The Experts below are selected from a list of 20094 Experts worldwide ranked by ideXlab platform
Peter G. Gibson - One of the best experts on this subject based on the ideXlab platform.
-
Chronic Cough in vocal cord dysfunction description of a clinical entity
Respiratory Medicine, 2020Co-Authors: Sarah L Kapela, Anne E Vertigan, Peter G. GibsonAbstract:Abstract Background and aim Vocal Cord Dysfunction (VCD) and Chronic Cough (CC) are challenging conditions which lead to significant quality of life impairment. The underlying mechanisms are poorly understood, but laryngeal dysfunction may be common to both conditions. The aim of this study was to determine the characteristics of Cough in VCD and whether patients with Cough have coexisting VCD. Method Participants included 51 patients with VCD and a comparison group of 39 patients with Chronic Cough that was refractory to medical treatment. Participants underwent a comprehensive assessment including questionnaires, laryngoscopy, Cough frequency monitoring and voice testing. Results Patients with VCD had significant Cough morbidity with an increased Cough frequency of 17.3 Coughs/hour and reduced Cough quality of life with mean Leicester Cough Questionnaire Score of 12.8. Breathing pattern abnormalities were also common in VCD and there was a strong correlation between the number of breathing pattern abnormalities and Cough frequency (r = −0.827, p = 0.002). Cough measures were not significantly different between patients with VCD and those with CC. Moderate-severe PVFM was present in 69% of patients with CC. Abnormal vocal fold closure during phonation was also present in patients with Chronic Cough and was similar between the VCD (n = 40, 78.4%) and Cough (n = 25, 64.1%) groups, p = 0.240. Conclusion Cough is an important symptom in VCD. Patients presenting with Chronic Cough may have underlying VCD as a cause of their Cough. Since Cough and VCD symptoms co-occur clinicians need to consider Cough when are treating VCD and VCD when treating Chronic Cough.
-
treatment of unexplained Chronic Cough chest guideline and expert panel report
Chest, 2016Co-Authors: Peter G. Gibson, Lorcan Mcgarvey, Anne E Vertigan, Kenneth W Altman, Gang Wang, Surinder S BirringAbstract:Background Unexplained Chronic Cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC. Methods This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for Cough severity, Cough frequency, and Cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a Chronic Cough of > 8 weeks' duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the American College of Chest Physicians organization methodology. Results Eleven RCTs and five systematic reviews were included. The 11 RCTs reported data on 570 participants with Chronic Cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used an assortment of descriptors and assessments to identify UCC. Although gabapentin and morphine exhibited positive effects on Cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) were affected by intervention fidelity bias; when this factor was addressed, ICS were found to be ineffective for UCC. Esomeprazole was ineffective for UCC without features of gastroesophageal acid reflux. Studies addressing nonacid gastroesophageal reflux disease were not identified. A multimodality speech pathology intervention improved Cough severity. Conclusions The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology-based Cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge as well as areas for future research.
-
arnold s nerve Cough reflex evidence for Chronic Cough as a sensory vagal neuropathy
Journal of Thoracic Disease, 2014Co-Authors: Nicole M Ryan, Peter G. Gibson, Surinder S BirringAbstract:Arnold’s nerve ear-Cough reflex is recognised to occur uncommonly in patients with Chronic Cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflex Cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic Cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory Chronic Cough was due to sensory neuropathy associated with ear-Cough reflex hypersensitivity. In both cases, the Cough as well as the Arnold’s nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of Cough due to sensory laryngeal neuropathy (SLN).
-
gabapentin for refractory Chronic Cough a randomised double blind placebo controlled trial
The Lancet, 2012Co-Authors: Surinder S Birring, Nicole M Ryan, Peter G. GibsonAbstract:Summary Background Refractory Chronic Cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory Chronic Cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory Chronic Cough. We established the efficacy of gabapentin in patients with refractory Chronic Cough. Methods This randomised, double-blind, placebo-controlled trial was undertaken at an outpatient clinic in Australia. Adults with refractory Chronic Cough (>8 weeks' duration) without active respiratory disease or infection were randomly assigned to receive gabapentin (maximum tolerable daily dose of 1800 mg) or matching placebo for 10 weeks. Block randomisation was done with randomisation generator software, stratified by sex. Patients and investigators were masked to assigned treatment. The primary endpoint was change in Cough-specific quality of life (Leicester Cough questionnaire [LCQ] score) from baseline to 8 weeks of treatment, analysed by intention to treat. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000248369. Findings 62 patients were randomly assigned to gabepentin (n=32) or placebo (n=30) and ten patients withdrew before the study end. Gabapentin significantly improved Cough-specific quality of life compared with placebo (between-group difference in LCQ score during treatment period 1·80, 95% CI 0·56–3·04; p=0·004; number needed to treat of 3·58). Side-effects occurred in ten patients (31%) given gabapentin (the most common being nausea and fatigue) and three (10%) given placebo. Interpretation The treatment of refractory Chronic Cough with gabapentin is both effective and well tolerated. These positive effects suggest that central reflex sensitisation is a relevant mechanism in refractory Chronic Cough. Funding National Health and Medical Research Council of Australia and Hunter Medical Research Institute, Newcastle, Australia.
-
Cough reflex sensitivity improves with speech language pathology management of refractory Chronic Cough
Cough, 2010Co-Authors: Nicole M Ryan, Peter G. Gibson, Anne E Vertigan, Sarah L BoneAbstract:Speech language pathology is an effective management intervention for Chronic Cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active Cough suppression, reduced Cough sensitivity or increased Cough threshold from reduced laryngeal irritation. Objective measures such as Cough reflex sensitivity and Cough frequency could be used to determine whether the treatment response was due to reduced underlying Cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed. The aim of this study was to investigate subjective and objective measures of Cough before, during and after speech language pathology treatment for refractory Chronic Cough and the mechanism underlying the improvement. Adults with Chronic Cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory Chronic Cough. The primary outcome measures were capsaicin Cough reflex sensitivity, automated Cough frequency detection and Cough-related quality of life. Following treatment there was a significant improvement in Cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective Cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 Coughs/hr, p = 0.009), and Cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001). This is the first study to show that speech language pathology management is an effective intervention for refractory Chronic Cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased Cough sensitivity, decreased urge to Cough and an increased Cough threshold. Speech language pathology may be a useful and sustained treatment for refractory Chronic Cough. Australian New Zealand Clinical Trials Register, ACTRN12608000284369.
Surinder S Birring - One of the best experts on this subject based on the ideXlab platform.
-
managing Chronic Cough as a symptom in children and management algorithms chest guideline and expert panel report
Chest, 2020Co-Authors: Anne B. Chang, Surinder S Birring, Richard S Irwin, John J Oppenheimer, Todd M Adams, Kenneth W Altman, Elie Azoulay, Fiona H Blackhall, Donald C Bolser, Louis Philippe BouletAbstract:Background Cough is one of the most common presenting symptoms to general practitioners. The objective of this article is to collate the pediatric components of the CHEST Chronic Cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with Chronic Cough. Methods We reviewed all current CHEST Expert Cough Panel's statements and extracted recommendations and suggestions relating to children aged ≤ 14 years with Chronic Cough (> 4 weeks duration). Additionally, we undertook systematic reviews to update other sections we considered relevant and important. Results The eight recent CHEST guidelines relevant to children, based on systematic reviews, reported some high-quality evidence in the management of Chronic Cough in children (eg, use of algorithms and management of wet/productive Cough using appropriate antibiotics). However, much evidence is still inadequate, particularly in the management of non-specific Cough in the community. Conclusions The recommendations and suggestions related to the management of Chronic Cough in the pediatric age group have been based upon high-quality systematic reviews and are summarized in this article. Compared to the 2006 Cough Guidelines, there is now high-quality evidence for some aspects of the management of Chronic Cough in children. However, further studies particularly in primary health care are required.
-
Chronic Cough health status assessment with eq 5d 5l questionnaire
European Respiratory Journal, 2017Co-Authors: Peter Siu Pan Cho, Surinder S Birring, Hannah Fletcher, R D Turner, Irene J HigginsonAbstract:Introduction: EuroQol Five Dimensions Five Level questionnaire (EQ-5D-5L) can be used to assess generic health status and cost-utility. We investigated EQ-5D-5L health status in Chronic Cough and performed a systematic review of the literature in other respiratory diseases. Method: Prospective study of patients with Chronic Cough from a specialist clinic who completed EQ-5D (range -0.594 to 1; high score = better health), Cough severity visual analogue scale (VAS) and Leicester Cough Questionnaire (LCQ). Systematic review of literature was conducted for studies of EQ-5D-5L in other respiratory diseases. Results: 101 patients had Chronic Cough of mean (SD) duration 9 (8) months; mean age 53 (14) years; 68% female. Associated diagnoses included asthma (20%), refractory/unexplained (74%) and other (16%). Median (IQR) symptom and health status scores were: Cough VAS 63 (41-81) mm, LCQ total 10 (8-13), EQ-5D index 0.74 (0.67-0.88) and EQ-5D VAS 66 (50-80). Mean (SD) EQ-5D index for refractory Cough was 0.747 (0.221). EQ-5D index was associated with LCQ (ρ=0.30; p The systematic review identified 4 studies that reported EQ-5D-5L. Mean (SD) EQ-5D index was 0.80 (0.17) in Chronic obstructive pulmonary disease (Nolan, C. M. et al. Thorax 2016; 6:493) and was 0.69 (0.22) in interstitial lung disease (Wapenaar, M. et al. Chron Respir Dis 2016; 1:1479972316674425). Conclusion: Generic health status in Chronic Cough is impaired and is modestly associated with LCQ but not with Cough VAS. Further studies are need to assess health economics with EQ-5D and LCQ in Chronic Cough.
-
physiotherapy and speech and language therapy intervention for Chronic Cough
Pulmonary Pharmacology & Therapeutics, 2017Co-Authors: Surinder S Birring, Sarah V Floyd, Charles C Reilly, Peter Siu Pan ChoAbstract:There are few effective pharmacological therapies available to treat refractory Chronic Cough. Functional MRI studies of the brain have recently shown that patients with Chronic Cough have dysfunctional inhibitory control of Cough. Self-management therapies delivered by physiotherapists or speech therapists are effective at suppressing Cough. They enable patients to consciously suppress the urge to Cough. The intervention consists of education, laryngeal hygiene, Cough suppression and distraction measures and behaviour modification. The efficacy of Physiotherapy and Speech And Language Intervention (PSALTI) has been confirmed in two randomised control trials. In one trial, there was a 41% reduction in Cough frequency with PSALTI, assessed objectively with the Leicester Cough Monitor, and a clinically significant improvement in quality of life. Importantly, the improvement in Cough was sustained when therapy was discontinued. The addition of the Speech Pathology Treatment to neuromodulator drug therapy, Pregabalin has also been evaluated in a clinical trial. There was a clinically significant improvement in quality of life, and this was sustained when therapy was discontinued. The mechanism of action of PSALTI is not known and this should be investigated in future. Further studies are needed to identify the components of PSALTI that deliver the most benefit, and determine whether PSALTI is effective in Cough associated with other Chronic lung disorders.
-
occupational and environmental contributions to Chronic Cough in adults chest expert panel report
Chest, 2016Co-Authors: Susan M Tarlo, Richard S Irwin, Anne E Vertigan, John J Oppenheimer, Todd M Adams, Kenneth W Altman, Elie Azoulay, David J Prezant, Alan F Barker, Surinder S BirringAbstract:Background In response to occupational and environmental exposures, Cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to Chronic Cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. Methods MEDLINE and TOXLINE literature searches were supplemented by articles identified by the Cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of Chronic Cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the Cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full Cough panel. Results The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; Chronic Cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Conclusions Despite increased understanding of Cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of Cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of Cough in the future.
-
validity and reliability of the thai version of the leicester Cough questionnaire in Chronic Cough
Asian Pacific Journal of Allergy and Immunology, 2016Co-Authors: Prapaporn Pornsuriyasak, Surinder S Birring, Theerasuk Kawamatawong, Sasivimol Rattanasiri, Visasiri Tantrakul, T Pongmesa, Ammarin ThakkinstianAbstract:Leicester Cough Questionnaire (LCQ), previously developed in England, is a validated, self-completed QoL instrument for assessment of Chronic Cough. This study aimed to develop a Thai version of the LCQ (LCQ-T) and assess its validityand reliability among adult Thai patients with subacute to Chronic Cough. Methods: A total of 146 patients with a Cough lasting for more than 3 weeks consented to participate in this study and self-administered the LCQ-T, together with the following 3 instruments: Borg Cough Scale (BCS), Short Form-36 (SF-36), and Hospital Anxiety Depression Scale (Thai-HADS). The LCQ-T was developed by applying a forward-backward translation approach. The LCQ-T comprises 19 items divided into 3 domains: physical (8 items), psychological (7 items), and social (4 items). To validate the LCQ-T, concurrent validity, internal consistency reliability, and test-retest reliability were assessed. Results: Participants included 96 women and 50 men with a mean (SD) age of 59.6 (14.4) years. The concurrent validity comparing LCQ-T to BCS yielded statistically significant Pearson correlation coefficients (r= -0.74, P<0.05). The correlation coefficients for SF-36 and Thai-HADS were also significant. The LCQ-T demonstrated very good internal consistency in all domains and the overall scale, with the Cronbach’s alpha coefficients ranging from 0.89 to 0.94. The 3-day repeatability of the LCQ-T in 25 clinically stable patients was high with the intra-class correlation coefficients ranging between 0.81 and 0.90. Conclusion: LCQ-T is a valid and reliable Cough-specific instrument for assessing symptoms and QoL of adult Thai patients with subacute to Chronic Cough. Keywords: Chronic Cough; Leicester Cough Questionnaire; Thai; validation; reliability DOI: 10.12932/AP0685.34.3.2016
I D Pavord - One of the best experts on this subject based on the ideXlab platform.
-
long term low dose erythromycin in patients with unexplained Chronic Cough a double blind placebo controlled trial
Thorax, 2010Co-Authors: Nadia Yousaf, Surinder S Birring, Sergio Matos, Debbie Parker, W Monteiro, I D PavordAbstract:AIMS: Unexplained Chronic Cough is a common condition with no satisfactory treatments. Previous work has suggested that Cough may be linked to neutrophilic airway inflammation. This study tested the hypothesis that long-term low-dose erythromycin reduces the induced sputum neutrophil count and 24 h Cough frequency in patients with unexplained Chronic Cough. METHODS: 30 patients with an unexplained Chronic Cough lasting more than 8 weeks were randomly assigned to take 250 mg erythromycin once daily (n=15) or placebo (n=15) for 12 weeks in a double-blind parallel group study. Cough frequency, Cough reflex sensitivity and Cough severity were assessed at baseline, 6, 12 and 24 weeks. The primary outcome measure was change in 24 h Cough frequency at 12 weeks. RESULTS: There was no difference in the change in Cough frequency between the erythromycin and placebo groups at 12 weeks (mean difference in fold change 1.1; 95% CI 0.7 to 1.5; p=0.585) or at other times. There was a statistically significant between-treatment difference in the change in sputum neutrophils at 12 weeks (−10.2% vs +6.6% with erythromycin and placebo; mean difference 16.8%; 95% CI 1.6 to 32.1; p=0.03) but not at other times. There was no difference in the change in other measures of Cough between treatments. CONCLUSIONS: Treatment with low-dose erythromycin for 12 weeks reduces the induced sputum neutrophil count but not Cough frequency or severity in patients with unexplained Chronic Cough.
-
the leicester Cough monitor preliminary validation of an automated Cough detection system in Chronic Cough
European Respiratory Journal, 2008Co-Authors: Surinder S Birring, T Fleming, Sergio Matos, A A Raj, D H Evans, I D PavordAbstract:Chronic Cough is a common condition that presents to both primary and secondary care. Assessment and management are hampered by the absence of well-validated outcome measures. The present study comprises the validation of the Leicester Cough Monitor (LCM), an automated sound-based ambulatory Cough monitor. Cough frequency was measured with the LCM and compared with Coughs and other sounds counted manually over 2 h of a 6-h recording by two observers in nine patients with Chronic Cough in order to determine the sensitivity and specificity of the LCM. Automated Cough frequency was also compared with manual counts from one observer in 15 patients with Chronic Cough and eight healthy subjects. All subjects underwent 6-h recordings. A subgroup consisting of six control and five patients with stable Chronic Cough underwent repeat automated measurements > or = 3 months apart. A further 50 patients with Chronic Cough underwent 24-h automated Cough monitoring. The LCM had a sensitivity and specificity of 91 and 99%, respectively, for detecting Cough and a false-positive rate of 2.5 events x h(-1). Mean+/-SEM automated Cough counts x patient x h(-1) was 48+/-9 in patients with Chronic Cough and 2+/-1 in the control group (mean difference 46 counts x patient x h(-1); 95% confidence interval (CI) 20-71). The automated Cough counts were repeatable (intra-subject SD 11.4 Coughs x patient x h(-1); intra-class correlation coefficient 0.9). The Cough frequency in patients undergoing 24-h automated monitoring was 19 Coughs x patient x h(-1); daytime (08:00-22:00 h) Cough frequency was significantly greater than overnight Cough frequency (25 versus 10 Coughs x patient x h(-1); mean difference 15 Coughs x patient x h(-1), 95% CI 8-22). The Leicester Cough Monitor is a valid and reliable tool that can be used to assess 24-h Cough frequency in patients with Cough. It should be a useful tool to assess patients with Cough in clinical trials and longitudinal studies.
-
management of Chronic Cough
The Lancet, 2008Co-Authors: I D Pavord, Kian Fan ChungAbstract:Cough that remains unexplained after basic clinical assessment is a common reason for referral to secondary care. Much of the evidence about management of isolated Chronic Cough is derived from case series; this evidence suggests that isolated Chronic Cough is usually due to asthma, gastro-oesophageal reflux disease, and upper airway conditions, and that it can be cured in most people by treatment of these conditions. However, there is increasing recognition that satisfactory control of Chronic Cough is not achieved in a substantial number of patients seen in secondary care. Moreover, there is a concern that perpetuation of the belief that Chronic Cough is solely due to the effects of comorbid conditions is inhibiting research into the pathophysiology of an abnormally heightened Cough reflex, and jeopardising development of improved treatments. We advocate a change in emphasis, which makes a clear distinction between Cough due to corticosteroid-responsive eosinophilic airway diseases and corticosteroid-resistant non-eosinophilic Cough. We recommend that some factors with weak evidence of an association with Cough are best viewed as potential aggravating factors of an intrinsic abnormality of the Cough reflex, rather than the cause. We call for more research into the basic mechanisms and pharmacological control of an abnormally heightened Cough reflex, and recommend ways to assess the effects of potentially antitussive treatments.
-
prevalence pathogenesis and causes of Chronic Cough
The Lancet, 2008Co-Authors: Kian Fan Chung, I D PavordAbstract:Cough is a reflex action of the respiratory tract that is used to clear the upper airways. Chronic Cough lasting for more than 8 weeks is common in the community. The causes include cigarette smoking, exposure to cigarette smoke, and exposure to environmental pollution, especially particulates. Diseases causing Chronic Cough include asthma, eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip syndrome or rhinosinusitis, Chronic obstructive pulmonary disease, pulmonary fibrosis, and bronchiectasis. Doctors should always work towards a clear diagnosis, considering common and rare illnesses. In some patients, no cause is identified, leading to the diagnosis of idiopathic Cough. Chronic Cough is often associated with an increased response to tussive agents such as capsaicin. Plastic changes in intrinsic and synaptic excitability in the brainstem, spine, or airway nerves can enhance the Cough reflex, and can persist in the absence of the initiating Cough event. Structural and inflammatory airway mucosal changes in non-asthmatic Chronic Cough could represent the cause or the traumatic response to repetitive Coughing. Effective control of Cough requires not only controlling the disease causing the Cough but also desensitisation of Cough pathways.
-
induced sputum inflammatory mediator concentrations in Chronic Cough
American Journal of Respiratory and Critical Care Medicine, 2004Co-Authors: Surinder S Birring, Christopher E Brightling, A J Wardlaw, Peter Bradding, Debbie Parker, I D PavordAbstract:Previous studies have shown evidence of airway inflammation in patients with Chronic Cough and have suggested that the Cough may be due to release of tussive mediators and activation of afferent sensory nerve endings. We measured the concentration of various proinflammatory and tussive mediators in induced sputum supernatants from 20 patients with Cough variant asthma or eosinophilic bronchitis, 20 patients with nonasthmatic Chronic Cough, 22 patients with idiopathic Chronic Cough, and 18 healthy control subjects. We measured histamine, cysteinyl-leukotrienes, prostanoids (prostaglandin D2 and prostaglandin E2), and interleukin-8 by enzyme immunoassay. The median sputum histamine concentrations were significantly higher in patients with idiopathic Chronic Cough (8.0 ng/ml) and Cough variant asthma/eosinophilic bronchitis (10.2 ng/ml) than in normal subjects (2.6 ng/ml; 95% confidence interval of difference from idiopathic Chronic Cough, 0.8 to 25.8 [p = 0.009] and 95% confidence interval of difference from Cough variant asthma/eosinophilic bronchitis, 1.1 to 20.1 [p = 0.01]). Median sputum prostaglandin D2 and prostaglandin E2 concentrations were significantly higher in all categories of Chronic Cough. Our findings support the view that there is release of inflammatory and tussive mediators in patients with Chronic Cough and suggest that there might be similarities in the mechanism of Cough in a diverse range of conditions.
Nicole M Ryan - One of the best experts on this subject based on the ideXlab platform.
-
arnold s nerve Cough reflex evidence for Chronic Cough as a sensory vagal neuropathy
Journal of Thoracic Disease, 2014Co-Authors: Nicole M Ryan, Peter G. Gibson, Surinder S BirringAbstract:Arnold’s nerve ear-Cough reflex is recognised to occur uncommonly in patients with Chronic Cough. In these patients, mechanical stimulation of the external auditory meatus can activate the auricular branch of the vagus nerve (Arnold’s nerve) and evoke reflex Cough. This is an example of hypersensitivity of vagal afferent nerves, and there is now an increasing recognition that many cases of refractory or idiopathic Cough may be due to a sensory neuropathy of the vagus nerve. We present two cases where the cause of refractory Chronic Cough was due to sensory neuropathy associated with ear-Cough reflex hypersensitivity. In both cases, the Cough as well as the Arnold’s nerve reflex hypersensitivity were successfully treated with gabapentin, a treatment that has previously been shown to be effective in the treatment of Cough due to sensory laryngeal neuropathy (SLN).
-
gabapentin for refractory Chronic Cough a randomised double blind placebo controlled trial
The Lancet, 2012Co-Authors: Surinder S Birring, Nicole M Ryan, Peter G. GibsonAbstract:Summary Background Refractory Chronic Cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory Chronic Cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory Chronic Cough. We established the efficacy of gabapentin in patients with refractory Chronic Cough. Methods This randomised, double-blind, placebo-controlled trial was undertaken at an outpatient clinic in Australia. Adults with refractory Chronic Cough (>8 weeks' duration) without active respiratory disease or infection were randomly assigned to receive gabapentin (maximum tolerable daily dose of 1800 mg) or matching placebo for 10 weeks. Block randomisation was done with randomisation generator software, stratified by sex. Patients and investigators were masked to assigned treatment. The primary endpoint was change in Cough-specific quality of life (Leicester Cough questionnaire [LCQ] score) from baseline to 8 weeks of treatment, analysed by intention to treat. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000248369. Findings 62 patients were randomly assigned to gabepentin (n=32) or placebo (n=30) and ten patients withdrew before the study end. Gabapentin significantly improved Cough-specific quality of life compared with placebo (between-group difference in LCQ score during treatment period 1·80, 95% CI 0·56–3·04; p=0·004; number needed to treat of 3·58). Side-effects occurred in ten patients (31%) given gabapentin (the most common being nausea and fatigue) and three (10%) given placebo. Interpretation The treatment of refractory Chronic Cough with gabapentin is both effective and well tolerated. These positive effects suggest that central reflex sensitisation is a relevant mechanism in refractory Chronic Cough. Funding National Health and Medical Research Council of Australia and Hunter Medical Research Institute, Newcastle, Australia.
-
Cough reflex sensitivity improves with speech language pathology management of refractory Chronic Cough
Cough, 2010Co-Authors: Nicole M Ryan, Peter G. Gibson, Anne E Vertigan, Sarah L BoneAbstract:Speech language pathology is an effective management intervention for Chronic Cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active Cough suppression, reduced Cough sensitivity or increased Cough threshold from reduced laryngeal irritation. Objective measures such as Cough reflex sensitivity and Cough frequency could be used to determine whether the treatment response was due to reduced underlying Cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed. The aim of this study was to investigate subjective and objective measures of Cough before, during and after speech language pathology treatment for refractory Chronic Cough and the mechanism underlying the improvement. Adults with Chronic Cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory Chronic Cough. The primary outcome measures were capsaicin Cough reflex sensitivity, automated Cough frequency detection and Cough-related quality of life. Following treatment there was a significant improvement in Cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective Cough frequency (Mean ± SD at baseline: 72.5 ± 55.8 vs. post treatment: 25 ± 27.9 Coughs/hr, p = 0.009), and Cough reflex sensitivity (Mean ± SD log C5 at baseline: 0.88 ± 0.48 vs. post treatment: 1.65 ± 0.88, p < 0.0001). This is the first study to show that speech language pathology management is an effective intervention for refractory Chronic Cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased Cough sensitivity, decreased urge to Cough and an increased Cough threshold. Speech language pathology may be a useful and sustained treatment for refractory Chronic Cough. Australian New Zealand Clinical Trials Register, ACTRN12608000284369.
Richard S Irwin - One of the best experts on this subject based on the ideXlab platform.
-
managing Chronic Cough as a symptom in children and management algorithms chest guideline and expert panel report
Chest, 2020Co-Authors: Anne B. Chang, Surinder S Birring, Richard S Irwin, John J Oppenheimer, Todd M Adams, Kenneth W Altman, Elie Azoulay, Fiona H Blackhall, Donald C Bolser, Louis Philippe BouletAbstract:Background Cough is one of the most common presenting symptoms to general practitioners. The objective of this article is to collate the pediatric components of the CHEST Chronic Cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with Chronic Cough. Methods We reviewed all current CHEST Expert Cough Panel's statements and extracted recommendations and suggestions relating to children aged ≤ 14 years with Chronic Cough (> 4 weeks duration). Additionally, we undertook systematic reviews to update other sections we considered relevant and important. Results The eight recent CHEST guidelines relevant to children, based on systematic reviews, reported some high-quality evidence in the management of Chronic Cough in children (eg, use of algorithms and management of wet/productive Cough using appropriate antibiotics). However, much evidence is still inadequate, particularly in the management of non-specific Cough in the community. Conclusions The recommendations and suggestions related to the management of Chronic Cough in the pediatric age group have been based upon high-quality systematic reviews and are summarized in this article. Compared to the 2006 Cough Guidelines, there is now high-quality evidence for some aspects of the management of Chronic Cough in children. However, further studies particularly in primary health care are required.
-
occupational and environmental contributions to Chronic Cough in adults chest expert panel report
Chest, 2016Co-Authors: Susan M Tarlo, Richard S Irwin, Anne E Vertigan, John J Oppenheimer, Todd M Adams, Kenneth W Altman, Elie Azoulay, David J Prezant, Alan F Barker, Surinder S BirringAbstract:Background In response to occupational and environmental exposures, Cough can be an isolated symptom reflecting exposure to an irritant with little physiological consequence, or it can be a manifestation of more significant disease. This document reviews occupational and environmental contributions to Chronic Cough in adults, focusing on aspects not previously covered in the 2006 ACCP Cough Guideline or our more recent systematic review, and suggests an approach to investigation of these factors when suspected. Methods MEDLINE and TOXLINE literature searches were supplemented by articles identified by the Cough panel occupational and environmental subgroup members, to identify occupational and environmental aspects of Chronic Cough not previously covered in the 2006 ACCP Cough Guideline. Based on the literature reviews and the Delphi methodology, the Cough panel occupational and environmental subgroup developed guideline suggestions that were approved after review and voting by the full Cough panel. Results The literature review identified relevant articles regarding: mechanisms; allergic environmental causes; Chronic Cough and the recreational and involuntary inhalation of tobacco and marijuana smoke; nonallergic environmental triggers; laryngeal syndromes; and occupational diseases and exposures. Consensus-based statements were developed for the approach to diagnosis due to a lack of strong evidence from published literature. Conclusions Despite increased understanding of Cough related to occupational and environmental triggers, there remains a gap between the recommended assessment of occupational and environmental causes of Cough and the reported systematic assessment of these factors. There is a need for further documentation of occupational and environmental causes of Cough in the future.
-
Chronic Cough Due to Gastroesophageal Reflux Disease ACCP Evidence-Based Clinical Practice Guidelines
2014Co-Authors: Richard S Irwin, F. C. C. P Cynthia, L. French, Frederick J CurleyAbstract:Background: Gastroesophageal reflux (GER) is a common cause of Chronic Cough. Moreover, Chronic Cough can be the sole presenting manifestation of GER disease (GERD). It has been suggested recently that GER most often causes Chronic Cough by stimulating the distal esophagus. To gain further diagnostic and pathophysiologic knowledge, we prospectively evaluated a group of patients with Chronic Coughlikely to be due to GER with extensive gastrointestinal and respiratory studies and then observed their response to antireflux therapy. Methods: We prospectively characterized 12 subjects whose Chronic Cough was likely to be due to GER by chest radiographs, barium esophagography, 24-h esophageal pH monitoring (EPM) with probes in the distal and proximal esophagus, esophagoscopy, and bronchoscopy. Then, prio
-
Chronic Cough due to gastroesophageal reflux disease accp evidence based clinical practice guidelines
Chest, 2006Co-Authors: Richard S IrwinAbstract:Objectives: To critically review and summarize the literature on Cough and gastroesophageal reflux disease (GERD), and to make evidence-based recommendations regarding the diagnosis and treatment of Chronic Cough due to GERD. Design/methodology: Ovid MEDLINE literature review (through March 2004) for all studies published in the English language and selected articles published in other languages such as French since 1963 using the medical subject heading terms "Cough," "gastroesophageal reflux," and "gastroesophageal reflux disease." Results: GERD, singly or in combination with other conditions, is one of the most common causes of Chronic Cough. In patients with normal chest radiographic findings, GERD most likely causes Cough by stimulation of an esophageal-bronchial reflex. When GERD causes Cough, there may be no GI symptoms up to 75% of the time. While 24-h esophageal pH monitoring is the most sensitive and specific test in linking GERD and Cough in a cause-effect relationship, it has its limitations. In addition, there is no general agreement on how to best interpret the test, and it cannot detect non-acid reflux events. Therefore, when patients fit the clinical profile that has a high likelihood of predicting that GERD is the cause of Cough, antireflux medical therapy should be empirically instituted. While some patients improve with minimal medical therapy, others require more intensive regimens. When empiric treatment fails, it cannot be assumed that GERD has been ruled out as a cause of Chronic Cough. Rather, an objective investigation for GERD is then recommended because the empiric therapy may not have been intensive enough or medical therapy may have failed. Surgery may be efficacious when intensive medical therapy has failed in selected patients who have undergone an extensive objective GERD evaluation. Conclusions: Accurately diagnosing and successfully treating Chronic Cough due to GERD can be a major challenge.
-
impact of Chronic Cough on quality of life
JAMA Internal Medicine, 1998Co-Authors: Cynthia L French, Richard S Irwin, Frederick J Curley, Carole J KrikorianAbstract:Background Cough is the most common complaint for which adult patients seek medical care in the United States; however, the reason(s) for this is unknown. Objectives To determine whether Chronic Cough was associated with adverse psychosocial or physical effects on the quality of life and whether the elimination of Chronic Cough with specific therapy improved these adverse effects. Methods The study design was a prospective before-and-after intervention trial with patients serving as their own controls. Study subjects were a convenience sample of 39 consecutive and unselected adult patients referred for evaluation and management of a Chronic, persistently troublesome Cough. Baseline data were available for 39 patients and follow-up for 28 patients (22 women and 6 men). At baseline, demographic, Adverse Cough Outcome Survey (ACOS), and Sickness Impact Profile (SIP) data were collected and patients were managed according to a validated, systematic protocol. Following specific therapy for Cough, ACOS and SIP instruments were readministered. Results The ages, sex, duration, and spectra and frequencies of the causes of Cough were similar to multiple other studies. At baseline, patients reported a mean±SD of 8.6±4.8 types of adverse occurrences related to Cough. There were significant correlations between multiple ACOS items and total, physical, and psychosocial SIP scores. Psychosocial score correlated with total number of symptoms (P Conclusions Chronic Cough was associated with deterioration in patients' quality of life. The health-related dysfunction was most likely psychosocial. The ACOS and SIP appear to be valid tools in assessing the impact of Chronic Cough.