinics, accumulation outcome data through specific measurement tools advances basic science preclinical studies, increasingly apparent model inadequate.2 Asthma conditions. certainly aggravate but far universal, only minority diagnosis present sole symptom.6 Furthermore, empirical rhinosinusitis isolated little those conditions probably no effect than acting placebo.7 An alternative paradigm been proposed gained ground publication previous versions guidelines. Influenced long-established literature pain, condition sharing latter considered neuroinflammatory neuropathic disorder.8 substrate crux hypersensitivity neural circuity. On this basis, cases best entity its own right. Hitherto putative asthma GORD, better aggravating factors 'treatable traits' underlying process hypersensitivity.2 newer supported observational experimental evidence, including pathological samples; increased density sensory nerve fibres bronchial specimens patients cough.9 Clinical questionnaires documented consistent patient descriptions triggers sensations cough,10 measured responses inhaled tussogenic compounds reflex testing observed.11 Finally, functional magnetic resonance demonstrated changes cortical centres promote fail supress coughing.12, A very similar phenomenon refractory unexplained also CANVAS (cerebellar ataxia neuropathy vestibular areflexia syndrome), inherited neurological disorder underpinned repeat expansion sequences gene RFC1, giving support neuropathic, although incompletely understood, basis general.14 Developments subsequently focused more controlling exaggerated response previously. Morphine, gabapentin, pregabalin repurposed drugs randomized controlled trial evidence treatments likely higher within nervous control coughing.2 Most promising though pipeline novel medications at various stages development, culminating new era trials antitussive agents.15 These largely target peripheral receptors number under investigation, whose influence fully appreciated recent years. furthest along P2X3 inhibitors, adenosine triphosphate-mediated pathway reductions frequency cough.16 Gefapixant licensed Japan, Switzerland European Union. Non-pharmacological approaches treating fruitful, again approaching merit, employing behavioural techniques improve dysfunctional physiological pathways contributing hypersensitivity, delivered speech therapist physiotherapist.17 Excluding serious causes might enough provide reassurance seeking advice cough. experiencing negative impacts secondary aggravants judiciously tailored according context. will save resources, reduce harms wider tests bronchoscopy gastrointestinal studies without risk, involve disparate disconnected specialists clinics. 'empirical' reflux, pointing presence avoided, doing so strengthened frustration clinician who traditionally had else offer patient. Rather, targeted treatable traits (which smoking, obesity obstructive sleep apnoea) when they evident, earlier recognition needed.2 guidelines hopefully come improvements systematic holistic approach interest outcomes patients, often suffer wide-ranging and, until now, neglected problem. Open access publishing facilitated Griffith University, part Wiley - University agreement via Council Australian Librarians. Stuart Mazzone author position Australia; Surinder Birring British Thoracic Society Statement No disclosures made.

Language: Английский

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Decoding the Impact of the Placebo Response in Clinical Trials for Chronic Cough

ERJ Open Research, Journal Year: 2024, Volume and Issue: 10(5), P. 00335 - 2024

Published: June 27, 2024

Chronic cough is a prevalent and challenging condition, with limited treatment options available. The interpretation of clinical trial results for antitussive drugs complicated by the presence placebo response, which can confound outcomes impede regulatory approval. This review aims to explore impact response on trials medications elucidate underlying mechanisms involved. multifaceted nature effects, including pharmacological, psychological/neurobiological nonspecific discussed. Additionally, potential solutions address in future medication development, such as strategic study design, appropriate choice end-points meticulous patient selection, are proposed. More progress harness this issue urgently needed.

Language: Английский

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Clinical outcomes of persistent cough following coronavirus disease 2019 infection: a 1-year retrospective cohort study

Asia Pacific Allergy, Journal Year: 2025, Volume and Issue: unknown

Published: March 20, 2025

Background: Cough is one of the multiple prolonged symptoms observed in patients who had coronavirus disease 2019 (COVID-19) infection. Objective: We assessed clinical outcomes and identified factors contributing to cough persistence post-COVID-19. Methods: This retrospective cohort study included adults visited a specialist clinic between 2022 2023. All participants underwent systematic investigation treatment for persistent cough. was at 2- 12-month follow-ups. Participants were classified as having if they current troublesome follow-ups, severity visual analog scale (VAS) score change below 30. Results: Sixty-six (mean age 48.7 years; 72.7% women) analyzed divided into 2 groups: (33.3%) remitted (66.7%). The group significantly higher prevalence abnormal laryngeal sensation, sputum production, breathing difficulty, airway eosinophilia; their VAS changes months also lower. Multivariate analyses indicated associations 1 year such eosinophilia (adjusted odds ratio [aOR], 6.78), sensation (aOR, 6.42), low reduction 1.05). Conclusion: Persistent remained significant issue one-third after COVID-19. features commonly chronic present those have experienced COVID-19, which contributed These findings underscore need assessment tailored strategies effectively manage

Language: Английский

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Gefapixant en tos crónica

Panorama actual del medicamento, Journal Year: 2025, Volume and Issue: 49(481), P. 192 - 201

Published: March 25, 2025

Gefapixant es un antagonista selectivo de los receptores purínicos del subtipo P2X3, que son canales iónicos Ca2+ regulados por ATP expresados en las fibras C sensitivas nervio vago vías respiratorias. La unión extracelular –liberado células la mucosa respiratoria condiciones inflamación– a P2X3 se detecta como una señal daño parte C, activan respuesta inflamación o irritantes químicos, y median sensación necesidad toser para el paciente, inicia reflejo tos. Por tanto, bloqueo ejerce gefapixant sobre activadora reduce sobreactivación nervios sensitivos consecuente tos excesiva. Con base ese mecanismo, medicamento ha sido autorizado tratamiento crónica refractaria idiopática. primer fármaco específicamente aprobado esta indicación, con mecanismo acción inaugura vía terapéutica abordaje (first in class), carácter no narcótico periférica. A pesar su modesta eficacia, cuenta potencial beneficiar varios miles pacientes España, buena tolerabilidad (perfil eventos adversos más manejable otras alternativas) conveniente pauta administración puede permitir adherencia al tratamiento.

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Endobronchial Hamartomas as a rare cause of Chronic Cough

Respiratory Medicine Case Reports, Journal Year: 2025, Volume and Issue: unknown, P. 102210 - 102210

Published: April 1, 2025

Language: Английский

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Value-based outcome measures in cough

Expert Review of Respiratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 25, 2025

Language: Английский

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Laryngeal Hypersensitivity From the Perspective of Pain Science: An Integrative Review of Empirical Studies on Associated Factors and Processes

Journal of Voice, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Laryngeal hypersensitivity (LHS) is a state of heightened sensorimotor response to stimuli in the upper airway. Although its clinical picture becoming progressively clearer with recent research progress, specificities about associated factors and processes remain be clarified. The aim this integrative review was synthesize published empirical data from human studies on LHS, focusing related pathophysiology. Integrative literature; Pubmed, EMBASE, Web Science. Keywords following three main concepts were used query databases: (1) manifestations potentially an irritable larynx (dysphonia, inducible laryngeal obstruction (ILO), chronic cough, globus); (2) hypersensitivity; (3) Peer-reviewed English providing original pathophysiology LHS included, no restriction based study design. In total, 54 papers met inclusion criteria. Factors identified, namely psychological lifestyle factors, airway inflammation injuries exogenous/endogenous irritants, infections, or mucosal atrophy, sex hormones, (4) metabolic abnormalities, (5) aberrant respiratory behavior. Given parallels between pain-related mechanisms suggested mechanisms, identified as putatively contributing categorized light current pain literature. Findings suggest that may stem peripheral tissue insult, neuropathic and/or maladaptive neuroplasticity. Gaps literature part driven by uneven repartition across various alleged LHS. fact, large majority pertained very few addressing muscle tension dysphonia, ILO, globus. Future can focus potential role such dysphonia development guidelines identify specific underlying at play symptoms.

Language: Английский

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Unmet needs and future directions of treatment options for chronic cough

Expert Review of Respiratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 28, 2025

Chronic cough is a persistent condition that significantly affects patients' quality of life and poses diagnostic therapeutic challenges. Traditional anatomical approaches often fail to address the underlying mechanisms, leading suboptimal treatment outcomes. This review aims summarize challenges management chronic highlights recent advances several promising drug candidates in trials. PUBMED/CINAHL/Web Science/Scopus were searched (February 2025). Over past 40 years, has evolved from mere symptom recognized disease. A key observation hypersensitivity afferent vagus its central projections cause state urge being precipitated by otherwise innocuous stimuli. Clinical trial designs have also advanced, incorporating placebo run-in periods reduce effects refining patient-reported outcomes modern standards. Additionally, realization variability cough, both diurnal day-to-day, highlighted need for continuous monitoring, which only recently been available consequence revolution electronic applications. However, progress hindered widespread lack awareness among healthcare professionals patients, underscoring urgent education on this condition.

Language: Английский

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