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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Cough is an important airway defence mechanism mediated by a neuro-immune interaction. A dysregulation of either or both of the airway immune or nervous system could lead to an altered (frequently increased) cough reflex sensitivity and increased coughing. Up to 10% of patients presenting to secondary care in the United Kingdom do so because of a cough lasting more than 8 weeks (chronic cough) and 75% of us will, at some time in our life, present to primary because of a prolonged cough. Chronic cough is particularly prevalent in middle-aged females. Cough associated with corticosteroid responsive type-2 airway inflammation is present in only 12% of patients, and when present, is often associated with normal airway responsiveness (eosinophilic bronchitis). Despite this, many patients are treated with inhalers on the assumption that they have cough variant asthma or eosinophilic bronchitis.
The spectrum of voice disorders – classification
Published in Stephanie Martin, Working with Voice Disorders, 2020
The pathophysiology of chronic cough includes cough reflex sensitivity, central sensitisation, peripheral sensitisation and VCD with, it is suggested, 8–10% of the adult population experiencing chronic cough (Song et al., 2015). This is not to be confused with a persistent dry cough that can be the side effect of prescription drugs from the ACE inhibitor family, used to mitigate high blood pressure, for example, Ramipril or perindopril.
Disorders of the respiratory system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
The inner lining of the trachea is a cilia-lined mucus membrane which wafts mucus and particles upwards. Nerve endings in the larynx, trachea and bronchi are sensitive to irritation. A cough reflex is generated via the vagus nerve to expel mucus and/or foreign material from the mouth. Bronchioles are made up of smooth muscle. This makes them responsive to autonomic nerve stimulation. The diameter of the air passages is therefore altered by the contraction or relaxation of these involuntary muscles. Asthma is a condition whereby a range of factors cause inflammation, narrowing of the airways, and contraction of the smooth muscle of the airway walls (broncho-spasm). Gastro-oesophageal reflux can trigger asthma in the third trimester.
Premedication with Oral Midazolam Suppress Fentanyl- Induced Cough in Children: A Randomized Double-Blind Trial
Published in Egyptian Journal of Anaesthesia, 2023
Mohamed said mostafa elmeligy, Neveen A. Kohaf, Reda K. Abdelrahman
FIC is commonly caused by fentanyl during the induction of general anesthesia, especially in pediatrics [14]. Fentanyl was classified as a cough-suppressant medicine due to its antagonistic effect on the mu receptor in the lung’s periphery and inhibition of the cough center in the medulla oblongata’s central region [15]. However, paradoxically, it commonly induces coughing shortly after its administration [3]. FIC’s precise mechanisms have not been exactly elucidated. However, there are several suggested mechanisms, including pulmonary chemoreflex: FIC may be regulated by irritant receptors or vagal C-fiber receptors (juxta-capillary receptors). These receptors may trigger a cough reflex when stimulated [16]. Also, fentanyl-induced constriction of the tracheal smooth muscle leads to triggering of pulmonary mucosal irritant receptors and cough induction [3]. Also, fentanyl may cause the production of histamine by the mast cells in the lungs, which can induce cough [17]. In addition, muscle rigidity generated by fentanyl can cause abrupt adduction of the vocal cords or supraglottic blockage by soft tissue, resulting in cough [18].
An update on current and emerging drug treatments for idiopathic pulmonary fibrosis
Published in Expert Opinion on Pharmacotherapy, 2023
Athina Trachalaki, Nadiya Sultana, Athol Umfrey Wells
Cough is one of the main IPF symptoms, present in more than 80% of the patients. The pathophysiology and mechanism of cough in IPF is complex and poorly understood. Treatment includes reducing the cough reflex, addressing underlying scarring with antifibrotics and management of comorbidities that can influence cough, such as GERD [57]. Cough reflex therapies, such as gabapentin, slow-release morphine sulfate and amitriptyline have been shown to improve chronic cough of idiopathic etiology [58,59]. Apart from pharmacological interventions, speech and language therapy might be promising for cough reduction. A meta-analysis of a small number of studies showed that speech and language therapy can improve quality of life and reduce 24-hour cough frequency, however the results were short‐lived, lasting up to four weeks [60].
Emerging drugs in the treatment of chronic cough
Published in Expert Opinion on Emerging Drugs, 2023
Danica Brister, Mustafaa Wahab, Moaaz Rashad, Nermin Diab, Martin Kolb, Imran Satia
The involuntary cough reflex is designed to protect against aspiration of food, foreign bodies and prevent the inhalation of noxious gases. It can be triggered by stimulation of peripheral receptors of vagal nerve fibers innervating the larynx, upper and lower airways. There are at least two known subtypes of vagal nerve afferents involved in the cough reflex response; myelinated A fibers which originate in the nodose ganglion, and the slower, unmyelinated C-fibers of the jugular ganglion (Figure 1) [50,51]. A fibers are predominantly mechanosensitive, whilst C-fibers are activated by chemical and temperature triggers and will respond to flavors and fragrances such as capsaicin, garlic, cinnamaldehyde, and methanol [51–53]. Multiple receptor subtypes have been identified on these afferent fibers, including ligand gated ion channels (LGIC), and G protein coupled receptors. LGIC include transient receptor protein (TRP) vanilloid 1 (TRPV1), TRP ankyrin 1 (TRPA1), and TRP melastin 8 (TRPM8) can be found on both alpha-delta and c-fibers [50,52]. Purinergic receptors, such as P2×3, are activated by extracellular ATP release in response to cellular injury and within the upper airway are expressed on C-fibers of the jugular ganglion [10]. Patients with RCC/UCC demonstrate a heightened response to capsaicin inhalation compared to healthy controls, which may be mediated by more peripheral receptors, the or the sensitization of peripheral nerves [10].