http://www.coughjournal.com The most accessed research articles published by Cough 2012-01-23T00:00:00Z Worldwide paediatricians advocate that children should be managed differently from adults. In this article, similarities and differences between children and adults related to cough are presented. Physiologically, the cough pathway is closely linked to the control of breathing (the central respiratory pattern generator). As respiratory control and associated reflexes undergo a maturation process, it is expected that the cough would likewise undergo developmental stages as well. Clinically, the 'big three' causes of chronic cough in adults (asthma, post-nasal drip and gastroesophageal reflux) are far less common causes of chronic cough in children. This has been repeatedly shown by different groups in both clinical and epidemiological studies. Therapeutically, some medications used empirically for cough in adults have little role in paediatrics. For example, anti-histamines (in particular H1 antagonists) recommended as a front-line empirical treatment of chronic cough in adults have no effect in paediatric cough. Instead it is associated with adverse reactions and toxicity. Similarly, codeine and its derivatives used widely for cough in adults are not efficacious in children and are contraindicated in young children. Corticosteroids, the other front-line empirical therapy recommended for adults, are also minimally (if at all) efficacious for treating non-specific cough in children. In summary, current data support that management guidelines for paediatric cough should be different to those in adults as the aetiological factors and treatment in children significantly differ to those in adults. http://www.coughjournal.com/content/1/1/7 Anne Chang Cough 2005, null:7 2005-09-20T00:00:00Z doi:10.1186/1745-9974-1-7 /content/figures/1745-9974-1-7-toc.gif Cough 1745-9974 ${item.volume} 7 2005-09-20T00:00:00Z XML Cough is one of the most common symptoms for which patients seek medical attention from primary care physicians and pulmonologists. Cough is an important defensive reflex that enhances the clearance of secretions and particles from the airways and protects the lower airways from the aspiration of foreign materials. Therapeutic suppression of cough may be either disease-specific or symptom related. The potential benefits of an early treatment of cough could include the prevention of the vicious cycle of cough. There has been a long tradition in acute cough, which is frequently due to upper respiratory tract infections, to use symptom-related anti-tussives. Suppression of cough (during chronic cough) may be achieved by disease-specific therapies, but in many patients it is often necessary to use symptomatic anti-tussives, too. According to the current guidelines of the American College of Chest Physician on "Cough Suppressants and Pharmacologic Protussive Therapy" and additional clinical trials on the most frequent anti-tussive drugs, it should be possible to diagnose and treat cough successfully in a majority of cases. Among drugs used for the symptomatic treatment of cough, peripherally acting anti-tussives such as levodropropizine and moguisteine show the highest level of benefit and should be recommended especially in children. By improving our understanding of the specific effects of these anti-tussive agents, the therapeutic use of these drugs may be refined. The present review provides a summary of the most clinically relevant anti-tussive drugs in addition to their potential mechanism of action. http://www.coughjournal.com/content/7/1/7 Francesco De Blasio Johann Virchow Mario Polverino Alessandro Zanasi Panagiotis Behrakis Gunsely Kilinc Rossella Balsamo Gianluca De Danieli Luigi Lanata Cough 2011, null:7 2011-10-10T00:00:00Z doi:10.1186/1745-9974-7-7 /content/figures/1745-9974-7-7-toc.gif Cough 1745-9974 ${item.volume} 7 2011-10-10T00:00:00Z XML Background: Acute cough is one of the most common complaints prompting patient visits to healthcare professionals. Despite the broad repercussions of acute cough on patient quality of life, school and work productivity, and public health resources, research on this condition is minimal, as are the available treatment options. Many patients use over-the-counter medicines, which are often ineffective for symptom relief. Some therapies may achieve antitussive activity, but at the expense of unpleasant or intolerable side effects.Unmet needsWhen considering the treatments currently available for the management of acute cough, the multiple limitations of such treatments are quite apparent. Most of these treatments lack clinically proven efficacy and reliability to support their use. This reinforces the need for the generation of quality scientific data from well-performed clinical trials. Hopefully, the result will be the development of safer, more effective and more reliable therapeutic options in the management of acute cough.Cough assessment and managementAcute cough can be due to a variety of causes, and it is worthwhile to consider these pathogenic factors in some detail. It is also important to be familiar with the effects that acute cough has on patients' quality of life, work productivity, and the healthcare system; proper awareness of these effects may contribute to better understanding of the social impact of cough. In reference to the available treatments for the management of acute cough, adequate knowledge of the type of over-the-counter and prescription products in the market, as well as their mode of action and advantages/disadvantages, may provide expanded pharmacotherapeutic opportunities and facilitate better clinical decisions. However, due to the drawbacks of current treatment options, ideas for future cough management and newer products need to be considered and tested. Conclusion: In view of the socio-economic impact of acute cough and the limitations of available treatments, a renewed interest in the management of acute cough needs to be encouraged. The current strategies for acute cough management need to be reassessed, with a focus on developing new, reliable products and formulations with proven efficacy and safety. http://www.coughjournal.com/content/5/1/11 Peter Dicpinigaitis Gene Colice Mary Jo Goolsby Gary Rogg Sheldon Spector Birgit Winther Cough 2009, null:11 2009-12-16T00:00:00Z doi:10.1186/1745-9974-5-11 /content/figures/1745-9974-5-11-toc.gif Cough 1745-9974 ${item.volume} 11 2009-12-16T00:00:00Z XML Chronic cough is a common reason for presentation to both general practice and respiratory clinics. In up to 25% of cases, the cause remains unclear after extensive investigations. We report 4 patients presenting with an isolated chronic cough who were subsequently found to have obstructive sleep apnoea. The cough improved rapidly with nocturnal continuous positive airway pressure therapy. Further studies are required to investigate the prevalence of coexistence of these common conditions. http://www.coughjournal.com/content/3/1/7 Surinder Birring Alvin Ing Kevin Chan Gavina Cossa Sergio Matos Michael Morgan Ian Pavord Cough 2007, null:7 2007-07-02T00:00:00Z doi:10.1186/1745-9974-3-7 /content/figures/1745-9974-3-7-toc.gif Cough 1745-9974 ${item.volume} 7 2007-07-02T00:00:00Z XML Narcotic antitussives such as codeine reveal the antitussive effect primarily via the μ-opioid receptor in the central nervous system (CNS). The κ-opioid receptor also seems to contribute partly to the production of the antitussive effect of the drugs. There is controversy as to whether δ-receptors are involved in promoting an antitussive effect. Peripheral opioid receptors seem to have certain limited roles. Although narcotic antitussives are the most potent antitussives at present, certain types of coughs, such as chronic cough, are particularly difficult to suppress even with codeine. In guinea pigs, coughs elicited by mechanical stimulation of the bifurcation of the trachea were not able to be suppressed by codeine. In gupigs with sub-acute bronchitis caused by SO2 gas exposure, coughing is difficult to inhibit with centrally acting antitussives such as codeine. Some studies suggest that neurokinins are involved in the development of codeine-resistant coughs. However, evidence supporting this claim is still insufficient. It is very important to characterize opiate-resistant coughs in experimental animals, and to determine which experimentally induced coughs correspond to which types of cough in humans. In this review, we describe the mechanisms of antitussive effects of narcotic antitussives, addressing codeine-sensitive and -resistant coughs, and including our own results. http://www.coughjournal.com/content/3/1/8 Kazuo Takahama Tetsuya Shirasaki Cough 2007, null:8 2007-07-09T00:00:00Z doi:10.1186/1745-9974-3-8 /content/figures/1745-9974-3-8-toc.gif Cough 1745-9974 ${item.volume} 8 2007-07-09T00:00:00Z XML Background: Cough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice. Methods: Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions. Results: A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches. Conclusion: The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations. http://www.coughjournal.com/content/6/1/9 Alex Molassiotis Jaclyn Smith Mike Bennett Fiona Blackhall David Taylor Burhan Zavery Amelie Harle Richard Booton Elaine Rankin Mari Lloyd-Williams Alyn Morice Cough 2010, null:9 2010-10-06T00:00:00Z doi:10.1186/1745-9974-6-9 /content/figures/1745-9974-6-9-toc.gif Cough 1745-9974 ${item.volume} 9 2010-10-06T00:00:00Z XML Background: Little is known regarding mechanistic and phenotypic differences between cough variant asthma (CVA), presenting with a chronic cough as the sole symptom that responds to bronchodilators, and classic asthma with wheezing during methacholine inhalation. Here we reported airway sensitivity, airway reactivity, and as the main concern, the appearance of cough and wheezes during methacholine inhalation in patients with CVA or classic asthma. Methods: We cross-sectionally examined the degrees of airway sensitivity, the point where resistance started to increase, and reactivity, the slope of the methacholine-resistance curve, and the appearance of cough and wheezes in steroid-naïve adult patients with classic asthma (n = 58) or CVA (n = 55) while they were continuously inhaling methacholine during simultaneous measurement of respiratory resistance. Results: Patients with CVA were less sensitive and less reactive to inhaled methacholine and wheezed less frequently but coughed more frequently during methacholine-induced bronchoconstriction than did patients with classic asthma. Multivariate analysis revealed that airway hypersensitivity and lower baseline FEV1/FVC were associated with the appearance of wheezes, whereas a diagnosis of CVA was associated with coughing. Conclusion: There are mechanistic and phenotypic differences between CVA and classic asthma during methacholine inhalation. Frequent coughing during bronchoconstriction may be a distinctive feature of CVA. http://www.coughjournal.com/content/5/1/3 Hisako Matsumoto Akio Niimi Masaya Takemura Tetsuya Ueda Masafumi Yamaguchi Hirofumi Matsuoka Makiko Jinnai Kazuo Chin Michiaki Mishima Cough 2009, null:3 2009-03-09T00:00:00Z doi:10.1186/1745-9974-5-3 /content/figures/1745-9974-5-3-toc.gif Cough 1745-9974 ${item.volume} 3 2009-03-09T00:00:00Z XML Background: Cough is one of the most frequent symptoms in children and is the most common symptom for which children visit a health care provider. Methods: This is an observational study on acute cough associated with upper respiratory tract infection (URTI) in children. The study evaluates the epidemiology and impact of cough on quality of sleep and children's activities, and the outcome of cough with antitussive treatments in pediatric routine clinical practice. Study assessments were performed through a pediatric cough questionnaire (PCQ), developed by the Italian Society of Cough Study. A total of 433 children visited by family care pediatricians for acute cough due to an URTI were enrolled in this study, with mean age of 6.1 years (SD 3.6). Cough type, duration, severity and frequency, cough impact on sleep disturbances of children and parents and on school and sport activities were assessed at baseline. In a subset of 241 children who were either treated with antitussive drugs (levodropropizine n=101, central antitussives n=60) or received no treatment (n=80), the outcome of cough after 6 days was analyzed in terms of resolution, improvement, no change, or worsening. Descriptive analysis, chi sq, and multivariate analysis with stepwise logistic regression were performed. Results: Cough disturbed sleep in 88% of children and 72% of parents. In children treated with cough suppressants, the duration, type, intensity, and frequency cough were similar at baseline in the two groups respectively treated with levodropropizine and central antitussives (cloperastine and codeine). Both levodropropizine and central drugs reduced cough intensity and frequency. However, percentage of cough resolution was higher with levodropropizine than with central antitussives (47% vs. 28% respectively, p=0.0012). Conclusions: Acute cough disturbs sleep in most children and their parents. Both levodropropizine and central antitussives reduced cough intensity, with levodropropizine producing a higher cough resolution rate. http://www.coughjournal.com/content/8/1/1 Francesco De Blasio Peter V. Dicpinigaitis Bruce K. Rubin Gianluca De Danieli Luigi Lanata Alessandro Zanasi Cough 2012, null:1 2012-01-23T00:00:00Z doi:10.1186/1745-9974-8-1 /content/figures/1745-9974-8-1-toc.gif Cough 1745-9974 ${item.volume} 1 2012-01-23T00:00:00Z PDF Background: In order to assess severity of cough from patients' perspectives and capture the effects of treatment in clinical trials, a measurement tool must show evidence of validity and reliability. The purpose of this study was to characterize cough severity from patients' perspectives as the initial step in the development of a new patient-reported outcome (PRO) measure for use in clinical trials. Methods: This focus groups study included patients with clinician confirmed chronic cough recruited from a large internal medicine clinic in the US. A semi-structured focus group guide was designed to elicit information about patients' experiences with cough severity and their characterization of symptoms. The focus group data were coded to identify concepts and terminology of cough severity. Results: Three focus groups were conducted [n = 22; 6 male; mean age 66.1 (± 12.9)]. Etiology included GERD, asthma, bronchitis, post-nasal drip, and other. Three domains of cough severity were identified: frequency, intensity, and disruption. In addition to a single cough, participants in all focus groups described coughing in uncontrollable paroxysms they called "fits," "bouts," "spells," or "episodes." The urge to cough, described as an important sign of impending cough, was considered a component of cough frequency. Participants also described daytime activity and nighttime sleep disruption as an indication of cough severity. Finally, participants described variability in cough severity. Conclusion: Results suggest that patients describe cough severity in terms of frequency, intensity, and disruptiveness, indicating these 3 domains should be addressed when evaluating cough severity and outcomes of treatment. http://www.coughjournal.com/content/5/1/5 Margaret Vernon Nancy Kline Leidy Alise Nacson Linda Nelsen Cough 2009, null:5 2009-03-19T00:00:00Z doi:10.1186/1745-9974-5-5 /content/figures/1745-9974-5-5-toc.gif Cough 1745-9974 ${item.volume} 5 2009-03-19T00:00:00Z XML The cough reflex represents a primary defensive mechanism for airway protection in a variety of mammalian species. However, excessive and inappropriate coughing can emerge as a primary presenting symptom of many airway diseases. Cough disorders are characterized by a reduction in the threshold for reflex initiation and, as a consequence, the occurrence of cough in response to stimuli that are normally innocuous in nature. The current therapeutic strategies for the treatment of cough disorders are only moderately effective. This undoubtedly relates in part to limitations in our understanding of the neural components comprising the cough reflex pathway. The aim of this review is to provide an overview of current concepts relating to the sensory innervation to the mammalian airways, focusing particularly on the sensory receptors that regulate cough. In addition, the review will highlight particular areas and issues relating to cough neurobiology that are creating controversy in the field. http://www.coughjournal.com/content/1/1/2 Stuart Mazzone Cough 2005, null:2 2005-08-04T00:00:00Z doi:10.1186/1745-9974-1-2 /content/figures/1745-9974-1-2-toc.gif Cough 1745-9974 ${item.volume} 2 2005-08-04T00:00:00Z XML