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Peter V Dicpinigaitis - One of the best experts on this subject based on the ideXlab platform.
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effect of tobacco and electronic cigarette use on Cough Reflex sensitivity
Pulmonary Pharmacology & Therapeutics, 2017Co-Authors: Peter V DicpinigaitisAbstract:Abstract Multiple previous studies have shown that otherwise healthy tobacco cigarette smokers have suppressed Cough Reflex sensitivity compared with nonsmokers and furthermore, that smoking cessation, even after years of tobacco use, leads to prompt enhancement of Cough Reflex sensitivity. Thus, Cough Reflex sensitivity is demonstrated to be a dynamic phenomenon, responding to the presence or absence of influences such as tobacco smoke. These studies, however, were unable to identify whether it was the influence of nicotine, or one or more of the numerous components of tobacco cigarette smoke, that were responsible for this effect. More recently, it has been shown that a single exposure to electronic cigarette (e-cig) vapor causes inhibition of Cough Reflex sensitivity in healthy lifetime nonsmokers. An identical study employing a non-nicotine containing e-cig confirmed an absence of effect on Cough Reflex sensitivity, thus implicating nicotine as the causative agent of these findings. Recent animal studies demonstrate Cough suppression after injection of nicotine into the brains of cats, thus supporting a centrally-mediated antitussive effect of nicotine to explain the results of the aforementioned studies of tobacco smoke and e-cig vapor exposure in humans.
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effect of e cigarette use on Cough Reflex sensitivity
Chest, 2016Co-Authors: Alis J. Dicpinigaitis, Peter V Dicpinigaitis, Alfredo Lee Chang, Abdissa NegassaAbstract:Background E-cigarettes (e-cigs) have attained widespread popularity, yet knowledge of their physiologic effects remains minimal. The aim of this study was to evaluate the effect of a single exposure to e-cig vapor on Cough Reflex sensitivity. Methods Thirty healthy nonsmokers underwent Cough Reflex sensitivity measurement using capsaicin Cough challenge at baseline, 15 min, and 24 h after e-cig exposure (30 puffs 30 s apart). The end point of Cough challenge is the concentration of capsaicin inducing five or more Coughs (C 5 ). The number of Coughs induced by each e-cig inhalation was counted. A subgroup of subjects (n = 8) subsequently underwent an identical protocol with a non-nicotine-containing e-cig. Results Cough Reflex sensitivity was significantly inhibited (C 5 increased) 15 min after e-cig use (−0.29; 95% CI, −0.43 to −0.15; P 5 returned to baseline (0.24; 95% CI, 0.10-0.38; P = .0002 vs post-15-min value). A subgroup of eight subjects demonstrating the largest degree of Cough Reflex inhibition had no suppression after exposure to a non-nicotine-containing e-cig ( P = .0078 for comparison of ΔC 5 after nicotine vs non-nicotine device). Furthermore, more Coughing was induced by the nicotine-containing vs non-nicotine-containing device ( P = .0156). Conclusions A single session of e-cig use, approximating nicotine exposure of one tobacco cigarette, induces significant inhibition of Cough Reflex sensitivity. Exploratory analysis of a subgroup of subjects suggests that nicotine is responsible for this observation. Our data, consistent with previous studies of nicotine effect, suggest a dual action of nicotine: an immediate, peripheral protussive effect and a delayed central antitussive effect. Trial Registry ClinicalTrials.gov; No.: NCT02203162 ; URL: www.clinicaltrials.gov .
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Effect of e-cigarette use on Cough Reflex sensitivity
Chest, 2016Co-Authors: Peter V Dicpinigaitis, Alis J. Dicpinigaitis, Alfredo Lee Chang, Abdissa NegassaAbstract:BACKGROUND E-cigarettes (e-cigs) have attained widespread popularity, yet knowledge of their physiologic effects remains minimal. The aim of this study was to evaluate the effect of a single exposure to e-cig vapor on Cough Reflex sensitivity. METHODS Thirty healthy nonsmokers underwent Cough Reflex sensitivity measurement using capsaicin Cough challenge at baseline, 15 min, and 24 h after e-cig exposure (30 puffs 30 s apart). The end point of Cough challenge is the concentration of capsaicin inducing five or more Coughs (C5). The number of Coughs induced by each e-cig inhalation was counted. A subgroup of subjects (n = 8) subsequently underwent an identical protocol with a non-nicotine-containing e-cig. RESULTS Cough Reflex sensitivity was significantly inhibited (C5 increased) 15 min after e-cig use (?0.29; 95% CI, ?0.43 to ?0.15; P < .0001); 24 h later, C5 returned to baseline (0.24; 95% CI, 0.10-0.38; P = .0002 vs post-15-min value). A subgroup of eight subjects demonstrating the largest degree of Cough Reflex inhibition had no suppression after exposure to a non-nicotine-containing e-cig (P = .0078 for comparison of ?C5 after nicotine vs non-nicotine device). Furthermore, more Coughing was induced by the nicotine-containing vs non-nicotine-containing device (P = .0156). CONCLUSIONS A single session of e-cig use, approximating nicotine exposure of one tobacco cigarette, induces significant inhibition of Cough Reflex sensitivity. Exploratory analysis of a subgroup of subjects suggests that nicotine is responsible for this observation. Our data, consistent with previous studies of nicotine effect, suggest a dual action of nicotine: an immediate, peripheral protussive effect and a delayed central antitussive effect. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02203162; URL: www.clinicaltrials.gov.
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Suppression of Cough-Reflex sensitivity by electronic cigarette use: Effect of nicotine
European Respiratory Journal, 2015Co-Authors: Peter V Dicpinigaitis, Alfredo Lee Chang, Alis J. DicpinigaitisAbstract:Background: Electronic cigarettes (e-cigs) have gained significant popularity worldwide yet studies evaluating their physiological effects are scarce. We recently demonstrated that a single exposure to e-cig vapor in healthy nonsmokers causes significant inhibition of Cough Reflex sensitivity (ATS 2015). The aim of the present study was to investigate the role of nicotine in this phenomenon by comparing the effect of nicotine- and non-nicotine-containing e-cig exposure on Cough and Cough Reflex sensitivity. Methods: In our initial study 30 subjects underwent baseline Cough Reflex sensitivity measurement employing capsaicin Cough challenge and again one day later 15 minutes after inhalation of 30 puffs of a nicotine-containing e-cig (Blu, Lorillard, USA) administered 30 seconds apart thus approximating the nicotine delivery of one tobacco cigarette. The number of Coughs induced by e-cig inhalation was recorded. The standard endpoint of Cough challenge was used: concentration of capsaicin inducing ≥5 Coughs (C 5 ). Subjects with the highest degree of inhibition of Cough Reflex sensitivity, defined as C 5 increase of ≥2 doubling concentrations (n=8) underwent an identical protocol using a non-nicotine-containing e-cig (BlueStar, USA). Results: The 8 subjects who had experienced the largest inhibition of Cough Reflex sensitivity after nicotine-containing e-cig exposure demonstrated no effect after use of the non-nicotine e-cig (p=0.0078). However, nicotine e-cig inhalation acutely induced more Coughs than did the nicotine-free e-cig: 8.9±8.0(SD) vs. 1.3±2.4, p=0.0156. Conclusion: Our results suggest a dual action of nicotine: an immediate peripheral protussive effect and a delayed central antitussive effect.
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Inhibition of Cough Reflex sensitivity by diphenhydramine during acute viral respiratory tract infection
International Journal of Clinical Pharmacy, 2015Co-Authors: Peter V Dicpinigaitis, Yvonne E. Gayle, Sean Dhar, Amber Johnson, John Brew, Wilson Caparros-wanderleyAbstract:Background : Currently available over-the-counter Cough remedies historically have been criticized for lack of scientific evidence supporting their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors’ knowledge it has never been shown to inhibit Cough Reflex sensitivity in subjects with pathological Cough. Objective : To evaluate the effect of diphenhydramine on Cough Reflex sensitivity. Setting : Montefiore Medical Center, an academic medical center in New York City. Methods : Twenty two subjects with acute viral upper respiratory tract infection (common cold) underwent Cough Reflex sensitivity measurement employing capsaicin challenge on 3 separate days, 2 h after ingesting single doses of study drug (to coincide with peak blood concentrations), administered in randomized, double-blind manner: a multicomponent syrup containing diphenhydramine (25 mg), phenylephrine (10 mg), in a natural cocoa formulation; dextromethorphan (30 mg) syrup; and, placebo syrup. The standard endpoint of Cough challenge was used: concentration of capsaicin inducing ≥5 Coughs (C5). Main outcome measure : Effect on Cough Reflex sensitivity (C5). Results : A significant difference ( p = 0.0024) was established among groups, with pairwise analysis revealing a significant increase in mean log C5 (0.4 ± 0.55 (SD); p
Amit Tibb - One of the best experts on this subject based on the ideXlab platform.
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stability of Cough Reflex sensitivity during viral upper respiratory tract infection common cold
Pulmonary Pharmacology & Therapeutics, 2014Co-Authors: Peter V Dicpinigaitis, Amit Tibb, David L Ramsey, Andrew N Carr, Cathy L PooreAbstract:Abstract Cough is among the symptoms most commonly associated with an acute, viral upper respiratory tract infection (URI), such as the common cold. Two previous studies incorporating capsaicin Cough challenge methodology have demonstrated that Cough Reflex sensitivity is transiently enhanced during URI. These studies used single measurements of Cough Reflex sensitivity during the URI period. To our knowledge, no previous studies have included multiple measurements of Cough Reflex sensitivity to capsaicin during a URI to evaluate the stability of this measure during the acute viral illness. In the current methodological investigation, we performed capsaicin Cough challenges in 42 subjects with URI who were otherwise healthy, adult, nonsmokers (25 female). Subjects were enrolled within 72 h of onset of illness and randomly assigned to 3 groups ( n = 14 each) that underwent Cough Reflex sensitivity measurement (C 2 and C 5 ) at days 0 and 1 for group 1; days 2 and 3 for group 2; or days 4 and 5 for group 3. Each subject returned 4–8 weeks post-viral infection to establish a healthy baseline measurement (recovery). Our results support that Cough Reflex sensitivity to capsaicin, as measured by C 5 , is a sensitive measure that remains stable during 6 days of a URI. These results suggest that Cough Reflex sensitivity measures in the presence of a URI provide a sensitive and reproducible approach that could be used in future investigations seeking to test experimental antitussive therapies.
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Cough Reflex sensitivity during acute viral upper respiratory tract infection common cold
European Respiratory Journal, 2011Co-Authors: Peter V Dicpinigaitis, Amit Tibb, David Hull, Angela QuAbstract:One previous study has demonstrated that Cough Reflex sensitivity to inhaled capsaicin is transiently enhanced during acute viral respiratory tract infection (URI) by comparing single Cough Reflex sensitivity measurements at baseline and during URI (O9Connell F, et al. Respir Med 1996;90:279-286). To our knowledge, no one has performed multiple measurements of Cough Reflex sensitivity during acute URI to evaluate presence or absence of stability during the acute viral illness. To date, we have evaluated 37 otherwise healthy adult nonsmokers with acute URI. Subjects underwent capsaicin Cough challenge testing, as previously described in the ERS guidelines (Morice et al. Eur Respir J 2007;29:1256-1276), on 2 consecutive days within the first 8 days of their illness, and again after 4-8 weeks (post-recovery). Briefly, subjects inhaled single, vital-capacity breaths of nebulized capsaicin, administered in incremental doubling concentrations, until the concentration inducing 5 or more Coughs (C5) was attained. All 37 subjects had serial C5 measurements within 1 doubling concentration during the acute illness. Post-recovery mean log C5 was significantly higher than during illness (0.84±0.08 [SEM] vs. 0.50±0.08; p=0.000004). Our results demonstrate that Cough Reflex sensitivity remains stable in the acute phase of URI, and confirm previous findings of a transient increase of Cough Reflex sensitivity during URI compared to healthy baseline levels. The demonstration of stability of Cough Reflex sensitivity during the early stages of URI is relevant to potential investigators planning to evaluate the effect of a pharmacological intervention on Cough Reflex sensitivity during URI.
Cathy L Poore - One of the best experts on this subject based on the ideXlab platform.
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stability of Cough Reflex sensitivity during viral upper respiratory tract infection common cold
Pulmonary Pharmacology & Therapeutics, 2014Co-Authors: Peter V Dicpinigaitis, Amit Tibb, David L Ramsey, Andrew N Carr, Cathy L PooreAbstract:Abstract Cough is among the symptoms most commonly associated with an acute, viral upper respiratory tract infection (URI), such as the common cold. Two previous studies incorporating capsaicin Cough challenge methodology have demonstrated that Cough Reflex sensitivity is transiently enhanced during URI. These studies used single measurements of Cough Reflex sensitivity during the URI period. To our knowledge, no previous studies have included multiple measurements of Cough Reflex sensitivity to capsaicin during a URI to evaluate the stability of this measure during the acute viral illness. In the current methodological investigation, we performed capsaicin Cough challenges in 42 subjects with URI who were otherwise healthy, adult, nonsmokers (25 female). Subjects were enrolled within 72 h of onset of illness and randomly assigned to 3 groups ( n = 14 each) that underwent Cough Reflex sensitivity measurement (C 2 and C 5 ) at days 0 and 1 for group 1; days 2 and 3 for group 2; or days 4 and 5 for group 3. Each subject returned 4–8 weeks post-viral infection to establish a healthy baseline measurement (recovery). Our results support that Cough Reflex sensitivity to capsaicin, as measured by C 5 , is a sensitive measure that remains stable during 6 days of a URI. These results suggest that Cough Reflex sensitivity measures in the presence of a URI provide a sensitive and reproducible approach that could be used in future investigations seeking to test experimental antitussive therapies.
Yvonne E. Gayle - One of the best experts on this subject based on the ideXlab platform.
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Inhibition of Cough Reflex sensitivity by diphenhydramine during acute viral respiratory tract infection
International Journal of Clinical Pharmacy, 2015Co-Authors: Peter V Dicpinigaitis, Yvonne E. Gayle, Sean Dhar, Amber Johnson, John Brew, Wilson Caparros-wanderleyAbstract:Background : Currently available over-the-counter Cough remedies historically have been criticized for lack of scientific evidence supporting their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors’ knowledge it has never been shown to inhibit Cough Reflex sensitivity in subjects with pathological Cough. Objective : To evaluate the effect of diphenhydramine on Cough Reflex sensitivity. Setting : Montefiore Medical Center, an academic medical center in New York City. Methods : Twenty two subjects with acute viral upper respiratory tract infection (common cold) underwent Cough Reflex sensitivity measurement employing capsaicin challenge on 3 separate days, 2 h after ingesting single doses of study drug (to coincide with peak blood concentrations), administered in randomized, double-blind manner: a multicomponent syrup containing diphenhydramine (25 mg), phenylephrine (10 mg), in a natural cocoa formulation; dextromethorphan (30 mg) syrup; and, placebo syrup. The standard endpoint of Cough challenge was used: concentration of capsaicin inducing ≥5 Coughs (C5). Main outcome measure : Effect on Cough Reflex sensitivity (C5). Results : A significant difference ( p = 0.0024) was established among groups, with pairwise analysis revealing a significant increase in mean log C5 (0.4 ± 0.55 (SD); p
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inhibition of Cough Reflex sensitivity by diphenhydramine during acute viral respiratory tract infection
International Journal of Clinical Pharmacy, 2015Co-Authors: Peter V Dicpinigaitis, Yvonne E. Gayle, Sean Dhar, Amber Johnson, John Brew, Wilson CaparroswanderleyAbstract:Background: Currently available over-the-counter Cough remedies historically have been criticized for lack of scientific evidence supporting their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors’ knowledge it has never been shown to inhibit Cough Reflex sensitivity in subjects with pathological Cough. Objective: To evaluate the effect of diphenhydramine on Cough Reflex sensitivity. Setting: Montefiore Medical Center, an academic medical center in New York City. Methods: Twenty two subjects with acute viral upper respiratory tract infection (common cold) underwent Cough Reflex sensitivity measurement employing capsaicin challenge on 3 separate days, 2 h after ingesting single doses of study drug (to coincide with peak blood concentrations), administered in randomized, double-blind manner: a multicomponent syrup containing diphenhydramine (25 mg), phenylephrine (10 mg), in a natural cocoa formulation; dextromethorphan (30 mg) syrup; and, placebo syrup. The standard endpoint of Cough challenge was used: concentration of capsaicin inducing ≥5 Coughs (C5). Main outcome measure: Effect on Cough Reflex sensitivity (C5). Results: A significant difference (p = 0.0024) was established among groups, with pairwise analysis revealing a significant increase in mean log C5 (0.4 ± 0.55 (SD); p < 0.01) for the diphenhydramine-containing medication versus placebo, but not for dextromethorphan versus placebo. Conclusions: Our results provide the initial evidence of the ability of diphenhydramine to inhibit Cough Reflex sensitivity in subjects with acute pathological Cough. Timing of Cough Reflex sensitivity measurement may not have allowed demonstration of maximal antitussive effect of dextromethorphan.
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effect of guaifenesin on Cough Reflex sensitivity
Chest, 2003Co-Authors: Peter V Dicpinigaitis, Yvonne E. GayleAbstract:BACKGROUND: Guaifenesin, a commonly used agent for the treatment of Cough, is termed an expectorant since it is believed to alleviate Cough discomfort by increasing sputum volume and decreasing its viscosity, thereby promoting effective Cough. Despite its common usage, relatively few studies, yielding contrasting results, have been performed to investigate the action and efficacy of guaifenesin. STUDY OBJECTIVES: To evaluate the effect of guaifenesin on Cough Reflex sensitivity. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Academic medical center. PARTICIPANTS: Fourteen subjects with acute viral upper respiratory tract infection (URI) and 14 healthy volunteers. INTERVENTIONS: On 2 separate days, subjects underwent capsaicin Cough challenge 1 to 2 h after receiving a single, 400-mg dose (capsules) of guaifenesin or matched placebo. MEASUREMENTS AND RESULTS: The concentration of capsaicin inducing five or more Coughs (C(5)) was determined. Among subjects with URI, mean (+/- SEM) log C(5) after guaifenesin and placebo were 0.92 +/- 0.17 and 0.66 +/- 0.14, respectively (p = 0.028). No effect on Cough sensitivity was observed in healthy volunteers. CONCLUSIONS: Our results demonstrate that guaifenesin inhibits Cough Reflex sensitivity in subjects with URI, whose Cough receptors are transiently hypersensitive, but not in healthy volunteers. Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding Cough receptors within the respiratory epithelium from the tussive stimulus.
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Effect of Guaifenesin on Cough Reflex Sensitivity
Chest, 2003Co-Authors: Peter V Dicpinigaitis, Yvonne E. GayleAbstract:BACKGROUND: Guaifenesin, a commonly used agent for the treatment of Cough, is termed an expectorant since it is believed to alleviate Cough discomfort by increasing sputum volume and decreasing its viscosity, thereby promoting effective Cough. Despite its common usage, relatively few studies, yielding contrasting results, have been performed to investigate the action and efficacy of guaifenesin. STUDY OBJECTIVES: To evaluate the effect of guaifenesin on Cough Reflex sensitivity. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Academic medical center. PARTICIPANTS: Fourteen subjects with acute viral upper respiratory tract infection (URI) and 14 healthy volunteers. INTERVENTIONS: On 2 separate days, subjects underwent capsaicin Cough challenge 1 to 2 h after receiving a single, 400-mg dose (capsules) of guaifenesin or matched placebo. Measurements and results: The concentration of capsaicin inducing five or more Coughs (C(5)) was determined. Among subjects with URI, mean (+/- SEM) log C(5) after guaifenesin and placebo were 0.92 +/- 0.17 and 0.66 +/- 0.14, respectively (p = 0.028). No effect on Cough sensitivity was observed in healthy volunteers. CONCLUSIONS: Our results demonstrate that guaifenesin inhibits Cough Reflex sensitivity in subjects with URI, whose Cough receptors are transiently hypersensitive, but not in healthy volunteers. Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding Cough receptors within the respiratory epithelium from the tussive stimulus.
Angela Qu - One of the best experts on this subject based on the ideXlab platform.
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Cough Reflex sensitivity during acute viral upper respiratory tract infection common cold
European Respiratory Journal, 2011Co-Authors: Peter V Dicpinigaitis, Amit Tibb, David Hull, Angela QuAbstract:One previous study has demonstrated that Cough Reflex sensitivity to inhaled capsaicin is transiently enhanced during acute viral respiratory tract infection (URI) by comparing single Cough Reflex sensitivity measurements at baseline and during URI (O9Connell F, et al. Respir Med 1996;90:279-286). To our knowledge, no one has performed multiple measurements of Cough Reflex sensitivity during acute URI to evaluate presence or absence of stability during the acute viral illness. To date, we have evaluated 37 otherwise healthy adult nonsmokers with acute URI. Subjects underwent capsaicin Cough challenge testing, as previously described in the ERS guidelines (Morice et al. Eur Respir J 2007;29:1256-1276), on 2 consecutive days within the first 8 days of their illness, and again after 4-8 weeks (post-recovery). Briefly, subjects inhaled single, vital-capacity breaths of nebulized capsaicin, administered in incremental doubling concentrations, until the concentration inducing 5 or more Coughs (C5) was attained. All 37 subjects had serial C5 measurements within 1 doubling concentration during the acute illness. Post-recovery mean log C5 was significantly higher than during illness (0.84±0.08 [SEM] vs. 0.50±0.08; p=0.000004). Our results demonstrate that Cough Reflex sensitivity remains stable in the acute phase of URI, and confirm previous findings of a transient increase of Cough Reflex sensitivity during URI compared to healthy baseline levels. The demonstration of stability of Cough Reflex sensitivity during the early stages of URI is relevant to potential investigators planning to evaluate the effect of a pharmacological intervention on Cough Reflex sensitivity during URI.
