Search

Introduction and Aims The TRPA1 ion channel is thought to have an important role in the cough reflex. It has been demonstrated that agonisation of TRPA1 receptors by inhalation of cinnamaldehyde, a specific agonist of TRPA1, induces cough in normal human volunteers. We wanted to determine the expression and characterisation of the TRPA1 receptor in human lung tissue. Methods Bronchial biopsies were obtained from patients with the Cough Hypersensitivity Syndrome on fibre-optic bronchoscopy. Biopsies were obtained from a major bronchus. Lung resection samples were obtained from patients undergoing surgery for lung cancer. Dorsal root ganglia were used as a positive control. These tissue samples were analysed by immunohistochemistry with a specific TRPA1 antibody. Results Samples from 14 patients (11 males, mean age 56 years) with the Cough Hypersensitivity Syndrome and 10 lung resection samples (6 males, mean age 68 years) were obtained. All the tissue samples stained for TRPA1. The TRPA1 stain was avidly taken up by the bronchial epithelium, smooth muscle bundles and nerve tissue. Conclusion We have described the distribution of the TRPA1 ion channel in lung tissue. TRPA1 is agonised by several environmental irritants and endogenous mediators of inflammation. The presence of TRPA1 ion channel in bronchial mucosal nerves and epithelium suggests an important role in the cough reflex. The identification of these ion channels on smooth muscle could suggest a role in asthmatic inflammation as well.

We read with interest the article by Qureshi and colleagues describing thoracic ultrasound (TUS) characteristics for the detection of malignant pleural effusions.1 This relatively simple bedside technique has been routinely performed by the respiratory physicians in our department in a busy general hospital for the last 4 years, resulting in a gradual reduction in the number of radiology departmental procedures from 63 to 17 per annum. A recent audit of our activity showed that over a period of 18 …

Introduction Gastro oesophageal reflux (GOR) is a very common cause for chronic cough. The clinical history of airway reflux differs from that of GOR disease and often the diagnosis of airways reflux is not considered. Although oesophageal investigations can support the diagnosis these are invasive, time consuming and expensive. The presence of pepsin in the oesophagus, or more proximally in the pharynx or the airways, suggest GOR. The aim of this study was to study the diagnostic utility of measuring pepsin in expectorated saliva in unselected patients presenting with chronic cough. Methods Consecutive patients referred to the Hull Cough Clinic were instructed to collect expectorated saliva on three occasions following symptoms (paroxysm of cough). Saliva was collected into tubes containing 0.5 ml of 0.01 M citric acid and analysed for the presence of pepsin using a lateral flow test comprising two unique human monoclonal antibodies to pepsin (Peptest™, RDBiomed Ltd). The cut off value to determine pepsin positivity was 25 ng/ml. Patients also completed the Hull Airways Reflux Questionnaire (HARQ), a validated tool to diagnose airways reflux. Results 72 patients were included in this study (females 49, mean age 58.3 years). Salivary pepsin assay was positive in at least one sample in 46 (64%). 24, 10 and 12 patients had 1, 2 and 3 positive tests respectively. 10 samples had pepsin levels above 250 ng/ml. For purpose of comparison this data was examined against 300 similar pepsin assays from 100 healthy subjects with no typical or atypical reflux symptoms. In this group only 6 of 300 samples had more than 250 ng/ml of pepsin measured and 64% had all three samples negative for pepsin. 1 This is shown in table 1. The median HARQ score was 30 (range 1–67). Conclusion A high proportion of patients with chronic cough have demonstrable levels of pepsin in expectorated saliva at the time of having symptoms. This non invasive test may be a useful investigation to support the diagnosis of airway reflux. References Hayat JO et al . Is pepsin detected in the saliva of healthy individuals? Gut 2013: 62 (Suppl 1) A108–A109.

We read with interest the article by Gonzalez et al 1 on gender differences in survival following hospitalisation of chronic obstructive pulmonary disease (COPD) patients in a large cohort of a Canadian population. There are limited data on gender differences and mortality in COPD. Despite women having worse dyspnoea and health status, they appear to have a lower mortality rate than men.2 The study conducted by Gonzalez and coworkers demonstrated an interesting finding of a significantly better mean survival and time to rehospitalisation in female patients. We conducted a study of …

A 76-year-old male who was a previous smoker presented with symptoms suggestive of recurrent lower respiratory tract infections. There was no associated anorexia, weight loss or breathlessness. During one of these episodes he had …