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Cough‐ and asthma‐like symptoms are common adverse reactions to angiotensin‐converting enzyme inhibitors (ACEi). However, attributing these symptoms to the use of ACEi might be masked by clinical confounders. We report a 68‐year‐old female residing in a long‐term acute‐care facility for patients requiring prolonged invasive mechanical ventilation treated for years with ACEi. Daily reversible bouts of life‐threatening severe bronchospasm gradually developed over 6 weeks and abruptly resolved following the cessation of ACEi treatment. The late appearance of bronchospasm and the unique clinical setup of chronic invasive ventilation in a patient with smoking‐related chronic obstructive lung disease are among the principal confounders that delay the identification of the causative association between ACEi and respiratory compromise. Chronic positive pressure ventilation may also conceal small airway reactivity and obstruction, similar to auto‐positive end‐expiratory pressure (auto‐PEEP). Conceivably, angiotensin receptor blockers should be preferred over ACEi in such patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to estimate the safety and efficacy of spray cryotherapy (SCT) in patients with chronic obstructive pulmonary disease (COPD). Methods: We recruited patients aged 40–80 years with a confirmed diagnosis of COPD without serious complications (defined as two consecutive years of chronic cough and cough for at least 3 months with lung function forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] < 70% after inhaled bronchodilators and Global Initiative for Chronic Obstructive Lung Disease [GOLD] grade II–IV). The safety of this study was assessed by incidence of adverse events, and the efficacy was evaluated by St. George's Respiratory Questionnaire (SGRQ), COPD assessment test (CAT), Leicester Cough Questionnaire (LCQ) and changes in exercise capacity, histomorphology and lung function. Results: Eight patients eventually received three complete sessions of SCT, each lasting 41.10 ± 19.72 min. No adverse complications were recorded within 3 months after SCT. Clinically meaningful improvements in SGRQ, CAT, LCQ and exercise capacity were observed at 3 months after SCT: −15.75 ± 6.76 (95% confidence interval [CI] 10.10−21.40; p <.001), −6.88 ± 3.91 (95% CI 3.61−10.14; p =.002), −18.13 ± 13.81 (95% CI 6.58−29.67; p =.008) and 72.75 ± 33.11 (95% CI −100.43 to −45.07; p <.001), respectively. The density of airway epithelial goblet cells per unit area was significantly reduced (p <.05), and lung function parameters such as ∆FVC, ∆FEV1 and ∆ peak expiratory flow (∆PEF) were improved (p =.007,.021 and.012). Conclusions: SCT is a safe and effective strategy to provide a better quality of life for COPD patients. [ABSTRACT FROM AUTHOR]

Background: Low‐dose long‐term azithromycin is recommended in clinical practice guidelines for obstructive airway diseases (OAD); however, an optimal therapeutic regimen is not yet established. Aim: To understand the patterns of azithromycin use in OAD, characterise the patients who received it and evaluate its safety and efficacy using real‐world data. Methods: We audited 91 patients who had received azithromycin for at least 4 weeks for the management of asthma, chronic obstructive pulmonary disease (COPD) or non‐cystic fibrosis bronchiectasis. Results: The mean age was 65 ± 18 years, 60% were female and 48% were ex‐smokers. The majority had asthma (75%), either alone (50%) or in combination with COPD (12%) or bronchiectasis (13%). Most (64%) reported cough or sputum at baseline. The most common treatment regimen was azithromycin 250 mg daily (73%) for more than 1 year (57%), with only seven adverse events. There was a significant reduction in the proportions of patients requiring emergency department visits (48% vs 32%; P < 0.001) and hospital admissions (35% vs 31%; P < 0.001) after starting azithromycin. In 88% of cases, physicians favoured the use of azithromycin. Conclusion: Physicians are currently using low‐dose azithromycin for a long duration of more than 1 year for the management of OAD. The typical case definition is an older non‐smoking adult with persistent asthma, often in combination with another OAD and presenting with bothersome cough or sputum. Azithromycin was well tolerated and led to reduced healthcare utilisation. Further research is required to establish an optimal dosage regimen of azithromycin in OAD. [ABSTRACT FROM AUTHOR]

Background: To compare peramivir 300 mg single‐dose, peramivir 600 mg repeat‐dose, and oseltamivir effects on health‐related quality of life, including respiratory symptoms and general conditions, time to symptom alleviation, time to fever resolution, incidence of exacerbations, and virus titer, in influenza patients with chronic respiratory disease. Methods: We report additional outcomes from a 2‐week, multicenter, randomized, open‐label study in Japan (UMIN000030118). Influenza patients with chronic respiratory disease received intravenous peramivir (300 mg single‐dose [n = 66], 600 mg repeat‐dose [600 mg/d of 2 consecutive days; n = 70]) or oral oseltamivir (75 mg twice daily, 5 days; n = 72). The principal endpoint of this analysis was change from baseline to Day 14 at each time point in Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scores. Results: Both peramivir regimens reduced total CAT score at Day 3 more than oseltamivir (peramivir 600 mg vs oseltamivir, P =.0032; peramivir 300 mg vs oseltamivir, P =.0203). Cough/phlegm CAT scores were most improved with peramivir 600 mg. Median time to alleviation of three respiratory symptoms was longer with peramivir 600 mg (68.9 hours) than with peramivir 300 mg (50.6 hours, hazard ratio [HR] 1.57; P =.0191) and shorter with peramivir 300 mg than oseltamivir (78.8 hours, HR 0.62; P =.0141). Alleviation of seven influenza symptoms and fever resolution was shortest with peramivir 300 mg. Conclusions: Rapid improvement in CAT score, including cough, and shorter time to alleviation of respiratory symptoms associated with peramivir is of potential benefit to patients with chronic respiratory disease. [ABSTRACT FROM AUTHOR]

Background: Chronic cough is a common respiratory symptom, and, if persistent, the patient's quality of life can worsen and result in a depressive mood, or vice versa. Although previous reports suggest a relationship between chronic cough and depression, we further investigated this relationship according to smoking status and lung function. Methods: This observational study used cross‐sectional data from the 6th Korean National Health and Nutrition Examination Survey (2014 and 2016). Propensity score matching using age, sex, smoking status, and lung function was performed for participants with and without chronic cough to reduce the confounding effects associated with depressive mood. Questionnaires recorded coughs persisting for >3 months and the Patient Health Questionnaire‐9 (PHQ‐9) assessed the severity of depressive mood. Results: Among 12 494 participants who were >18 years old, 226 with chronic cough were matched with 226 with non‐chronic cough. Overall, chronic cough participants showed higher PHQ‐9 scores than the non‐chronic cough participants (4.29 ± 5.23 vs. 2.63 ± 3.38, P <.001). When stratified by sex, the difference remained significant in women (5.69 ± 5.96 vs. 3.05 ± 3.97, P <.001) but not in men (3.18 ± 4.27 vs. 2.31 ± 3.65, P =.092). When stratified by lung function status, the difference remained significant for those with normal lung function (4.32 ± 5.32 vs. 2.78 ± 3.86, P =.003) and reduced lung function (4.19 ± 4.93 vs. 2.11 ± 3.55, P ≤ 0.001). Multivariate logistic regression analysis revealed that chronic cough was associated with PHQ‐9 score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.014–1.27, P =.014), chronic obstructive pulmonary disease (OR, 4.87; 95% CI, 1.041–22.86, P =.044) and physician‐diagnosed bronchial asthma (OR, 2.93; 95% CI, 1.162–7.435, P =.023). Conclusions: Depressive mood is significantly correlated with chronic cough in females. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to utilize an artificial neural network in an exploratory fashion to predict self‐management behaviors based on reported symptoms in a sample of stable patients with chronic obstructive pulmonary disease (COPD). Design and Methods: Patient symptom data were collected over 21 consecutive days. Symptoms included distress due to cough, chest tightness, distress due to mucus, dyspnea with activity, dyspnea at rest, and fatigue. Self‐management abilities were measured and recorded periodically throughout the study period and were the dependent variable for these analyses. Self‐management ability scores were broken into three equal tertiles to signify low, medium, and high self‐management abilities. Data were entered into a simple artificial neural network using a three‐layer model. Accuracy of the neural network model was calculated in a series of three models that respectively used 7, 14, and 21 days of symptom data as input (independent variables). Symptom data were used to determine if the model could accurately classify participants into their respective self‐management ability tertiles (low, medium, or high scores). Through analysis of synaptic weights, or the strength or amplitude of a connection between variables and parts of the neural network, the most important variables in classifying self‐management abilities could be illuminated and served as another outcome in this study. Findings: The artificial neural network was able to predict self‐management ability with 93.8% accuracy if 21 days of symptom data were included. The neural network performed best when predicting the low and high self‐management abilities but struggled in predicting those with medium scores. By analyzing the synaptic weights, the most important variables determining self‐management abilities were gender, followed by chest tightness, age, cough, breathlessness during activity, fatigue, breathlessness at rest, and phlegm. Conclusions: The results of this study suggest that self‐management abilities could potentially be predicted through understanding and reporting of patient's symptoms and use of an artificial neural network. Future research is clearly needed to expand on these findings. Clinical Relevance: Symptom presentation in chronically ill patients directly impacts self‐management behaviors. Patients with COPD experience a number of symptoms that have the potential to impact their ability to manage their chronic disease, and artificial neural networks may help clinicians identify patients at risk for poor self‐management abilities. [ABSTRACT FROM AUTHOR]

COPD, exacerbations, lifetime trajectory, research priorities, treatment Keywords: COPD; exacerbations; lifetime trajectory; research priorities; treatment EN COPD exacerbations lifetime trajectory research priorities treatment 742 744 3 07/19/21 20210801 NES 210801 The New Horizons in chronic obstructive pulmonary disease (COPD) papers set out to describe our current knowledge, and to look towards the advances that will influence care, outcomes and future discovery. In most COPD trials, there are no prespecified analyses to examine these different causes of COPD and their response to treatment. Natural history of chronic obstructive pulmonary disease exacerbations in a general practice-based population with chronic obstructive pulmonary disease. [Extracted from the article]

Keywords: asthma; bronchial thermoplasty; obesity; precision medicine; treatable traits EN asthma bronchial thermoplasty obesity precision medicine treatable traits 651 656 6 05/28/20 20200601 NES 200601 Abbreviations BT bronchial thermoplasty COAT COugh Assessment Test COPD chronic obstructive pulmonary disease CT computed tomography DPI dry powder inhaler FEV 1 forced expiratory volume in 1 s FRC functional residual capacity FVC forced vital capacity GWAS genome-wide association study ICS inhaled corticosteroid IL interleukin ILO inducible laryngeal obstruction IST incremental shuttle walk test LABA long-acting beta-agonist LCQ Leicester Cough Questionnaire MDT multidisciplinary team OCT optical coherence tomography OSA obstructive sleep apnoea pMDI pressurized metered-dose inhaler ROS reactive oxygen species SNP single nucleotide polymorphism TRPA1 transient receptor potential A1 VCD vocal cord dysfunction Summary Treatable traits and a multidisciplinary assessment identify the heterogeneous problems associated with asthma, especially in those with severe disease. The application of bronchial thermoplasty in severe asthma improves clinical symptoms with the treatment acting primarily on second- to seventh-generation airways, reducing gas trapping and dynamic hyperinflation that can be associated with severe asthma; predicting responders remains to be defined. This suggests, in a cohort of adults with asthma and in whom over 70% had a BMI in excess of 25, that some nocturnal symptoms thought to be asthma may be due to undiagnosed sleep apnoea.[23] Endobronchial optical coherence tomography (OCT) is a technique that allows visualization of airway microstructures, internally examined during bronchoscopy, and allows the study of dynamic airway changes. [Extracted from the article]

For the pain score, the lidocaine-NSS nebuliser in the AB and BA groups was 1.19 ± 1.17 and 1.31 ± 1.74, respectively ( I P i = .813), while that for the NSS nebuliser was 0.5 ± 1.55 and 1.06 ± 1.73, respectively ( I P i = .340). Therefore, the lidocaine-NSS nebuliser could reduce pain better than the NSS nebuliser in patients who did not receive painkiller. The results revealed that the lidocaine-NSS nebuliser was more effective at reducing cough and pain symptoms than the standard NSS nebuliser that can also reduce the cough reflex but not as well. [Extracted from the article]

Chronic obstructive pulmonary disease (COPD) is a major health burden throughout the world.[1] The burden is disproportionately higher in Asia (than elsewhere) where ~2 million individuals die each of year from this disease, representing two-thirds of all COPD deaths around the world.[2] Owing largely to population growth and ageing, this number is expected to grow to 3 million deaths/year by the year 2040.[2] Cordova-Rivera I et al i . applied wearable accelerometer on 67 patients with moderate COPD (mean forced expiratory volume of 1 s (FEV SB 1 sb ) of 56% and mean age of 70 years) and found that on average patients walked 2858 steps/day.[4] In contrast, control subjects (i.e. those without COPD) walked 7640 steps/day. Given the high prevalence of cardiovascular complications during acute COPD exacerbations, cardiopulmonary imaging may be helpful in the assessment of COPD patients during major "lung attacks". There is widespread consensus that pulmonary rehabilitation imparts clinical benefits for COPD patients; however, as noted by Holland, only ~1% of eligible COPD patients participate.[16] Patients with severe COPD with elevated PaCO SB 2 sb are generally excluded from participation in pulmonary rehabilitation owing to severe breathlessness and concerns about worsening hypercapnic respiratory failure during exercise. [Extracted from the article]

Background and objective: Symptoms negatively impact the quality of life and long‐term prognosis of patients with chronic obstructive pulmonary disease (COPD). Little is known about the relationship linking airway inflammation and symptoms in stable COPD. In this study, we evaluated whether respiratory symptoms in COPD are related to sputum inflammatory cellular profile and whether symptom changes are associated with changes in airway inflammation. Methods: A total of 40 patients with stable COPD with moderate‐to‐severe airflow obstruction were enrolled. Patients were visited weekly over 4 weeks. At each visit, patients underwent clinical assessments, lung function tests and sputum induction. Patients recorded daily dyspnoea, sputum and cough scores. Results: The changes between two consecutive visits in the percent of sputum neutrophils and eosinophils were related to the changes in the cough (P < 0.001; r = 0.63) and dyspnoea scores (P < 0.001; r = 0.58) of the prior week. Furthermore, using regression analyses, we were able to demonstrate that changes in the cough score were specifically associated to the change in neutrophils, while changes in the dyspnoea score and use of rescue medications were associated with changes in eosinophils numbers. Conclusion: Our study showed an association between symptoms and the sputum inflammatory profile. In particular, changes in symptoms (cough and dyspnoea) were correlated with changes in the specific sputum inflammatory cell components of airway inflammation (neutrophils and eosinophils, respectively), providing novel information on the mechanisms of disease manifestation. The symptom severity and variability negatively impact the short‐ and long‐term prognosis of chronic obstructive pulmonary disease (COPD). Our study showed an association between symptoms and the sputum inflammatory profile. In particular, changes in cough and dyspnoea were correlated with changes in neutrophils and eosinophils, respectively, providing novel information on the mechanisms of disease manifestation. See relatedEditorial [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease accounts as the leading cause of mortality worldwide prominently affected by genetic and environmental factors. The disease is characterized by persistent coughing, breathlessness airways inflammation followed by a decrease in forced expiratory volume1 and exacerbations, which affect the quality of life. Determination of genetic, epigenetic, and oxidant biomarkers to evaluate the progression of disease has proved complicated and challenging. Approaches including exome sequencing, genome‐wide association studies, linkage studies, and inheritance and segregation studies played a crucial role in the identification of genes, their pathways and variation in genes. This review highlights multiple approaches for biomarker and gene identification, which can be used for differential diagnosis along with the genome editing tools to study genes associated with the development of disease and models their function. Further, we have discussed the approaches to rectify the abnormal gene functioning of respiratory tissues and various novel gene editing techniques like Zinc finger nucleases (ZFN), transcription activator‐like effector nucleases (TALEN), and clustered regulatory interspaced short palindromic repeats/CRISPR‐associated protein 9 (CRISPR/Cas9). [ABSTRACT FROM AUTHOR]

Background and objective: Aerosol transmission of Pseudomonas aeruginosa has been suggested as a possible mode of respiratory infection spread in patients with cystic fibrosis (CF); however, whether this occurs in other suppurative lung diseases is unknown. Therefore, we aimed to determine if (i) patients with bronchiectasis (unrelated to CF) or chronic obstructive pulmonary disease (COPD) can aerosolize P. aeruginosa during coughing and (ii) if genetically indistinguishable (shared) P. aeruginosa strains are present in these disease cohorts. Methods: People with bronchiectasis or COPD and P. aeruginosa respiratory infection were recruited for two studies. Aerosol study: Participants (n = 20) underwent cough testing using validated cough rigs to determine the survival of P. aeruginosa aerosols in the air over distance and duration. Genotyping study:P. aeruginosa sputum isolates (n = 95) were genotyped using the iPLEX20SNP platform, with a subset subjected to the enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC‐PCR) assay to ascertain their genetic relatedness. Results: Aerosol study: Overall, 7 of 20 (35%) participants released P. aeruginosa cough aerosols during at least one of the cough aerosol tests. These cough aerosols remained viable for 4 m from the source and for 15 min after coughing. The mean total aerosol count of P. aeruginosa at 2 m was two colony‐forming units. Typing study: No shared P. aeruginosa strains were identified. Conclusion: Low viable count of P. aeruginosa cough aerosols and a lack of shared P. aeruginosa strains observed suggest that aerosol transmission of P. aeruginosa is an unlikely mode of respiratory infection spread in patients with bronchiectasis and COPD. Our study shows that patients with bronchiectasis and chronic obstructive pulmonary disease (COPD) can release potentially infectious aerosols during coughing; however, no shared stains of Pseudomonas aeruginosa were identified in our study. The results suggest that aerosol transmission is an unlikely mode of cross‐infection in patients with bronchiectasis and COPD. Watch the video abstract See related Editorial [ABSTRACT FROM AUTHOR]

Background: In this study, we investigated the relationship between chronic cough and clinicopathological features in postoperative patients with non‐small cell lung cancer (NSCLC) and evaluated the effectiveness of acupuncture therapy for the treatment of postoperative chronic cough in patients with NSCLC. Methods: We retrospectively evaluated 171 patients with NSCLC who received lobectomy at our center between September 2017 and February 2018. The Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ‐MC) was used to evaluate the degree of cough in patients. Postoperative cough was assessed by a visual analog scale (VAS). Results: The total LCQ‐MC score for the whole group was 19.79 ± 0.53 before surgery and 18.40 ± 0.70 after surgery (p < 0.001). Logistic regression analysis showed that right lung cancer, difficult airway, acute cough and history of COPD were independent predictors of chronic cough. Of the 68 patients diagnosed with chronic cough, 41 received acupuncture therapy (acupuncture therapy group), and 27 received no acupuncture therapy (no therapy group). No significant difference was found between the two groups in terms of their LCQ‐MC scores at eight weeks after surgery (p = 0.756). However, the acupuncture therapy group had a significantly higher LCQ‐MC score than the no therapy group at 10 weeks after surgery (p = 0.002). Conclusions: Right lung cancer, difficult airway, acute cough, and history of COPD are independent predictors of chronic cough after surgery. For patients with chronic cough, acupuncture therapy can shorten the recovery time and improve quality of life after surgery. [ABSTRACT FROM AUTHOR]

Objectives: Chronic obstructive pulmonary disease (COPD) is underdiagnosed in the general population and possibly also in people living with HIV (PLWH). We evaluated the diagnostic performance of symptoms and risk factors for assessment of airflow limitation in PLWH and in uninfected controls. Methods: Spirometry was performed in the Copenhagen Comorbidity in HIV Infection (COCOMO) study and Copenhagen General Population Study (CGPS), and airflow limitation was defined by forced expiratory volume in 1 s/forced vital capacity < lower limit of normal. We calculated the sensitivity, specificity, predictive values and area under the curve (AUC) of symptoms and risk factors for assessment of airflow limitation in PLWH and uninfected controls. Results: A total of 1083 PLWH and 12 074 uninfected controls were included in the study. The sensitivity for sputum, chronic cough, breathlessness, wheezing, current and cumulative smoking and self‐reported COPD was higher, but the specificity lower, in PLWH than in uninfected controls. The negative and positive predictive values were largely similar between the groups. The AUCs were similar or slightly higher in PLWH and highest for > 20 pack‐years smoked [0.65; 95% confidence interval (CI) 0.58–0.72] and wheezing (0.64; 95% CI 0.57–0.71). A summed score for five variables was associated with slightly higher AUC in PLWH compared with uninfected controls [0.71 (95% CI 0.63–0.79) versus 0.65 (95% CI 0.63–0.68), respectively; P = 0.06]. Conclusions: Clinical variables were relatively poor discriminators of airflow limitation in PLWH and uninfected controls. Active COPD case finding by screening for symptoms and relevant exposures, as recommended in the general population, is likely to yield similar diagnostic power in PLWH. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 18-month-old boy presented with stridor and respiratory difficulty. Topics include thermal epiglottitis has a rare medical emergency that progress rapidly to life-threatening airway obstruction without immediate diagnosis and appropriate intervention; and thermal injuries to the epiglottis occuring after drinking hot beverages and inhaling hot gas in children.

Background and Aims Mounier-Kuhn syndrome is a rare disease with abnormal enlargement of major airways, but epidemiological studies are lacking, and currently the most available data about it come from case reports, making it difficult to collate changes in a particular patient to those in previously published cases. The aim of this work is to systematically review cases published in the last 25 years and to use descriptive statistics to summarize the patient demographic and clinical information therein in order to acquire details about patient clinical characteristics. Methods Cases published in world literature between 1987 and 2013 were sought and reviewed according to PRISMA guidelines. Cases were included only if patient's age was at least 18 years, and a computed tomography scan with tracheal measurements was available. Results An 8:1 male predominance was found in 89 identified reports (128 cases). Mean age was 53.9 years, and average tracheal diameter was 36.1 mm. No correlation between increasing age and increasing tracheal diameter was found. Bronchiectasis, tracheal diverticulosis and tracheobronchial dyskinesia were common (49.2%, 33.6% and 28.9%, respectively). Cough, dyspnea and recurrent respiratory infections (71.1%, 51.6% and 50.8%, respectively) were the most common complaints. Conclusions The data confirm that syndrome mostly manifests with nonspecific respiratory symptoms and is significantly more common in males. Importantly, there was no connection between age and airway diameter, a fact that could mean that the enlargement does not progress over time, and its severity depends on some other yet undetermined factors. [ABSTRACT FROM AUTHOR]

Introduction Chronic obstructive pulmonary disease (COPD) is one of the leading causes of respiratory morbidity and mortality with limited data on palliative care and evidence of reluctance to end-of-life discussions. Objectives The primary objective of this study was to evaluate the understanding of palliative care as an option in COPD. Moreover, we wanted to identify any barriers to resuscitation discussions in this group of patients. Methods We developed a questionnaire addressing the aims of the study. Patients with COPD were prospectively recruited into the study and completed palliative questionnaire, Leicester cough questionnaire, Borg dyspnoea index and Medical Research Council dyspnoea scale. Results The patient population was predominantly male (60%) with mean age of 70 years (range 43-87 years). The mean forced expiratory volume in 1 s was 1.0 (range 0.3-2.3 L). The mean body mass index of the cohort was 24.3 (standard deviation 6.7, range 14.5-42). Ten patients (33%) were on home oxygen. Thirteen (43%) patients understood the term non-invasive ventilation, and 11 of those would consider it again if needed. Only 13% of patients knew that palliative care is an option in COPD. Eleven patients understood the term cardiopulmonary resuscitation, and only five (16%) ever had a discussion regarding resuscitation. Conclusion This study demonstrates that there is extremely limited awareness of palliative care in patients with COPD. Moreover, the barriers to the end-of-life discussions should be explored to improve the end-of-life care in this disease. [ABSTRACT FROM AUTHOR]

A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed. [ABSTRACT FROM AUTHOR]

Bronchodilator drugs are the foundation for the treatment of chronic obstructive pulmonary disease. The principal inhaled bronchodilator treatments used are β2-agonists and anticholinergics, either alone or in combination. Currently available β2-agonists are of either short duration and used multiple times/day, or of long duration, which requires twice-daily administration. Indacaterol is considered an ultra-long-acting β2-agonist and was recently approved for use in the United States. Its duration of action is approximately 24 hours, allowing for once-daily administration. Cough was the most commonly reported adverse effect with use of indacaterol. Cough usually occurred within 15 seconds of inhalation of the drug, lasted around 6 seconds, was not associated with bronchospasm, and did not cause discontinuation of the drug. Otherwise, the drug's safety profile was similar to that of other bronchodilators. Based on similar improvement in spirometric measurements compared with other bronchodilator drugs and the convenience of its once-daily dosing, indacaterol may be beneficial in the management of mild-to-moderate chronic obstructive pulmonary disease, either alone or in combination with anticholinergic drugs administered once/day. [ABSTRACT FROM AUTHOR]

Background and objective: It has yet to be determined whether the presence of productive cough is a risk factor for the development of COPD. The aim of the present study was to obtain more information on this potential association in Japanese men. Methods: Seven hundred and eighty-three men with normal spirometry who did not have respiratory disease were recruited. The subjects were divided into three groups: group A, non-smokers; group B, those with a positive smoking history without productive cough; and group C, those with a positive smoking history and productive cough. The incidence rates of COPD were compared among the three groups and the relative risks for the development of COPD were assessed. Results: During the mean follow-up period of 33.6 ± 20.4 months, 19 (2.4%) subjects developed COPD. The incidence rate of COPD was significantly higher in group C than in group B (10.1 vs 2.2%, P = 0.003). A multivariate analysis of data for all subjects, current smokers and former smokers revealed that productive cough was an independent risk factor for the development of COPD in all subjects and former smokers but not in current smokers. Conclusions: Productive cough was an independent risk factor for the development of COPD in Japanese men. In particular, former smokers who complain of this symptom should be regarded as being at high risk for the development of COPD. The data suggested that stage 0 disease, as defined in the Global Initiative for Chronic Obstructive Lung Disease 2001 guidelines, is relevant for the identification of subjects at risk of developing COPD. [ABSTRACT FROM AUTHOR]

Background and objective: The causes of exacerbations in COPD patients are poorly understood. This study examined the association between cough-reflex sensitivity in patients with stable COPD and the frequency of subsequent exacerbations. Methods: The sampling frame for cases and controls for this study was patients attending a hospital outpatient clinic. cough-reflex sensitivity was evaluated using the log concentration of capsaicin causing five or more coughs (log C5). Subsequent COPD exacerbations were identified prospectively via symptom-based diaries over a 12-month period. Results: The study group comprised 45 COPD subjects and 10 controls. Mean log C5 was lower in the COPD group than in the control group (0.97 (95% confidence interval (CI): 0.76–1.18) versus 1.26 (95% CI: 0.81–1.71), P = 0.095). In the COPD group, log C5 was negatively correlated with serum CRP level ( r = −0.36, P = 0.02) and significantly associated with the exacerbation frequency ( r = −0.38, P = 0.01). Stepwise multiple regression analysis showed that cough-reflex sensitivity was significantly associated with exacerbation frequency ( r2 = 0.15, P = 0.01). Conclusions: Hypersensitivity of the cough reflex to inhaled capsaicin might reflect airway inflammation in stable COPD patients, which predisposes to frequent exacerbations. [ABSTRACT FROM AUTHOR]

Background: Chronic cough can be the first sign of chronic obstructive disease. A few, and mostly selected, studies exploring the effect of reduced daily tobacco consumption have shown a small effect on pulmonary symptoms. Aim: The aim of this study was to examine if smoking reduction (SR) (≥50% of daily tobacco consumption) or smoking cessation (SC) had an effect on chronic cough and phlegm. Methods: A total of 2408 daily smokers were included in a Danish population-based intervention study, Inter99. In the analyses, we included smokers with self-reported chronic cough or phlegm at baseline who also attended the 1-year follow-up. We investigated if SR or SC had improved the self-reported pulmonary symptoms, using logistic regression analyses. Results: Almost 34% of the smokers had chronic cough at baseline and 24.5% had chronic phlegm. Thirty-seven persons with cough at baseline and 24 with phlegm at baseline achieved substantial SR at 1-year follow-up. The corresponding numbers for SC were 63 and 39, respectively. In adjusted analyses, quitting or reducing smoking was associated with less reporting of cough [odds ratio (OR): 14.2; 95% confidence interval (CI): 5.9–34.4] and (OR: 3.7; 95% CI: 1.7–8.0), respectively, compared with unchanged smoking habits. It was also significantly more likely not to report phlegm at 1-year follow-up for those who had quit (OR: 7.1; 95% CI: 2.8–18.0), whereas SR was not significantly associated with termination of phlegm (OR: 2.5; 95% CI: 0.9–6.4) when compared with continuous smoking. Conclusion: SC significantly improved self-reported chronic cough and phlegm as expected. Substantial SR was achieved by few smokers but had a significantly positive effect on chronic cough. Please cite this paper as: Pisinger C, Godtfredsen NS and Jørgensen T. Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study. The Clinical Respiratory Journal 2008; 2: 41–46. [ABSTRACT FROM AUTHOR]

Objective: Inhaled mannitol induces both bronchoconstriction and cough. Nedocromil sodium greatly attenuates mannitol-induced bronchoconstriction. Knowledge about the effect of nedocromil on mannitol-provoked cough might, therefore, clarify the mechanisms of this response. Methodology: Inhalation challenges with mannitol powder were performed after inhalation of 8 mg of nedocromil or its placebo in 24 subjects with asthma. The study was double-blind, randomised, and placebo-controlled. The mannitol-provoked coughs were manually recorded and the mannitol-induced bronchoconstriction was measured with a spirometer. Results: The cumulative dose of mannitol that provoked at least two coughs tended to be higher on the nedocromil day than on the placebo day (34 (22-53) mg vs 26 (18-37) mg, P = 0.051). The cumulative number of coughs per dose of mannitol was slightly, but significantly, lower on the nedocromil than on the placebo day (4.2 (2.8-6.3) coughs/100 mg vs 6.1 (4.0-9.4) coughs/100 mg, P = 0.037). However, when analysed on a constant-dose basis, nedocromil provided no protection for coughing ( - 1% protection), whereas the protection for bronchoconstriction was clear (55% protection). Conclusions: Nedocromil strongly attenuates mannitol-induced bronchoconstriction but has a negligible effect on mannitol-provoked cough. Therefore, these responses seem to have different pathways in asthma. Recording of both provoked coughs and induced bronchoconstriction during mannitol challenge may provide supplementary information about a patient's disease. [ABSTRACT FROM AUTHOR]

Prevalence and clinical features of cough variant asthma in a general internal medicine outpatient clinic in JapanSHIRAHATA K, FUJIMOTO K, ARIOKA H, SHOUDA R, KUDO K, IKEDA S.Respirology2005;10: 354–358The aims of the present study were to examine the prevalence and clinical features of cough variant asthma (CVA) among patients with chronic and persistent cough at an outpatient clinic in Japan, and the efficacy of treatment with an inhaled corticosteroid.This prospective study was conducted at a general internal medicine outpatient clinic in Japan over a 12-month period. CVA was diagnosed as chronic cough without wheezing or any apparent cause, that had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyperresponsiveness to methacholine, and relief of cough after bronchodilator treatment. We also examined the effects of inhaled beclomethasone propionate on symptoms and differences in PEF between early morning and evening.Of 55 patients suffering from chronic cough, 23 satisfied the criteria for CVA. Their cough occurred more frequently at night and early in the morning. Early morning PEF was significantly lower than evening PEF with a mean variability of 11.5 ± 4.1%. Treatment with beclomethasone propionate improved coughing and significantly increased early morning PEF, reducing variability to less than 10%.These findings suggest that CVA is most common among patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of CVA. [ABSTRACT FROM AUTHOR]

Importance of atopic cough, cough variant asthma and sinobronchial syndrome as causes of chronic cough in Hokuriku area of JapanFUJIMURA M, ABO M, OGAWA H, NISHI K, KIBE Y, HIROSE T, NAKATSUMI Y, IWASA K.Respirology2005;10: 201–207A prospective multicentre study was conducted to elucidate the causes of chronic cough in Japan.All consecutive and unselected patients complaining of cough lasting 8 weeks or more, who visited our clinics from 1 June to 31 December 2001, were registered. The causes of chronic cough were diagnosed based on the criteria for definite and probable causes of cough as recommended by the Japanese Cough Research Society.Of the 248 patients enrolled, 72 patients (29.0%) were unavailable for follow up before their diagnostic assessment had been finalized. Among the 176 patients who were adequately assessed, a diagnosis was made in 165 patients (93.7%) either as single cause or as one of two casuses: atopic cough in 48 (29.1%) and 11 patients (6.7%); cough variant asthma in 46 (27.9%) and nine patients (5.5%); cough predominant asthma in 14 (8.5%) and three patients (1.8%); and sinobronchial syndrome (SBS) in 28 (17.7%) and 14 patients (8.5%), respectively. A diagnosis of gastro-oesophageal reflux-associated cough was made in a total of four patients (2.4%).Atopic cough, asthmatic cough consisting of cough variant asthma and cough predominant asthma, and SBS are major causes of chronic cough in Japan. [ABSTRACT FROM AUTHOR]

Association between stress and asthma symptoms: A population-based study OH Y-M, KIM YS, YOO SH, KIM SK, KIM DS. Respirology 2004; 9: 363–368 Although it is believed that stress contributes to asthma, there are no data from studies in the general population to support this belief. To determine whether stress influences asthma in the general population, a database from a nationwide survey to evaluate the relationship between stress and asthma symptoms was used in the present study. A database generated by the National Health and Nutrition Examination Survey I (in South Korea, 1998) was used for this cross-sectional study. Stratified random samples of 9263 subjects, aged 20 years or older, were selected from the entire population of the country; 95% of these subjects responded. Among the responders, 5048 subjects aged 20–44 years were included in the study. Subjects were interviewed using a questionnaire. Multivariate analysis was performed using multiple logistic regression. The prevalence of wheeze and waking in the night because of cough or shortness of breath in the preceding 12 months was 12.9 and 13.5%, respectively. Multivariate analysis showed that the odds ratios for asthma symptoms increased according to the severity of stress reported by the subjects. When stress levels were classified into four categories of little, some, much and very much stress, the odds ratios for wheeze in the preceding 12 months were 1.7 (95% confidence interval (CI) 1.1, 2.5), 2.6 (95% CI 1.7, 4.0) and 3.6 (95% CI 2.1, 5.9) for subjects reporting some, much and very much stress, respectively, relative to those reporting little stress. Using the same stress-level classifications, the odds ratios for waking in the night because of cough or shortness of breath in the preceding 12 months were 1.5 (95% CI 1.0, 2.3), 2.4 (95% CI 1.6, 3.6) and 4.0 (95% CI 2.5, 6.4), respectively. This cross-sectional study shows an association between stress and asthma symptoms in the general population of South Korea. [ABSTRACT FROM AUTHOR]

1 Sensory nerves regulate central and local reflexes such as airway plasma leakage, and cough and their function may be enhanced during inflammation. Evidence suggests that dopamine receptor agonists may inhibit sensory nerve-mediated responses. 2 In this study dopamine inhibited vagal sensory nerve induced micro vascular leakage in the rat. In order to characterize the receptor involved rat vagus preparations were utilized. Quinagolide (D[sub2/3] agonist), ropinirole (D[sub2/3/4/] agonist). SKF 38393 (D[sub1/5] agonist). AR-C68397AA (Viozan™) (dual D[sub2]/ B[sub2] agonist) and dopamine inhibited hypertonic saline induced depolarization by approximately 50%. Data suggests that AR-C68397AA and quinagolide also inhibited depolarization of the human vagus. 3 The quinagolide response was blocked by sulpiride (D[sub2/3] antagonist but not SCH 23390 (D[sub1/5] antagonist): ropinirole was partially blocked by sulpiride, totally blocked by spiperone (at a concentration that blocks all dopamine receptors) but not by SCH 23390. The response to SKF 38393 was not blocked by sulpiride but was by SCH 23390. The inhibition evoked by AR-C68397AA was only partially blocked by SCH 23390 but not by sulpiride or spiperone whereas dopamine was blocked by spiperone. The effect of dopamine was not stimulus-specific as it inhibited capsaicin-induced depolarization of the rat vagus in a spiperone sensitive manner. 4 In conclusion, dopamine receptor ligands inhibit depolarization of the rat and human vagus. These data suggest, that dopamine receptor agonists may be of therapeutic benefit in the treatment of symptoms such as cough and mucus secretion which are evident in respiratory diseases such as asthma and chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Cough variant asthma is an occult form of asthma in which the only sign or symptom is chronic cough. It is a common problem amongst all ages that frequently goes unrecognized, leading to underdiagnosis and undertreatment. To characterize the pathophysiological abnormalities in these patients, we performed bronchial provocation tests with methacholine using the stepwise doubling concentration technique, and measured the concentration of methacholine and the severity of airway obstruction when wheezing was first detected. Airway hyperresponsiveness, defined as PC20 in the cough variant asthma group was not significantly different from that of classic asthma. There was a good correlation between the PCW (the concentration of methacholine causing wheezing) and the PC20 with the PCW values higher than PC20 values in both groups. However, in the cough variant asthma group, the PCW: PC20 ratio was greater than that of the classic asthma group. Furthermore, the mean % fall in FEY1 at which wheezing was first detected in the former group was significantly larger than that of the latter group. The results indicated that the mechanism for the manifestation of cough without wheeze in the cough variant asthma may be a higher wheezing threshold, i.e. wheezing becomes audible at the greater degree of airway obstruction than classic asthma. They suggested that patients with cough variant asthma may represent a subset of asthmatic subjects whose airways are less able to produce a wheeze. [ABSTRACT FROM AUTHOR]

The article provides information on a study regarding the chronic and persistent cough related to vulnerability to psychological stress. Various cases of children with chronic barking cough related to vulnerability to psychological stress are also presented. Major causes of chronic cough in adulthood are asthma, post-nasal drip syndrome, and gastroesophageal reflux disease.

Examines the pathology of cough and asthma. Features of asthma, cough-variant asthma and eosinophilic bronchitis; Need to conduct immunological studies of the different asthma phenotypes to investigate fully the possibility that clinical patterns of disease are related to differences in pathology.

A 69-year-old man with chronic obstructive pulmonary disease (COPD) presented with an exacerbation of cough and breathlessness, as well as a 5 day history of sudden-onset bilateral calf tenderness. He had been commenced on inhaled steroids 4 1 /2 years earlier and then received maintenance oral prednisone. Upon examination, there was a haematoma inferior to the medial malleolus with no Achilles tenderness on the left side. On the right side, there was focal tenderness over the mid-portion of the Achilles tendon with pain accentuated upon dorsi flexion. A venous duplex study confirmed superficial venous thrombosis involving the left gastrocnemius vein extending proximally to the popliteal vein junction. The major axial deep veins of the left lower leg were patent. Findings on the right side were normal. A subsequent diagnostic ultrasound demonstrated unequivocal bilateral Achilles tendon ruptures. The patient subsequently underwent corrective surgery. There have been several reports of bilateral Achilles tendon rupture associated with long-term corticosteroid use. It is likely that this entity is underdiagnosed because of a lack of awareness of this association by physicians. Recognition and surgical intervention are likely to reduce morbidity and improve outcome. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a patient with abdominal pain resulting from abdominis muscle haematoma associated with the use of anticoagulation therapy.

The article informs that cough is one of the most frequent reasons for seeking a consultation with a doctor, and a cough lasting for more than 3 weeks may be related to a variety of pulmonary and nonpulmonary causes that include asthma, chronic rhinosinusitis, and gastro-oesophageal reflux (GOR). GOR, the movement of acid and other components of gastric contents from the oesophagus into the larynx and trachea, is one of the most commonly associated causes of chronic cough in all age groups. GOR may lead to symptoms or physical complications such as heartburn, chest pain, a sour taste, or regurgitation, and also a chronic persistent cough.

Editorial. Discusses the diagnosis of asthma in children. Basis of diagnosis in primary care on symptoms; Presentation of children with asthma in general practice; Characteristics of cough in asthma; Complexity of the cellular features and mechanisms which underlie the clinical syndrome of pediatric asthma.

The article presents abstracts on medical topics which include the articles "SEF Classification for COPD Management," by Asif Mujtaba and colleagues, "Predictors of Mortality for Adult Medical Emergency Patients with Pneumonia in Indonesia," by Martin Winardi and colleagues, and "Prostacyclin and Cough in Patients With Sinobronchial Syndrome," by Masaki Fujimura and colleagues.

The article presents abstracts of articles related to clinical respiratory medicine including "Prostacyclin and Cough in Patients With Bronchial Asthma," by Hideko Ikeda and colleagues, "It's Time to Call Attention to Clinical Significance of Basidiomycetous Fungi in Chronic Cough," by Haruhiko Ogawa, Masaki Fujimura, and Noriyuki Ohkura, and one on the therapeutic effects of Tai Chi in patients with chronic obstructive pulmonary disease (COPD).

The article presents abstracts of articles related to chronic obstructive pulmonary disease (COPD) including "Diagnostic Value of Tumor M2 Pyruvate Kinase in Patients With Lung Cancer," by Asuman Aslankara and colleagues, "Effects of Indacaterol in Addition to Tiotropium in Patients with COPD," by Tsukasa Ohnishi and colleagues, and "Prostacyclin and Cough in Patients with Bronchial Asthma," by Yoshihisa Ishiura and colleagues.