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Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5–2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin. [ABSTRACT FROM AUTHOR]

Individuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6-14.2]), phlegm production (OR 4.9 [95% CI: 2.2-10.5]), cough (OR 7.0 [95% CI: 3.0-16.2]), and dyspnea (OR 7.2 [95% CI: 1.7-31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1-21.9]) and bronchitis (OR 3.8 [95% CI: 1.9-7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population. [ABSTRACT FROM AUTHOR]

Objective Cineole has mucolytic, bronchodilating and anti-inflammatory properties and reduces the exacerbation rate in patients suffering from COPD, as well as ameliorates symptoms in patients suffering from asthma and rhinosinusitis. Based on these effects, we therefore postulated the hypothesis that patients with acute bronchitis would also benefit from therapy with Cineole. Methods As part of a double-blind, placebo-controlled, multi-center-study, a total of 242 patients with confirmed acute bronchitis was randomly selected to participate. Over a period of 10 days, all patients were administered 3 x 200 mg of Cineole, or a respective placebo, per day. The primary outcome measure was a Bronchitis Sum Score, which summarises the relevant symptoms of acute bronchitis. Results After 4 days of treatment it was notable, that the patient group treated with Cineole, showed significantly more improvements of the bronchitis-sum-score than those of the placebo group (p = 0.0383). The statistical significant difference of the individual outcome measures was especially underlined by the frequency of cough fits by p = 0.0001 after 4 days. Conclusions The effects of Cineole in the treatment of acute bronchitis were clearly measurable and could be proven after a treatment period of merely 4 days. This study corroborates the fact that Cineole actively and significantly reduces cough frequency after four days. Therefore it has been shown to have a great socioeconomic impact. Trial registration ISRCTN: ISRCTN37784439 [ABSTRACT FROM AUTHOR]

Over the last 40 years the assessment and treatment of chronic obstructive pulmonary disease has focused primarily on airflow obstruction with little significance given to the problem of cough. The reasons for this include a view that cough arises simply from the direct irritant and inflammatory effect of cigarette smoke or the presence of excess mucus in the airways. Doubt that cough is of any consequence to patients or responsive to current therapies has reinforced this opinion. At odds with this is the emerging evidence that cough impacts adversely on patients' health status and forms an important component of recently validated quality of life instruments. This article presents the arguments why the assessment and treatment of cough should have a more prominent place in the clinical management of COPD. [ABSTRACT FROM AUTHOR]

The article presents a study that assessed the efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The participants of the trial performed cycles of manually assisted breathing techniques with the addition of temporary positive expiratory pressure, and the control group was treated by manually assisted breathing techniques. Evidence showed that inspiratory capacity was higher in the active than in the control group.

The article offers helpful clues to coughs that can be self-managed and those which need to be taken more seriously. It describes the classifications of coughing, such as acute, resolving and chronic and persistent, and their underlying causes and symptoms. It also discusses the importance of taking a good history, when to refer and any medication or remedy that might help to alleviate the cough.

Upper-airway cough syndrome often coexists with other diseases that elicit chronic cough. However, the concomitant conditions are not always relevant to chronic cough, which complicates the cause diagnosis of chronic cough. The objective of this study was to explore the diagnosis and clinical implication of upper-airway cough syndrome with latent eosinophilic bronchitis. Eleven patients with upper-airway cough syndrome and latent eosinophilic bronchitis were retrospectively analyzed for their clinical manifestations, changes of eosinophilia in induced sputum, and cough threshold with capsaicin defined as capsaicin concentration that elicits two or more coughs (C2) and five or more coughs (C5) between pretreatment and post-treatment. All patients reported a history of allergic rhinitis, showed persistent dry cough or small amounts of viscid sputum with a time course of 2–60 months (median = 7 months), and presented with symptoms and signs of rhinitis, normal lung function, and airway responsiveness. Initial eosinophil percentage in induced sputum was 3.5–8.0%. Cough disappeared after 2–5 (3 ± 1) weeks of only oral antihistamine. With successful treatment, cough threshold C2 increased from 1.73 ± 1.45 to 4.43 ± 4.50 μmol/L ( t = 2.64, P = 0.025) and C5 increased from 2.79 ± 2.16 to 10.10 ± 8.22 μmol/L ( t = 3.10, P = 0.011). However, there was no significant change of eosinophil percentage in induced sputum (4.8 ± 1.5% vs. 4.4 ± 1.4%, t = 0.84, P = 0.427). Upper-airway cough syndrome with latent eosinophilic bronchitis is a unique condition. The recognition of the entity may avoid unnecessary use of corticosteroids. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the relation between bronchoconstriction and cough induced by methacholine (Mch) inhalation and to elucidate the role of C-fibers and rapidly adapting irritant receptors (RARs) in these reactions in conscious guinea pigs. The authors measured enhanced pause (Penh) as an index of bronchoconstriction and also measured the number of coughs induced by Mch inhalation in conscious guinea pigs. The authors also examined the effects of pretreatment with procaterol, capsaicin desensitization and moguisteine on these responses. There was a significant positive correlation between the increase in Penh and the number of coughs induced by Mch inhalation. Procaterol (0.1 mg/kg, intraperitoneal [i.p.]) completely abolished both the Mch-induced increase in Penh and cough. Capsaicin desensitization had no effect on Penh or the number of coughs. Moguisteine (0.02, 0.2, or 2 mg/kg, i.p.) dose-dependently inhibited the number of coughs but not the increase in Penh induced by Mch inhalation. Bronchoconstriction causes cough via RARs, but not C-fibers. Neither RARs nor C-fibers are involved in Mch-induced bronchoconstriction itself. [ABSTRACT FROM AUTHOR]

The article evaluates the role of exhaled nitric oxide (NO) for the investigation of chronic cough, especially of nonasthmatic eosinophilic bronchitis (NAEB). The results indicate that exhaled NO measurement may be useful as part of the initial evaluation for chronic cough, especially for the exclusion of NAEB. A low level of NO suggested little likelihood of NAEB for the nonasthamtic patients with chronic cough.

The article presents information on uncommon causes of cough. It focuses on identification of substantial number of uncommon or rare pulmonary and nonpulmonary disorders. Cough leads to respiratory diseases such as asthma or bronchitis. Cough is characterized as the most common respiratory symptom encountered by clinicians. Chronic cough, defined as cough lasting for more than 8 weeks, may interfere with patients' normal daily activities. Tracheobronchomegaly is an uncommon disorder that includes dilatation of the tracheobronchial tree and recurrent bouts of bronchitis and lung infections.

The article analyzes the pathogenesis, natural history, diagnosis, and therapeutics of chronic cough due to nonasthmatic eosinophilic bronchitis. One of the common cause of chronic cough is nonasthmatic eosinophilic bronchitis. The condition is manifested as a corticosteroid-responsive chronic cough in nonsmokers without airway function abnormalities that characterize asthma. A further characterization of the condition has been made possible by the development of safe and noninvasive processes of examining airway inflammation using induced sputum.

The article presents evidence for the diagnosis and treatment of cough due to chronic bronchitis. Chronic bronchitis is a bronchi disease where there is occurrence of cough and sputum expectoration when other respiratory or cardiac causes for the chronic productive cough are not considered. It is a cough phlegm syndrome and is caused by the interplay of noxious inhaled agents host factors. This interaction results in chronic inflammation in the walls and lumen of the airways. Researchers have found that avoidance is the most effective way to reduce or eliminate cough in patients with chronic bronchitis.

TRPV1 is a modulator of noxious stimuli known to be important in the cough reflex. We have compared the expression of TRPV1 in normal human airways and those from patients with chronic cough and found that there is up regulation in airways smooth muscle in disease. This increased expression appears to be intracellular and we have therefore examined the role of intracellular rat and human TRPV1 activity was found using intracellular calcium signalling with human intracellular TRPV1 being located in a thapsigargin insensitive compartment. Increase in TRPV1 activity may have a role in the airway hypersensitivity seen in chronic cough. [ABSTRACT FROM AUTHOR]

Background: Smoking is the primary cause of deterioration in forced expiratory volume (FEV1) and the development of chronic obstructive lung disease. This study assessed the independent association of smoking with respiratory symptoms and lung function in young adults who took part in the European Community Respiratory Health Survey (ECRHS-I). Methods: Cross-sectional multi-centre survey of a general population of young adults aged 20(44 years in the ECRHS(I conducted in five Spanish centres. Several groups were created in an exclusive and descendent manner from the subjects who completed the questionnaire in accordance with how they had answered the questions: asthma-related symptoms; chronic bronchitis symptoms; minor respiratory symptoms; chronic cough; and no respiratory symptoms. Among a subset of the population, forced spirometry tests were performed. Linear and logistical regression models were used to assess the relationship of smoking in the presence of symptoms and its impact on lung function, adjusted by other important variables. Results: The prevalence of respiratory symptoms was higher among smokers. After adjusting for geographical area, total IgE, age, sex, and FEV1, smoking was associated with an increased risk of chronic bronchitis and other respiratory symptoms. These risks increased with increasing number of cigarettes smoked per day. A deterioration of FEV1 and the FEV1/FVC ratio was also directly associated with the number of cigarettes smoked per day. Conclusion: Even among young adults, smoking confers a high risk of developing a number of respiratory symptoms and the deterioration of the ventilatory function. [ABSTRACT FROM AUTHOR]

Abstract: Findings by other authors indicate that exposure to chemical emissions from indoor paint is related to asthma symptoms in adults. In their first years of life children are receptive to obstructive airway diseases. The aim of this study was to investigate the influence of redecoration of the apartment on airway symptoms in infants during the first two years of life. The Leipzig Allergy Risk Children Study (LARS) is a birth cohort study with the following inclusion criteria: double positive family atopy anamnesis, cord blood IgE>0.9 kU/l, or low birth weight between 1500 – 2500 g. Within the context of LARS, 186 parents of risk children completed a questionnaire on the respiratory symptoms of their children and the redecoration of their apartment at the end of the first and second year of life. A total 22% of the children suffered from obstructive bronchitis once or more during their first year, and 11% experienced this condition during their second year of life. Redecoration of the apartment had a significant influence on the appearance of obstructive bronchitis in the first (OR 4.1 95%CI 1.4 – 11.9) and in the second year of life (OR 4.2 95%CI 1.4 – 12.9). (The OR are adjusted for cord blood-IgE >0.9 kU/l, birth weight ≤2500 g, male sex and double positive parental atopy anamnesis, dampness, smoking or pet in the apartment). Simultaneous contamination from redecoration activities and additional exposures such as smoking, a pet or dampness in the apartment increased the risk for obstructive bronchitis in the first year (OR 9.1; 95% CI 2.3 – 34.8) as well as in the second year (OR 5.1; 95%CI 1.6 – 15.6). Our data suggest that redecoration of the apartment is associated with the development of acute inflammations, but not with a chronic influence on the airways in atopy risk infants. At an exposure to more than one environmental factor, pronounced effects were seen. [Copyright &y& Elsevier]

BACKGROUND. The purpose of this study was to determine how family physicians in the United States diagnose acute bronchitis in otherwise healthy adults. METHODS. A 33-item questionnaire on the diagnosis and treatment of acute bronchitis was mailed to a random sample of 500 physicians who are members of the American Board of Family Practice. RESULTS. Two hundred sixty-five physicians responded. Of those who did hot respond, 32 could not be located. Of those who did respond, 10 were either retired or were practicing in another specialty. The net response rate was 56% (255/458). Responding physicians stated that character of cough and sputum production are the most important items used in diagnosing acute bronchitis. Fifty-eight percent indicated that the cough should be productive, and 60% stated that the sputum should be purulent. Seventy-two percent of respondents did not feel that wheezing or rhonchi need to be present. Younger physicians and those who selected antibiotics as their first treatment choice were more likely to define acute bronchitis as the presence of a productive cough with purulent sputum (P<.05). Physicians from an academic setting were more likely to define acute bronchitis as a productive cough (P<.05). Thirty-six percent of physicians from practices serving populations with ≥60% managed care patients included wheezing or rhonchi in the definition of acute bronchitis, compared with 26% of all others (P<.05). CONCLUSIONS. Variations in the diagnosis of acute bronchitis in otherwise healthy adults can be attributed to physician age, treatment choice, and practice setting. A significant number of family physicians did not require a productive cough as part of the diagnostic criteria for acute bronchitis. This finding needs to be considered in studies evaluating treatment. Additional qualitative studies are necessary to identify other factors involved in diagnosing acute bronchitis. [ABSTRACT FROM AUTHOR]

Plastic bronchitis is a rare, potentially life-threatening condition in which protein casts form within and occlude the bronchus, resulting in pulmonary failure, and has been identified as a complication after the Fontan procedure. We present a case of a 5-year-old girl who had undergone an extracardiac fenestrated Fontan repair as a component of staged palliation for tricuspid atresia. Six weeks following surgery, the patient presented with airway obstruction, coughing a bronchial cast. Medical therapies to optimize heart function and attempt to control cast formation were implemented, with little clinical impact. Following cardiac catheterization to stent open the fenestration, the symptoms of plastic bronchitis resolved. Cast expectoration recurred following spontaneous closure of the stented fenestration and again resolved with recreation of the baffle defect. Fenestration of the Fontan circuit alters hemodynamics, thereby providing an additional therapeutic option for this devastating disorder. [ABSTRACT FROM AUTHOR]

Eosinophilic bronchitis is an important cause of chronic cough. It is characterised by eosinophilic airway inflammation in the absence of airway hyperresponsiveness or other markers of variable airflow obstruction. Treatment with inhaled corticosteroids is associated with a short term improvement in cough and reduced sputum eosinophil count but the longer term outcome is uncertain. Reflux cough is a diagnosis based on the demonstration of gastroesophageal reflux on 24 hour oesophageal pH monitoring (OpHM) and a positive response to anti-reflux therapy. The aim of the study was to determine both the early and long term response to anti-reflux therapy in those with a "positive" pH study, and identily any features on OpHM which could accurately predict response therapy.

In the Hispanic Health and Nutrition Examination Survey (HHANES). Puerto Ricans had a higher age-adjusted prevalence of self-reported chronic bronchitis (2.9 percent. 95% CI = 2.2, 3.6) than Mexican Americans (1.7 percent, 95% CI = 1.3, 2.1) or Cubans (1.7 percent, 95% CI = 0.9, 2.5). The prevalence of chronic bronchitis was at least 2 times higher in smokers as compared to nonsmokers among Puerto Ricans and Cubans, but not for Mexican America. [ABSTRACT FROM AUTHOR]

This article presents a study, which seeks to examine whether inhaled beta-agonists control cough in upper respiratory infections or acute bronchitis. It notes that even without a history of lung disease, patients presenting with cough due to acute respiratory illness and with evidence of airflow obstruction appear to receive symptom relief from inhaled beta-agonists. Smokers may be another subgroup who benefit from treatment. However, important patient-oriented outcomes do not improve. If using inhaled albuterol to treat acute cough in practice, one must also consider the financial costs and adverse effects associated with treatment.

Background The fumes and gases released during welding can lead to respiratory ill-health. Aims To assess prevalence of respiratory symptoms (RS) and respiratory function (RF) of welders in comparison to a control group (CG). Methods A cross-sectional study was conducted among welders and controls selected from office support staff of a medical faculty. RS were determined by administering a questionnaire and RF with the use of an electronic spirometer. Results Forty-one welders and 41 controls participated. Chronic bronchitis was significantly higher among welders (27%; n = 11) than in controls (7%; n = 3) with an odds ratio of 4.6 [95% confidence interval (CI): 1.1–23.3]. Forced vital capacity (FVC), forced expiratory volume in the first second of forced vital capacity (FEV1.0), forced mid-expiratory flow rate (FEF25–75%) and peak expiratory flow rate (PEFR) were slightly higher among welders (2.97 l, 2.6 l, 3.4 l/s and 339 l/min, respectively) than in the CG (2.79 l, 2.4 l, 3.38 l/s and 323 l/min, respectively), the differences of which were not statistically significant. On comparison of the observed values of welders with the predicted normal values, the observed FVC (2.97 versus 3.35 l, respectively) and PEFR (339 versus 538 l/min) had significantly lower values. Conclusions Welders are at a higher risk of developing chronic bronchitis with non-impairment of lung function in comparison to the CG. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Although the main risk factor is smoking, 15–19% of COPD even in smokers has been attributed to occupational exposures. The aim of this study was to investigate the association between occupational exposure and risk of COPD. Methods: Participants were part of a cross-sectional study of risk factors for COPD. A total of 1232 completed a detailed respiratory questionnaire, spirometric testing and measurement of gas transfer. Job histories were coded according to the International Standard Classification of Occupations. These codes were then used to establish occupational exposures using the ALOHA job exposure matrix. Results: The prevalence of emphysema was 2.4%, chronic obstructive bronchitis 1.8%, and COPD 3.4%. Subjects ever exposed to biological dusts had an increased risk of chronic obstructive bronchitis (OR 3.19; 95% CI 1.27–7.97), emphysema (OR 3.18; 95% CI 1.41–7.13), and COPD (OR 2.70, 95% CI 1.39–5.23). These risks were higher in women than in men. For biological dust, the risk of emphysema and COPD was also significantly increased in both the duration of exposure categories, again in women but not in men. No significant increased risks for COPD were found for mineral dust (OR 1.13; 95% CI 0.57–2.27) or gases/fumes (OR 1.63; 95% CI 0.83–3.22). Conclusion: In this general population sample of adults, occupational exposures to biological dusts were associated with an increased risk of COPD which was higher in women. Preventive strategies should be aimed at reducing exposure to these agents in the workplace. Reproduced with permission from the BMJ Publishing Group. [Copyright &y& Elsevier]