scholarly journals Upper Airway Cough Syndrome in Pathogenesis of Chronic Cough

2020 ◽  
pp. S35-S42
Author(s):  
M. Lucanska ◽  
A. Hajtman ◽  
V. Calkovsky ◽  
P. Kunc ◽  
R. Pecova
Keyword(s):  
Chronic Cough ◽  
Sensory Nerve ◽  
Upper Airway ◽  
Vagal Afferents ◽  
Upper Airways ◽  
Cough Reflex ◽  
Postnasal Drip ◽  
Common Causes ◽  
Lower Airways ◽  
Human Airways

Cough is one of the most important defensive reflexes. However, extensive non- productive cough is a harmful mechanism leading to the damage of human airways. Cough is initiated by activation of vagal afferents in the airways. The site of their convergence is particularly the nucleus of the solitary tract (nTS). The second-order neurons terminate in the pons, medulla and spinal cord and there is also the cortical and subcortical control of coughing. Upper airway cough syndrome (UACS) – previously postnasal drip syndrome - is one of the most common causes of chronic cough together with asthma and gastroesophageal reflux. The main mechanisms leading to cough in patients with nasal and sinus diseases are postnasal drip, direct irritation of nasal mucosa, inflammation in the lower airways, upper airway inflammation and the cough reflex sensitization. The cough demonstrated by UACS patients is probably due to hypersensitivity of the upper airways sensory nerve or lower airways sensory nerve, or a combination of both. Further studies are needed to clarify this mechanism.

Chronic cough in children

2021 ◽  
pp. 175573802110033
Author(s):  
Katie Scott
Keyword(s):  
Chronic Cough ◽  
Upper Airway ◽  
Oesophageal Reflux ◽  
British Thoracic Society ◽  
Cough Reflex ◽  
Anatomy And Physiology ◽  
Airway Anatomy ◽  
Common Causes ◽  
Reflex Control

A chronic cough in children is defined in the British Thoracic Society guidelines as a cough of 8 weeks or more. The aetiology of a chronic cough in children differs from adult populations, due to decreased cough reflex control in children, differences in airway anatomy and physiology, and immunological and neurological maturation changes. The three most common causes of chronic cough in adults (asthma, gastro-oesophageal reflux, and upper airway cough syndrome) account for less than 10% of the causes in children. Thus, it is important to assess and manage chronic cough in children differently.

Approach to the Patient with Cough

2018 ◽  
Author(s):  
Christopher H. Fanta
Keyword(s):  
Respiratory Tract ◽  
Chronic Cough ◽  
Lower Respiratory Tract ◽  
Airflow Obstruction ◽  
Sensory Nerve ◽  
Lung Parenchyma ◽  
Flow Volume ◽  
Respiratory Compromise ◽  
Cough Reflex ◽  
Persistent Cough

The cough reflex is critically important in the clearance of abnormal airway secretions and protection of the lower respiratory tract from aspirated foreign matter. A weak or ineffective cough can lead to respiratory compromise from even a relatively minor bronchial infection. Persistent cough is often one of a constellation of symptoms indicative of respiratory disease—a potential clue in the differential diagnosis of the patient’s illness. Given the widespread distribution of sensory nerve endings of the cough reflex throughout the upper and lower respiratory tract, it is not surprising that myriad respiratory diseases, involving lung parenchyma and airways, can manifest with cough. Sometimes cough is the sole or predominant symptom in a patient who is otherwise well. Evaluating and treating the patient with persistent cough who has few, if any, other respiratory symptoms is a common challenge for the practicing physician. This review covers the normal cough mechanism, impaired cough, pathologic cough, cough suppressant therapy, and new developments. Figures show a flow-volume loop during cough, a posteroanterior chest x-ray in a patient presenting with chronic cough, flow-volume curves and spirograms documenting expiratory airflow obstruction, and the approach to the patient with chronic cough. The table lists selected examples of extrapulmonary physical findings of potential importance in the assessment of cough. This review contains 4 highly rendered figures, 1 table, and 94 references.

Omeprazole-Induced Intractable Cough

2003 ◽  
Vol 37 (11) ◽  
pp. 1607-1609 ◽  
Author(s):  
Mehran Howaizi ◽  
Christian Delafosse
Keyword(s):  
Adverse Effect ◽  
Chronic Cough ◽  
Package Insert ◽  
Pulmonary Involvement ◽  
Medline Search ◽  
Postnasal Drip ◽  
The Us ◽  
Common Causes ◽  
Persistent Cough ◽  
Drug Adverse Effect

OBJECTIVE: To report a case of chronic, persistent cough induced by omeprazole therapy. CASE SUMMARY: A 42-year-old white woman presented with chronic, persistent cough after omeprazole initiation for treatment of postoperative heartburn. The cough was permanent, dry, and exhausting and worsened at night. Omeprazole therapy was continued for 4 months because the persistent cough was thought to be related to gastroesophageal reflux disease (GERD). However, no cause of persistent, chronic cough was identified. After omeprazole discontinuation, the cough resolved. DISCUSSION: The most common causes of chronic cough in nonsmokers of all ages are postnasal drip syndrome, asthma, and GERD. However, persistent cough without bronchospasm or other pulmonary involvement may occur as a drug adverse effect. According to the US omeprazole package insert, cough is observed as an adverse reaction in 1.1% of patients, although this has not been mentioned in international drug information sources or medical literature. A MEDLINE search (1966–June 2003) using the terms cough, drug related, adverse effects, and omeprazole failed to find any data. In our patient, there was a temporal relationship between cough and medication use, suggesting a causal relationship. An objective causality assessment revealed that the adverse drug reaction was probable. The mechanism is unclear. CONCLUSIONS: Chronic, persistent cough may occur as an adverse effect of omeprazole therapy. Clinicians must be aware of this adverse effect to avoid useless and costly tests.

scholarly journals Origins of the inhibiting effects of nasal CPAP on nonnutritive swallowing in newborn lambs

2008 ◽  
Vol 105 (4) ◽  
pp. 1083-1090 ◽  
Author(s):  
Nathalie Samson ◽  
Bianca Roy ◽  
Alain Ouimet ◽  
François Moreau-Bussière ◽  
Dominique Dorion ◽  
...  
Keyword(s):  
Positive Airway Pressure ◽  
Upper Airway ◽  
Systematic Effect ◽  
Quiet Sleep ◽  
Upper Airways ◽  
Experimental Conditions ◽  
Nasal Cpap ◽  
Lower Airways ◽  
Respiratory Movements ◽  
Stimulation Of

The present study investigated the mechanism by which continuous positive airway pressure (CPAP) suppresses nonnutritive swallowing (NNS) during quiet sleep (QS) in newborn lambs. Eighteen full-term lambs were chronically instrumented and evenly distributed into three separate groups to determine the extent to which modulation of NNS may be attributed to stimulation of upper airway and/or bronchopulmonary mechanoreceptors. Six lambs were tracheotomized, six other lambs underwent a two-step bilateral intrathoracic vagotomy, and the remaining six lambs underwent chronic laryngotracheal separation (isolated upper airway group). Forty-eight hours after surgery, each nonsedated lamb underwent polysomnographic recordings on three consecutive days. States of alertness, NNS and respiratory movements were recorded. Results demonstrate that a CPAP of 6 cmH2O inhibited NNS during QS while administered directly on the lower airways and that bivagotomy prevented this inhibition. However, application of CPAP on the upper airways only also inhibited NNS during QS. Finally, the application of a CPAP of 6 cmH2O had no systematic effect on NNS-breathing coordination (assessed by the respiratory phase preceding and following NNS). In conclusion, our results suggest that bronchopulmonary receptors are implicated in the inhibiting effects of nasal CPAP of 6 cmH2O on NNS in all our experimental conditions, whereas upper airway receptors are only implicated in certain conditions.

Approach to the Patient with Cough

2018 ◽  
Author(s):  
Christopher H. Fanta
Keyword(s):  
Respiratory Tract ◽  
Chronic Cough ◽  
Lower Respiratory Tract ◽  
Airflow Obstruction ◽  
Sensory Nerve ◽  
Lung Parenchyma ◽  
Flow Volume ◽  
Respiratory Compromise ◽  
Cough Reflex ◽  
Persistent Cough

The cough reflex is critically important in the clearance of abnormal airway secretions and protection of the lower respiratory tract from aspirated foreign matter. A weak or ineffective cough can lead to respiratory compromise from even a relatively minor bronchial infection. Persistent cough is often one of a constellation of symptoms indicative of respiratory disease—a potential clue in the differential diagnosis of the patient’s illness. Given the widespread distribution of sensory nerve endings of the cough reflex throughout the upper and lower respiratory tract, it is not surprising that myriad respiratory diseases, involving lung parenchyma and airways, can manifest with cough. Sometimes cough is the sole or predominant symptom in a patient who is otherwise well. Evaluating and treating the patient with persistent cough who has few, if any, other respiratory symptoms is a common challenge for the practicing physician. This review covers the normal cough mechanism, impaired cough, pathologic cough, cough suppressant therapy, and new developments. Figures show a flow-volume loop during cough, a posteroanterior chest x-ray in a patient presenting with chronic cough, flow-volume curves and spirograms documenting expiratory airflow obstruction, and the approach to the patient with chronic cough. The table lists selected examples of extrapulmonary physical findings of potential importance in the assessment of cough. This review contains 4 highly rendered figures, 1 table, and 94 references.

scholarly journals The role of trigeminal nasal TRPM8-expressing afferent neurons in the antitussive effects of menthol

2013 ◽  
Vol 115 (2) ◽  
pp. 268-274 ◽  
Author(s):  
J. Plevkova ◽  
M. Kollarik ◽  
I. Poliacek ◽  
M. Brozmanova ◽  
L. Surdenikova ◽  
...  
Keyword(s):  
Citric Acid ◽  
Guinea Pigs ◽  
Upper Airway ◽  
Afferent Neurons ◽  
Tracheal Mucosa ◽  
Upper Airways ◽  
Cold Temperatures ◽  
Cold Sensitive ◽  
Lower Airways

The cold-sensitive cation channel TRPM8 is a target for menthol, which is used routinely as a cough suppressant and as an additive to tobacco and food products. Given that cold temperatures and menthol activate neurons through gating of TRPM8, it is unclear how menthol actively suppresses cough. In this study we describe the antitussive effects of (−)-menthol in conscious and anesthetized guinea pigs. In anesthetized guinea pigs, cough evoked by citric acid applied topically to the tracheal mucosa was suppressed by menthol only when it was selectively administered as vapors to the upper airways. Menthol applied topically to the tracheal mucosa prior to and during citric acid application or administered continuously as vapors or as an aerosol to the lower airways was without effect on cough. These actions of upper airway menthol treatment were mimicked by cold air delivered to the upper airways but not by (+)-menthol, the inactive isomer of menthol, or by the TRPM8/TRPA1 agonist icilin administered directly to the trachea. Subsequent molecular analyses confirmed the expression of TRPM8 in a subset of nasal trigeminal afferent neurons that do not coincidently express TRPA1 or TRPV1. We conclude that menthol suppresses cough evoked in the lower airways primarily through a reflex initiated from the nose.

scholarly journals DT-0111: a novel drug-candidate for the treatment of COPD and chronic cough

2019 ◽  
Vol 13 ◽  
pp. 175346661987796 ◽  
Author(s):  
Amir Pelleg ◽  
Fadi Xu ◽  
Jianguo Zhuang ◽  
Bradley Undem ◽  
Geoffrey Burnstock
Keyword(s):  
Chronic Cough ◽  
Ex Vivo ◽  
Sensory Nerve ◽  
Water Soluble ◽  
Vagal Afferents ◽  
Drug Candidate ◽  
Chronic Obstructive ◽  
Nerve Terminals ◽  
Axon Reflex

Background: Extracellular adenosine 5′-triphosphate (ATP) plays important mechanistic roles in pulmonary disorders in general and chronic obstructive pulmonary disease (COPD) and cough in particular. The effects of ATP in the lungs are mediated to a large extent by P2X2/3 receptors (P2X2/3R) localized on vagal sensory nerve terminals (both C and Aδ fibers). The activation of these receptors by ATP triggers a pulmonary-pulmonary central reflex, which results in bronchoconstriction and cough, and is also proinflammatory due to the release of neuropeptides from these nerve terminals via the axon reflex. These actions of ATP in the lungs constitute a strong rationale for the development of a new class of drugs targeting P2X2/3R. DT-0111 is a novel, small, water-soluble molecule that acts as an antagonist at P2X2/3R sites. Methods: Experiments using receptor-binding functional assays, rat nodose ganglionic cells, perfused innervated guinea pig lung preparation ex vivo, and anesthetized and conscious guinea pigs in vivo were performed. Results: DT-0111 acted as a selective and effective antagonist at P2X2/3R, that is, it did not activate or block P2YR; markedly inhibited the activation by ATP of nodose pulmonary vagal afferents in vitro; and, given as an aerosol, inhibited aerosolized ATP-induced bronchoconstriction and cough in vivo. Conclusions: These results indicate that DT-0111 is an attractive drug-candidate for the treatment of COPD and chronic cough, both of which still constitute major unmet clinical needs. The reviews of this paper are available via the supplementary material section.

scholarly journals Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Deborah C. Sylvester ◽  
Petros D. Karkos ◽  
Casey Vaughan ◽  
James Johnston ◽  
Raghav C. Dwivedi ◽  
...  
Keyword(s):  
Chronic Cough ◽  
Multidisciplinary Approach ◽  
High Technology ◽  
Multidisciplinary Assessment ◽  
Postnasal Drip ◽  
Common Causes ◽  
One Stop ◽  
Diagnostic Modalities ◽  
Difficult Cases ◽  
Noninvasive Tests

Objectives. Chronic cough is a multifactorial symptom that requires multidisciplinary approach. Over the last years, general practitioners refer increasingly more chronic cough patients directly to the otolaryngologist. The aim of this paper is to highlight the issues in diagnosis and management of chronic cough patients from the otolaryngologist perspective.Design. Literature review.Results. Gastroesophageal reflux and postnasal drip syndrome remain one of the most common causes of chronic cough. Better diagnostic modalities, noninvasive tests, and high technology radiological and endoscopic innovations have made diagnosis of these difficult-to-treat patients relatively easier. Multidisciplinary assessment has also meant that at least some of these cases can be dealt with confidently in one stop clinics.Conclusions. As the number of referrals of chronic cough patients to an Ear Nose Throat Clinic increases, the otolaryngologist plays a pivotal role in managing these difficult cases.

Infectious Comorbidities of Asthma in the Upper Airway

Asthma ◽  
2014 ◽  
pp. 260-278
Author(s):  
Claus Bachert ◽  
Griet Vandeplas
Keyword(s):  
Staphylococcus Aureus ◽  
Chronic Disease ◽  
Upper Airway ◽  
Airway Disease ◽  
Proper Treatment ◽  
Subjective Improvement ◽  
Upper Airways ◽  
Asthmatic Patients ◽  
Airway Pathology ◽  
Lower Airways

The link between the upper and lower airways is no longer a matter of debate. Acute or chronic disease of the upper airways and colonization by microorganisms such as Staphylococcus aureus leads to worsening of asthma symptoms. Asthmatic patients also are known to be more prone to developing chronic rhinosinusitis. Proper treatment of upper airway pathology, both medically and surgically, results in objective and subjective improvement of asthma. Understanding upper airway disease and its impact on asthma will provide new insights, not only in the pathogenesis of asthma, but also its treatment.

Approach to the Patient with Cough

2018 ◽  
Author(s):  
Christopher H. Fanta
Keyword(s):  
Respiratory Tract ◽  
Chronic Cough ◽  
Lower Respiratory Tract ◽  
Airflow Obstruction ◽  
Sensory Nerve ◽  
Lung Parenchyma ◽  
Flow Volume ◽  
Respiratory Compromise ◽  
Cough Reflex ◽  
Persistent Cough

The cough reflex is critically important in the clearance of abnormal airway secretions and protection of the lower respiratory tract from aspirated foreign matter. A weak or ineffective cough can lead to respiratory compromise from even a relatively minor bronchial infection. Persistent cough is often one of a constellation of symptoms indicative of respiratory disease—a potential clue in the differential diagnosis of the patient’s illness. Given the widespread distribution of sensory nerve endings of the cough reflex throughout the upper and lower respiratory tract, it is not surprising that myriad respiratory diseases, involving lung parenchyma and airways, can manifest with cough. Sometimes cough is the sole or predominant symptom in a patient who is otherwise well. Evaluating and treating the patient with persistent cough who has few, if any, other respiratory symptoms is a common challenge for the practicing physician. This review covers the normal cough mechanism, impaired cough, pathologic cough, cough suppressant therapy, and new developments. Figures show a flow-volume loop during cough, a posteroanterior chest x-ray in a patient presenting with chronic cough, flow-volume curves and spirograms documenting expiratory airflow obstruction, and the approach to the patient with chronic cough. The table lists selected examples of extrapulmonary physical findings of potential importance in the assessment of cough. This review contains 4 highly rendered figures, 1 table, and 94 references.

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