Uncommon causes of chronic cough associated with airway eosinophilia.
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ABSTRACT:
SUBMITTER: Xie J
PROVIDER: S-EPMC8182545 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
Uncommon causes of chronic cough associated with airway eosinophilia.
Xie Jiaxing J Chung Kian Fan KF Lai Kefang K
Journal of thoracic disease 20210501 5
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Project description:Introduction Chronic cough may represent a diagnostic challenge. Chronic parasitism of upper airways is an unusual cause. Objective To describe a case of human syngamosis as an uncommon cause of dry cough. Case Report An endoscopic exam performed in a woman suffering of chronic cough revealed a Y-shaped worm in the larynx identified as Syngamus laryngeus. Discussion This nematode parasitizes the upper respiratory tract of many animals including humans. The diagnosis is performed by the examination of the worm expelled by cough or by endoscopy. Endoscopic exam is easy to perform and is essential in the diagnosis of causes of chronic cough, even uncommon entities. Removal is the only efficient treatment.
| S-EPMC4399166 | biostudies-other
Project description:RationaleStructural airway changes related to chronic cough (CC) are described in the literature, but so far reported data are rare and non-conclusive. Furthermore, they derive mainly from cohorts with small sample sizes. Advanced CT imaging not only allows airway abnormalities to be quantified, but also to count the number of visible airways. The current study evaluates these airway abnormalities in CC and assesses the contribution of CC in addition to CT findings on the progression of airflow limitation, defined as a decline in forced expiratory volume in 1 s (FEV1) over time.MethodsA total of 1183 males and females aged ≥40 years with thoracic CT scans and valid spirometry from Canadian Obstructive Lung Disease, a Canadian multicentre, population-based study has been included in this analysis. Participants were stratified into 286 never-smokers, 297 ever-smokers with normal lung function and 600 with chronic obstructive pulmonary disease (COPD) of different severity grades. Imaging parameters analyses included total airway count (TAC), airway wall thickness, emphysema as well as parameters for functional small airway disease quantification.ResultsIrrespective of COPD presence, CC was not related to specific airway and lung structure features. Independent of TAC and emphysema score, CC was highly associated with FEV1 decline over time in the entire study population, particularly in ever-smokers (p<0.0001).ConclusionThe absence of specific structural CT features independently from COPD presence indicate that other underlying mechanisms are contributing to the symptomatology of CC. On top of derived CT parameters, CC seems to be independently associated with FEV1 decline.Trial registration numberNCT00920348.
| S-EPMC10186404 | biostudies-literature
Project description:BackgroundThe mechanisms of chronic cough are unclear. Many reactive oxygen species affect airway sensory C-fibres which are capable to induce cough. Several chronic lung diseases are characterised by cough and oxidative stress. In asthma, an association between the cough severity and airway oxidative stress has been demonstrated. The present study was conducted to investigate whether airway oxidative stress is associated with chronic cough in subjects without chronic lung diseases.MethodsExhaled breath condensate samples were obtained in 43 non-smoking patients with chronic cough and 15 healthy subjects. Exclusion criteria included a doctor's diagnosis of any lung disorders and any abnormality in lung x-ray. The concentration of 8-isoprostane was measured. In addition, the patients filled in Leicester Cough Questionnaire and underwent hypertonic saline cough provocation test, spirometry, ambulatory peak flow monitoring, nitric oxide measurement, and histamine airway challenge. In a subgroup of patients the measurements were repeated during 12 weeks' treatment with inhaled budesonide, 800 ug/day.ResultsThe 8-isoprostane concentrations were higher in the cough patients than in the healthy subjects (24.6 ± 1.2 pg/ml vs. 10.1 ± 1.7 pg/ml, p = 0.045). The 8-isoprostane concentration was associated with the Leicester Cough Questionnaire total score (p = 0.044) but not with the cough sensitivity to saline or other tests. Budesonide treatment did not affect the 8-isoprostane concentrations.ConclusionsChronic cough seems to be associated with airway oxidative stress in subjects with chronic cough but without chronic lung diseases. This finding may help to develop novel antitussive drugs.Trial registrationThe study was registered in ClinicalTrials.gov database (KUH5801112), identifier NCT00859274.
| S-EPMC4176500 | biostudies-literature
Project description: Not available
| S-EPMC6548022 | biostudies-literature
Project description:Background & aimsAlthough chronic cough is common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough.MethodsWe performed a blinded, cross-sectional study of nonsmoking patients with chronic cough (duration, >8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression.ResultsSeventeen patients met the inclusion criteria (88% female; 100% white; median age, 63 years [interquartile age range, 52-66 years]; mean body mass index, 30.6 [interquartile range, 27.9-34.0]); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 minutes after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17-1.82; P < .001) and 1.71-fold in association with the combination of phonation and reflux events.ConclusionsAntecedent phonation and reflux increased the rate of cough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough ClinicalTrials.gov number: NCT01263626.
| S-EPMC4761487 | biostudies-literature
Project description:Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management.
| S-EPMC9244241 | biostudies-literature
Project description:BackgroundChronic cough has many diverse causes, including common and uncommon causes. There are few comprehensive reports on rare causes of chronic cough. The purpose of this study is to determine the etiological distribution, clinical features, and diagnostic value of special examinations in patients with rare causes of chronic cough.MethodsA retrospective analysis of patients with chronic cough who underwent medical history taking, full examination, and etiological treatment over a 13-year period was conducted. Causes of chronic cough with a prevalence of less than 3% were defined as rare causes.ResultsA total of 1,554 patients were enrolled, and 39 causes of chronic cough were identified. Among them, 1,055 cases were due to common causes, whereas 235 cases were due to rare causes; the causes involved 7 bodily systems. The top five rare causes were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, obstructive sleep apnea syndrome (OSAS), and interstitial lung disease, accounting for 67.2% of all rare causes. Among 235 patients with rare causes, causes in 90 (38.3%) patients were detected by chest high-resolution computed tomography (HRCT), in 44 (18.7%) patients by bronchoscopy/nasopharyngoscopy, and in 21 (8.9%) patients by pulmonary spirometry and diffusing capacity testing.ConclusionsAmong the 31 rare causes of chronic cough in this cohort, the top five were protracted bacterial bronchitis, somatic cough syndrome, diffuse panbronchiolitis, OSAS, and interstitial lung disease. Special examinations, such as chest HRCT and bronchoscopy, should be considered after excluding common causes of chronic cough.
| S-EPMC8107567 | biostudies-literature
Project description:BackgroundSputum eosinophilia is a treatable trait for chronic cough. It is currently not clear whether the blood eosinophil counts could be used to identify sputum eosinophilia in patients with chronic cough. This study aimed to evaluate the diagnostic accuracy of blood eosinophils in comparison to other common type 2 biomarkers for identifying sputum eosinophilia in patients with chronic cough.MethodsIn this prospective study, a total of 658 patients with chronic cough were enrolled. Induced-sputum test, routine blood test, total immunoglobulin E (TIgE), and fractional exhaled nitric oxide (FeNO) level were measured. The percentage of sputum eosinophils (Eos%) ≥ 2.5% was defined as sputum eosinophilia. The area under the curve (AUC) of blood eosinophil counts, TIgE, and FeNO alone or in combination for predicting sputum eosinophilia were analyzed.ResultsThe AUC of blood eosinophil counts for predicting sputum eosinophilia in chronic cough patients was moderate [0.826 (0.767-0.885)], as compared to that of FeNO [0.784 (0.720-0.849), P = 0.280] and TIgE [0.686 (0.613-0.760), P = 0.001]. When combining blood eosinophil counts and FeNO for detecting sputum eosinophilia, a significantly larger AUC [0.868 (0.814-0.923), with a sensitivity of 84.2% and a specificity of 82.8%] was yielded, as compared to each single marker alone (all P < 0.05).ConclusionsBlood eosinophil counts have a moderate diagnostic value for identifying sputum eosinophilia in patients with chronic cough, while a combination of blood eosinophil counts and FeNO measurement can provide additional predictive value.
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Project description:BackgroundGabapentin is recommended for the treatment of chronic refractory cough (CRC). This study aims to identify its therapeutic predictors in a prospective clinical study.MethodsA total of 179 patients with CRC were treated with gabapentin. Prior to the therapy, all patients were assessed by Hull Airway Reflux Questionnaire (HARQ) and inhaled capsaicin challenge. When the treatment ended and cough resolution was confirmed, a stepwise logistic regression analysis was performed to identify the therapeutic predictors for gabapentin and to establish the prediction equation.ResultsGabapentin treatment achieved a therapeutic success rate of 66.48%. HARQ scores were significantly higher in responders than non-responders to gabapentin (29.79 ± 9.58 versus 21.95 ± 7.83, t = -3.685, p <0.001), which were positively related to the therapeutic efficacy of gabapentin (r = 0.433, p <0.001). The optimal cutoff point of 21.50 in HARQ presented with a moderate ability to predict gabapentin efficacy, with a sensitivity of 84.60% and specificity of 63.60%. Multiple logistic regression identified items of "A tickle in your throat, or a lump in your throat" (OR = 7.927, p = 0.005), "Cough when you get out of bed in the morning" (OR = 7.016, p = 0.045), and "Cough with eating" (OR = 6.689, p = 0.011) as independent predictors. The established logistic regression equation predicted 83.72% of the treatment success rate of gabapentin, which was verified by consequent preliminary revalidating study in 59 patients.ConclusionHARQ may be useful to screen patients with CRC most likely responsive to gabapentin, and help improve the therapeutic success.Trial registrationhttp://www.chictr.org/; No.: ChiCTR-ONC-13003123.
| S-EPMC7768311 | biostudies-literature
Project description:Chronic cough is one of the most common reasons for referral to a respiratory physician. Although fatal complications are rare, it may cause considerable distress in the patient's daily life. Western and local data shows that in patients with a normal chest radiograph, the most common causes are postnasal drip syndrome, postinfectious cough, gastro-oesophageal reflux disease and cough variant asthma. Less common causes are the use of angiotensin-converting enzyme inhibitors, smoker's cough and nonasthmatic eosinophilic bronchitis. A detailed history-taking and physical examination will provide a diagnosis in most patients, even at the primary care level. Some cases may need further investigations or specialist referral for diagnosis.
| S-EPMC4759375 | biostudies-literature