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Jaclyn A Smith - One of the best experts on this subject based on the ideXlab platform.
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gefapixant a p2x3 receptor antagonist for the treatment of refractory or unexplained chronic Cough a randomised double blind controlled parallel group phase 2b trial
The Lancet Respiratory Medicine, 2020Co-Authors: Jaclyn A Smith, Surinder S Birring, Anthony P Ford, Alyn H Morice, Michael M Kitt, Lorcan P Mcgarvey, Mandel R Sher, David Muccino, Lorcan McgarveyAbstract:Summary Background Gefapixant is a P2X3 receptor antagonist that has shown promise for the treatment of refractory and unexplained chronic Cough. The aim of this study was to evaluate the efficacy of gefapixant compared with placebo after 12 weeks of treatment for refractory chronic Cough or unexplained chronic Cough. Methods We did a 12-week, phase 2b, randomised, double-blind, placebo-controlled study in patients with refractory chronic Cough or unexplained chronic Cough aged 18–80 years who were recruited from 44 primarily outpatient pulmonologist or allergist sites in the UK and the USA. Eligible patients had refractory or unexplained chronic Cough lasting 1 year or longer, no radiographic chest abnormality, and 40 mm or more on a 100-mm Cough severity visual analogue scale at enrolment. Patients were randomly assigned to receive placebo or one of three doses (7·5 mg, 20 mg, or 50 mg) of oral gefapixant twice daily, every day, for 84 days; visits to investigative sites were on days 1, 28, 42, 56, 70, 84, and 85. The randomisation schedule was computer generated using a permuted block algorithm by Advance Research Associates (Santa Clara, CA, USA). Patients and all personnel involved in the conduct and interpretation of the study were masked to treatment assignment. The primary endpoint was placebo-adjusted change from baseline in awake Cough frequency after 12 weeks, assessed in the full analysis set, which is a subset of the intention-to-treat population. Adverse events were monitored and safety was evaluated in all patients receiving one or more doses of study drug. This trial is registered with ClinicalTrials.gov , NCT02612610 . Findings Between Dec 21, 2015, and July 26, 2016, 253 patients were randomly assigned to placebo (n=63), gefapixant 7·5 mg (n=64), gefapixant 20 mg (n=63), or gefapixant 50 mg (n=63) twice daily. The mean age of patients was 60·2 (SD 9·9) years and 193 (76%) were women. At 12 weeks, patients' geometric mean awake Cough frequency was 18·2 Coughs per h (geometric SD 3·1) with placebo, and 14·5 Coughs per h (3·7) with 7·5 mg, 12·0 Coughs per h (4·2) with 20 mg, and 11·3 Coughs per h (2·8) with 50 mg gefapixant. Estimated percentage change relative to placebo was −22·0% (−41·8 to 4·6; p=0·097) with 7·5 mg, −22·2% (−42·0 to 4·3; p=0·093) with 20 mg, and −37·0% (95% CI −53·3 to −14·9; p=0·0027) with 50 mg gefapixant. Dysgeusia was the most common adverse event, occurring in three (5%) patients given placebo, six (10%) given 7·5 mg gefapixant, 21 (33%) given 20 mg gefapixant, and 30 (48%) given 50 mg gefapixant. Interpretation Targeting purinergic receptor P2X3 with gefapixant at a dose of 50 mg twice daily significantly reduced Cough frequency in patients with refractory chronic Cough or unexplained chronic Cough after 12 weeks of treatment compared with placebo. Further development of gefapixant is warranted for the treatment of chronic Cough. Funding Afferent Pharmaceuticals (acquired by Merck & Co., Inc., Kenilworth, NJ, USA).
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the neurokinin 1 receptor antagonist orvepitant is a novel antitussive therapy for chronic refractory Cough results from a phase 2 pilot study volcano 1
Chest, 2020Co-Authors: Jaclyn A Smith, Imran Satia, Huda Badri, Julie Morris, David Allman, R F Miller, Andrew Wood, Michael TrowerAbstract:Background Substance P and the neurokinin-1 (NK-1) receptor are implicated in chronic refractory Cough pathophysiology. We assessed the efficacy and safety of orvepitant, a brain-penetrant NK-1 antagonist, in an open-label study in CRC patients with chronic refractory Cough. Methods Thirteen patients with daytime Cough frequency >3 to Results All patients completed the study. Mean baseline Cough frequency was 71.4/h. A statistically and clinically significant improvement in objective daytime Cough frequency was observed at week 4: reduction from baseline of 18.9 (26%) Coughs/h (95% CI, 9.6-28.3; P Conclusions Orvepitant resulted in a significant and sustained improvement in objective Cough frequency, severity VAS, and quality of life; appeared safe; and merits further clinical investigation. Trial Registry EU Clinical Trials Register; No.: 2014-003947-36; URL: www.clinicaltrialsregister.eu
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muscle activation and sound during voluntary single Coughs and Cough peals in healthy volunteers insights into Cough intensity
Respiratory Physiology & Neurobiology, 2018Co-Authors: Kevin Mcguinness, Katie Ward, Charles C Reilly, Julie Morris, Jaclyn A SmithAbstract:Abstract Very few studies have addressed how Coughing varies in intensity. We assessed the influence of Cough effort and operating volume on the mechanics of Coughing using respiratory muscle surface electromyography (EMG), oesophageal/gastric pressures and Cough sounds recorded from 15 healthy subjects [8 female, median age 30 (IQR 30–50)years] performing 120 voluntary Coughs from controlled operating volume/effort and three Cough peals. For single Coughs, low operating volumes and high efforts were associated with the highest EMG activity (p In conclusion, effort and operating volume have important influences on Cough mechanics but modulate muscle activation, pressure and Cough sound amplitude and energy differently. Consequently, these Cough sound parameters poorly represent voluntary Cough mechanics and have limited potential as a surrogate intensity measure.
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the interaction between bronchoconstriction and Cough in asthma
Thorax, 2017Co-Authors: Imran Satia, Mark Woodhead, Huda Badri, Paul M Obyrne, Stephen J. Fowler, Jaclyn A SmithAbstract:Variable airflow obstruction is a pathophysiological hallmark of asthma; however, the interactions between acute bronchoconstriction and the Cough reflex are poorly understood. We performed a randomised, single-blind, placebo-controlled, crossover study to investigate the interaction between bronchoconstriction and Cough in asthma. Capsaicin was administered to evoke Coughs and methacholine to induce bronchoconstriction. We demonstrated that acute bronchoconstriction increased capsaicin-evoked Coughs, which improved as airway calibre spontaneously resolved. However, capsaicin-evoked Coughing had no impact on methacholine-induced bronchoconstriction. This study provides evidence that bronchoconstriction increases the activation of capsaicin-responsive airway nerves, but the precise mechanisms and mediators involved require further evaluation. Trial registration number ISRCTN14900082.
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Investigating the interaction between bronchoconstriction and Cough in asthma
European Respiratory Journal, 2016Co-Authors: Imran Satia, Mark Woodhead, Paul M. O'byrne, Huda Badri, Stephen J. Fowler, Jaclyn A SmithAbstract:Background: Cough is the archetypal airway reflex but it is unclear if there is an interaction between bronchoconstriction and Cough reflex responses in asthma. Objective: To investigate the interaction between bronchoconstriction and Cough in subjects with mild atopic asthma. Methods: For each subjects we determined the methacholine PC20 and the dose of capsaicin required to cause half the maximal response (ED50). Subjects underwent three interventions in a randomised single-blinded placebo controlled manner to assess the effects of:1;bronchoconstriction on evoked Coughs,2;evoked Coughs on bronchoconstriction,3;spontaneous resolution of FEV1 after bronchoconstriction on evoked Coughs. Generalised estimating equations were used to model the interactions between bronchoconstriction and capsaicin evoked Coughs. Results: Fourteen subjects were recruited (median age 23, 64% female). Compared to placebo, methacholine induced bronchoconstriction increased capsaicin evoked Coughs (geometric mean 13.9 Coughs (95% C.I. 10.9-17.8) vs. 8.4 Coughs (6.6-10.7), 34% increase, p Conclusion: Bronchoconstriction heightens Cough responses to capsaicin in subjects with asthma.
Anne B. Chang - One of the best experts on this subject based on the ideXlab platform.
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can acute Cough characteristics from sound recordings differentiate common respiratory illnesses in children a comparative prospective study
Chest, 2021Co-Authors: Anne B. Chang, Nina Bisballemuller, Erin J Plumb, Victor M Oguoma, Susanne Halken, Gabrielle B MccallumAbstract:Background Acute respiratory illnesses cause substantial morbidity worldwide. Cough is a common symptom in these childhood respiratory illnesses, but no large cohort data are available on whether various Cough characteristics can differentiate between these etiologies. Research Question Can various clinically based Cough characteristics (frequency [daytime/ nighttime], the sound itself, or type [wet/dry]) be used to differentiate common etiologies (asthma, bronchiolitis, pneumonia, other acute respiratory infections) of acute Cough in children? Study Design and Methods Between 2017 and 2019, children aged 2 weeks to ≤16 years, hospitalized with asthma, bronchiolitis, pneumonia, other acute respiratory infections, or control subjects were enrolled. Spontaneous Coughs were digitally recorded over 24 hours except for the control subjects, who provided three voluntary Coughs. Coughs were extracted and frequency defined (Coughs/hour). Cough sounds and type were assessed independently by two observers blinded to the clinical data. Cough scored by a respiratory specialist was compared with discharge diagnosis using agreement (Cohen’s kappa coefficient [қ]), sensitivity, and specificity. Caregiver-reported Cough scores were related with objective Cough frequency using Spearman coefficient (rs). Results A cohort of 148 children (n = 118 with respiratory illnesses, n = 30 control subjects), median age = 2.0 years (interquartile range, 0.7-3.9), 58% males, and 50% First Nations children were enrolled. In those with respiratory illnesses, caregiver-reported Cough scores and wet Cough (range, 42%-63%) was similar. Overall agreement in diagnosis between the respiratory specialist and discharge diagnosis was slight (қ = 0.13; 95% CI, 0.03 to 0.22). Among diagnoses, specificity (8%-74%) and sensitivity (53%-100%) varied. Interrater agreement in Cough type (wet/dry) between blinded observers was almost perfect (қ = 0.89; 95% CI, 0.81 to 0.97). Objective Cough frequency was significantly correlated with reported Cough scores using visual analog scale (rs = 0.43; bias-corrected 95% CI, 0.25 to 0.56) and verbal categorical description daytime score (rs = 0.39; bias-corrected 95% CI, 0.22 to 0.54). Interpretation Cough characteristics alone are not distinct enough to accurately differentiate between common acute respiratory illnesses in children.
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Automatic Identification of Wet and Dry Cough in Pediatric Patients with Respiratory Diseases
Annals of Biomedical Engineering, 2013Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. Chang, Amalia Setyati, Rina TriasihAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis especially in children. Wet Coughs are more likely to be associated with lower respiratory track bacterial infections. At present during a typical consultation session, the wet/dry decision is based on the subjective judgment of a physician. It is not available for the non-trained person, long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop an automated technology to classify Cough into ‘wet’ and ‘dry’ categories. We propose novel features and a Logistic regression model (LRM) for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric Coughs (C = 536) recorded using a bed-side non-contact microphone from N = 78 patients. Results of the automatic classification were compared against two expert human scorers. The sensitivity and specificity of the LRM in picking wet Coughs were between 87 and 88% with 95% confidence interval on training/validation dataset (310 Cough events from 60 patients) and 84 and 76% respectively on prospective dataset (117 Cough events from 18 patients). The kappa agreement with two expert human scorers on prospective dataset was 0.51. These results indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
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automated algorithm for wet dry Cough sounds classification
International Conference of the IEEE Engineering in Medicine and Biology Society, 2012Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. ChangAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis. Wet Coughs are more likely to be associated with bacterial infections. At present, the wet/dry decision is based on the subjective judgment of a physician, during a typical consultation session. It is not available for long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop fully automated technology to classify Cough into ‘Wet’ and ‘Dry’ categories. We propose novel features and a Logistic regression-based model for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric and adult Coughs recorded using a bed-side non-contact microphone. The sensitivity and specificity of the classification were obtained as 79±9% and 72.7±8.7% respectively. These indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
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EMBC - Automated algorithm for Wet/Dry Cough sounds classification
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and, 2012Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. ChangAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis. Wet Coughs are more likely to be associated with bacterial infections. At present, the wet/dry decision is based on the subjective judgment of a physician, during a typical consultation session. It is not available for long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop fully automated technology to classify Cough into ‘Wet’ and ‘Dry’ categories. We propose novel features and a Logistic regression-based model for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric and adult Coughs recorded using a bed-side non-contact microphone. The sensitivity and specificity of the classification were obtained as 79±9% and 72.7±8.7% respectively. These indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
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Airway hyperresponsiveness and Cough-receptor sensitivity in children with recurrent Cough.
American journal of respiratory and critical care medicine, 1997Co-Authors: Anne B. Chang, Peter D. Phelan, Susan M Sawyer, Colin F. RobertsonAbstract:In children, recurrent Cough is a common presenting symptom that may represent asthma. We tested the hypotheses that children with recurrent Cough have increased Cough-receptor sensitivity (CRS) or airway hyperresponsiveness (AHR). Skin prick testing, the capsaicin CRS test, and hypertonic saline (HS) challenge were performed in 44 children (median age: 8.9 yr) with recurrent dry Cough (> or = 2 episodes of Cough, each lasting > or = 2 wk, within a period of 12 mo) and 44 controls. Measures of CRS were the concentration of capsaicin required to stimulate > or = 2 Coughs (Cth) and > or = 5 Coughs (C5). During the Coughing period, Cth (mean log: 0.62 [95% CI: 0.43 to 0.81]) and C5 (mean log: 1.15 [95% CI: 0.86 to 1.44]) of the subjects without AHR were significantly lower (p = 0.0026, 0.027, respectively) than Cth (mean log: 1.27 [95% CI: 0.88 to 1.66]) and C5 (mean log: 1.79 [95% CI: 1.21 to 2.37]) of the subjects with AHR and those of the controls (p = 0.0002 and 0.0001). During the Cough-free period, there was no difference in CRS among the groups. In subjects who demonstrated AHR, the provocation dose causing a > or = 15% fall in FEV1 (PD15) during the Cough period was significantly lower (p = 0.005) than that during the Cough-free period. We conclude that AHR or increased CRS is present during the Coughing phase in children with recurrent Cough.
Surinder S Birring - One of the best experts on this subject based on the ideXlab platform.
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gefapixant a p2x3 receptor antagonist for the treatment of refractory or unexplained chronic Cough a randomised double blind controlled parallel group phase 2b trial
The Lancet Respiratory Medicine, 2020Co-Authors: Jaclyn A Smith, Surinder S Birring, Anthony P Ford, Alyn H Morice, Michael M Kitt, Lorcan P Mcgarvey, Mandel R Sher, David Muccino, Lorcan McgarveyAbstract:Summary Background Gefapixant is a P2X3 receptor antagonist that has shown promise for the treatment of refractory and unexplained chronic Cough. The aim of this study was to evaluate the efficacy of gefapixant compared with placebo after 12 weeks of treatment for refractory chronic Cough or unexplained chronic Cough. Methods We did a 12-week, phase 2b, randomised, double-blind, placebo-controlled study in patients with refractory chronic Cough or unexplained chronic Cough aged 18–80 years who were recruited from 44 primarily outpatient pulmonologist or allergist sites in the UK and the USA. Eligible patients had refractory or unexplained chronic Cough lasting 1 year or longer, no radiographic chest abnormality, and 40 mm or more on a 100-mm Cough severity visual analogue scale at enrolment. Patients were randomly assigned to receive placebo or one of three doses (7·5 mg, 20 mg, or 50 mg) of oral gefapixant twice daily, every day, for 84 days; visits to investigative sites were on days 1, 28, 42, 56, 70, 84, and 85. The randomisation schedule was computer generated using a permuted block algorithm by Advance Research Associates (Santa Clara, CA, USA). Patients and all personnel involved in the conduct and interpretation of the study were masked to treatment assignment. The primary endpoint was placebo-adjusted change from baseline in awake Cough frequency after 12 weeks, assessed in the full analysis set, which is a subset of the intention-to-treat population. Adverse events were monitored and safety was evaluated in all patients receiving one or more doses of study drug. This trial is registered with ClinicalTrials.gov , NCT02612610 . Findings Between Dec 21, 2015, and July 26, 2016, 253 patients were randomly assigned to placebo (n=63), gefapixant 7·5 mg (n=64), gefapixant 20 mg (n=63), or gefapixant 50 mg (n=63) twice daily. The mean age of patients was 60·2 (SD 9·9) years and 193 (76%) were women. At 12 weeks, patients' geometric mean awake Cough frequency was 18·2 Coughs per h (geometric SD 3·1) with placebo, and 14·5 Coughs per h (3·7) with 7·5 mg, 12·0 Coughs per h (4·2) with 20 mg, and 11·3 Coughs per h (2·8) with 50 mg gefapixant. Estimated percentage change relative to placebo was −22·0% (−41·8 to 4·6; p=0·097) with 7·5 mg, −22·2% (−42·0 to 4·3; p=0·093) with 20 mg, and −37·0% (95% CI −53·3 to −14·9; p=0·0027) with 50 mg gefapixant. Dysgeusia was the most common adverse event, occurring in three (5%) patients given placebo, six (10%) given 7·5 mg gefapixant, 21 (33%) given 20 mg gefapixant, and 30 (48%) given 50 mg gefapixant. Interpretation Targeting purinergic receptor P2X3 with gefapixant at a dose of 50 mg twice daily significantly reduced Cough frequency in patients with refractory chronic Cough or unexplained chronic Cough after 12 weeks of treatment compared with placebo. Further development of gefapixant is warranted for the treatment of chronic Cough. Funding Afferent Pharmaceuticals (acquired by Merck & Co., Inc., Kenilworth, NJ, USA).
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Impaired Cough suppression in chronic refractory Cough.
The European respiratory journal, 2019Co-Authors: Peter Siu Pan Cho, Hannah Fletcher, Richard D. Turner, Caroline J. Jolley, Surinder S BirringAbstract:Functional brain imaging in individuals with chronic Cough demonstrates reduced activation in cortical regions associated with voluntary Cough suppression. Little is known about the ability of patients with chronic Cough to suppress Cough. This study aimed to compare the ability to voluntarily suppress Cough during inhaled capsaicin challenge in participants with chronic refractory Cough with that in healthy controls. In addition, this study aimed to assess the repeatability of capsaicin challenge test with voluntary Cough suppression. Participants with chronic refractory Cough and healthy controls underwent inhaled capsaicin challenge tests while attempting to suppress their Cough responses. After 5 days, either a conventional capsaicin challenge test with no Cough suppression attempt, or a repeat test with an attempt at Cough suppression was performed. Threshold capsaicin concentrations required to elicit one, two and five Coughs were calculated by interpolation. Objective 24-h Cough frequency was measured in individuals with chronic refractory Cough. Healthy controls were able to suppress capsaicin-evoked Cough while participants with chronic refractory Cough were not. Geometric mean±sd capsaicin dose thresholds for five Coughs with (CS5) and without (C5) suppression attempts were 254.40±3.78 versus 45.89±3.95 µmol·L−1, respectively, in healthy controls (p=0.033) and 3.34±5.04 versus 3.86±5.13 µmol·L−1, respectively, in participants with chronic refractory Cough (p=0.922). Capsaicin dose thresholds for triggering five Coughs with self-attempted Cough suppression were significantly lower in participants with chronic refractory Cough than in healthy controls; geometric mean±sd 4.94±4.43 versus 261.10±4.34 µmol·L−1, respectively; mean difference (95% CI) 5.72 (4.54–6.91) doubling doses (p Participants with chronic refractory Cough were less able to voluntarily suppress capsaicin-evoked Cough compared to healthy controls. This may have important implications for the pathophysiology and treatment of chronic Cough.
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P103 The urge to Cough in copd
Triggers and treatment of cough, 2017Co-Authors: A Solomon, Caroline J. Jolley, Psp Cho, H Fletcher, Irem Patel, Rd Turner, Surinder S BirringAbstract:Introduction Urge to Cough is a conscious perception of the need to Cough. We investigated urge-to-Cough, triggers and somatic sensations associated with Cough in patients with COPD and compared it to patients with chronic refractory Cough (CRC). Methods We undertook a prospective case-control study of COPD patients with chronic Cough (≥8 weeks) and patients with CRC. All patients completed a 27-item structured questionnaire (Cough Hypersensitivity Questionnaire; CHQ), that has a 5-point Likert response scale to assess urge-to-Cough, aggravating factors/triggers and somatic sensations (0–4; 0=never and 4=occurs all the time in relation to Cough). 10 COPD patients underwent a capsaicin challenge test to provoke an urge-to-Cough sensation and to assess Cough reflex sensitivity. The concentration of capsaicin that elicited 2 or more Coughs (C2) and 5 or more Coughs (C5) was recorded. Results 62 COPD and 40 CRC patients were recruited (mean(SD) age 64(11) vs 54(14) years, 48% vs 70% females, FEV1% predicted 48.2% (19.0) vs 94.1% (16.6) respectively). The top 5 Cough triggers and somatic sensations in patients with COPD and CRC are summarised in Table 1. The severity of sputum trigger of Cough and chest sensation associated with Cough were significantly greater in COPD compared to CRC; median(IQR) sputum scores: 3 (2–4) vs 2 (1–2) and chest sensation scores: 2 (2–4) vs 1 (0–2) respectively, both p Conclusion Sputum is a significant self-reported trigger of Cough in COPD. In contrast, urge to Cough occurs more frequently in CRC. There are likely to be multiple mechanisms of Cough in COPD and further studies should investigate whether phenotyping Cough on the basis of self-reported triggers and somatic sensations can guide therapy.
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Four-hour Cough frequency monitoring in chronic Cough.
Chest, 2012Co-Authors: Kai K. Lee, Sergio Matos, Ian D Pavord, David H. Evans, A Savani, Surinder S BirringAbstract:Background The recent development of automated Cough monitors has enabled objective assessment of Cough frequency. A study was undertaken to determine whether short-duration recordings ( Methods One hundred adults with chronic Cough underwent 24-h Cough frequency monitoring with the Leicester Cough Monitor and completed Cough visual analog scales (VASs) and the Leicester Cough Questionnaire (LCQ). Cough recordings were analyzed using customized software to derive Cough frequencies from 1 to 6 h and 24-h recordings. Responsiveness was assessed with repeat assessments following therapeutic trials. Results The median (interquartile range) 24-h Cough frequency was 11.5 (5.8-26.6) Coughs/h. Four hours was considered the shortest recording duration that represented 24-h Cough frequency (ρ = 0.9, P ≤ .001). Median 4-h Cough frequency was 16.6 (7.3-36.8) Coughs/h. Both 4-h and 24-h Cough frequency correlated moderately with Cough VAS (ρ = 0.49, P ≤ .01 and ρ = 0.44, P ≤ .01) and LCQ (ρ = −0.48, P ≤ .01; ρ = −0.50, P ≤ .01). Four-hour Cough frequency was responsive to improvements in Cough severity following trials of therapy. Conclusions Four-hour Cough frequency correlates highly with 24-h Cough frequency recordings and relates equally well with subjective measures in chronic Cough. Short-duration Cough monitoring could be a practical tool to validate the presence of Cough and assess response to trials of therapy in the clinic setting.
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PREDICTORS OF 24-H Cough FREQUENCY IN ACUTE Cough
Thorax, 2011Co-Authors: Kai K. Lee, Ian D Pavord, Sergio Matos, David H. Evans, Surinder S BirringAbstract:Introduction 24-hour Cough frequency monitoring is increasingly being used as an outcome measure to evaluate anti-tussive drugs. The optimal method of identifying patients with a significant Cough frequency for inclusion into clinical trials is not known. We investigated a range of Cough assessments screening tools that could be used for this purpose. Methods 35 healthy subjects with acute Cough due to upper respiratory infection (median (IQR) age 31 (23–35) years, 63% female, median (IQR) duration of Cough 4 (2–6) days) were recruited as part of a larger study. All subjects underwent ambulatory 24-h Cough frequency (CF 24 ) monitoring with the Leicester Cough Monitor, health related quality of life with the Leicester Cough Questionnaire-acute (LCQ) and Cough severity visual analogue scale (VAS). Receiver operating characteristic curve analyses were performed for the baseline screening tools LCQ, VAS and Cough frequency in first hour (CF 1 ) to identify patients with CF 24 =5, =7.5 and =10 Coughs/hr. Results The baseline geometric mean (logSD) CF 24 was 14.7 (0.5) Coughs/hr, CF 1 25.9 (0.4) Coughs/hr, mean (SEM) VAS 47 (3) mm and LCQ 14.3 (0.7). 4, 6 and 11 patients had CF 24 24 were poor, ranging from 0.51 to 0.58 and 0.50 to 0.68 respectively. The mean (SEM) AUC for CF 1 was 0.92 (0.05), 0.79 (0.10) and 0.86 (0.06) for detecting 24-h Cough frequency of =5, =7.5 and =10 Coughs/hr respectively. The sensitivity and specificity for Cough frequency recordings over 1 h to identify patients with significant 24-h Cough frequency are presented in Abstract S140 table 1. A good specificity (to exclude patients with low 24-h Cough frequency) was achievable at sensitivities ranging from 69 to 87%. Conclusion Subjective Cough severity and Cough-specific quality of life are poor screening tools for predicting objective 24-h Cough frequency. However, 1-h Cough frequency can be used as a screening tool to identify patients with significant 24-h Cough frequency for inclusion into future clinical trials.
Masahiro Kohzuki - One of the best experts on this subject based on the ideXlab platform.
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Effect of cigarette smoking on Cough reflex induced by TRPV1 and TRPA1 stimulations
Respiratory Medicine, 2011Co-Authors: Masashi Kanezaki, Satoru Ebihara, Takae Ebihara, Masahiro KohzukiAbstract:Summary Background Recent studies have shown that neurogenic inflammation induced by cigarette smoke is inhibited by TRPA1 antagonist, but not by TRPV1 antagonist. Since Cough reflex sensitivity is known to be modified by smoking status, we investigated the effects of cigarette smoking on TRPA1- and TRPV1-induced Cough and urge-to-Cough in healthy males. Methods Twenty-six healthy never-smokers and 30 healthy current smokers were recruited via public postings. Cough reflex thresholds and urge-to-Cough were evaluated by inhalation of capsaicin, a TRPV1 agonist, and cinnamaldehyde, a TRPA1 agonist. The Cough reflex thresholds were defined as the lowest concentrations of capsaicin and cinnamaldehyde that elicited two or more Coughs (C 2 ) and five or more Coughs (C 5 ), respectively. The urge-to-Cough was evaluated using the modified Borg scale. Results In capsaicin-induced Cough, the Cough reflex thresholds, as expressed by C 2 and C 5 , in current smokers were significantly higher than those in never-smokers ( p p p 2 and C 5 between never-smokers and current smokers, nor were there any significant differences in urge-to-Cough log–log slope between never-smokers and current smokers. There were no significant differences in the thresholds of the urge-to-Cough between never-smokers and current smokers. Conclusion The study suggests that smoking has a differential effect on Cough responses between TRPV1 and TRPA1 stimulations.
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Aging deteriorated perception of urge-to-Cough without changing Cough reflex threshold to citric acid in female never-smokers
Cough, 2011Co-Authors: Satoru Ebihara, Masashi Kanezaki, Takae Ebihara, Peijun Gui, Miyako Yamasaki, Hiroyuki Arai, Masahiro KohzukiAbstract:Background The effect of aging on the cognitive aspect of Cough has not been studied yet. The purpose of this study is to investigate the aging effect on the perception of urge-to-Cough in healthy individuals. Methods Fourteen young, female, healthy never-smokers were recruited via public postings. Twelve elderly female healthy never-smokers were recruited from a nursing home residence. The Cough reflex threshold and the urge-to-Cough were evaluated by inhalation of citric acid. The Cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more Coughs (C_2) and five or more Coughs (C_5). The urge-to-Cough was evaluated using a modified the Borg scale. Results There was no significant difference in the Cough reflex threshold to citric acid between young and elderly subjects. The urge-to-Cough scores at the concentration of C_2 and C_5 were significantly smaller in the elderly than young subjects. The urge-to-Cough log-log slope in elderly subjects (0.73 ± 0.71 point · L/g) was significantly gentler than those of young subjects (1.35 ± 0.53 point · L/g, p < 0.01). There were no significant differences in the urge-to-Cough threshold estimated between young and elderly subjects. Conclusions The Cough reflex threshold did not differ between young and elderly subjects whereas cognition of urge-to-Cough was significantly decreased in elderly subjects in female never-smokers. Objective monitoring of Cough might be important in the elderly people.
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aging deteriorated perception of urge to Cough without changing Cough reflex threshold to citric acid in female never smokers
Cough, 2011Co-Authors: Satoru Ebihara, Masashi Kanezaki, Takae Ebihara, Miyako Yamasaki, Hiroyuki Arai, Masahiro KohzukiAbstract:The effect of aging on the cognitive aspect of Cough has not been studied yet. The purpose of this study is to investigate the aging effect on the perception of urge-to-Cough in healthy individuals. Fourteen young, female, healthy never-smokers were recruited via public postings. Twelve elderly female healthy never-smokers were recruited from a nursing home residence. The Cough reflex threshold and the urge-to-Cough were evaluated by inhalation of citric acid. The Cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more Coughs (C2) and five or more Coughs (C5). The urge-to-Cough was evaluated using a modified the Borg scale. There was no significant difference in the Cough reflex threshold to citric acid between young and elderly subjects. The urge-to-Cough scores at the concentration of C2 and C5 were significantly smaller in the elderly than young subjects. The urge-to-Cough log-log slope in elderly subjects (0.73 ± 0.71 point · L/g) was significantly gentler than those of young subjects (1.35 ± 0.53 point · L/g, p < 0.01). There were no significant differences in the urge-to-Cough threshold estimated between young and elderly subjects. The Cough reflex threshold did not differ between young and elderly subjects whereas cognition of urge-to-Cough was significantly decreased in elderly subjects in female never-smokers. Objective monitoring of Cough might be important in the elderly people.
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Perception of urge-to-Cough and dyspnea in healthy smokers with decreased Cough reflex sensitivity
Cough, 2010Co-Authors: Masashi Kanezaki, Satoru Ebihara, Takae Ebihara, Peijun Gui, Miyako Yamasaki, Etsuhiro Nikkuni, Chihiro Suda, Masahiro KohzukiAbstract:Background Although cigarette smoking has been implicated as an important risk factor for the development of respiratory symptoms, the perceptional aspects of two symptoms in smokers have not been fully elucidated. Therefore, we simultaneously evaluated the Cough reflex sensitivity, the cognition of urge-to-Cough and perception of dyspnea in both healthy smokers and non-smokers. Methods Fourteen male healthy never-smokers and 14 age-matched male healthy current-smokers were recruited via public postings. The Cough reflex sensitivity and the urge-to-Cough were evaluated by the inhalation of citric acid. The perception of dyspnea was evaluated by Borg scores during applications of external inspiratory resistive loads. Results The Cough reflex threshold to citric acid, as expressed by the lowest concentration of citric acid that elicited two or more Coughs (C_2) and the lowest concentration of citric acid that elicited five or more Coughs (C_5) in smokers was significantly higher than in non-smokers. The urge-to-Cough log-log slope in smokers was significantly milder than that of non-smokers. There were no significant differences in the urge-to-Cough threshold between non-smokers and smokers. There were no significant differences in perceptions of dyspnea between non-smokers and smokers. Conclusions The study showed that decreased Cough reflex sensitivity in healthy smokers was accompanied by a decreased cognition of urge-to-Cough whereas it was not accompanied by the alternation of perception of dyspnea. Physicians should pay attention to the perceptual alterations of Cough in smokers.
V Swarnkar - One of the best experts on this subject based on the ideXlab platform.
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automatic Cough segmentation from non contact sound recordings in pediatric wards
Biomedical Signal Processing and Control, 2015Co-Authors: Yusuf A Amrulloh, Rina Triasih, Udantha R. Abeyratne, V Swarnkar, Amalia SetyatiAbstract:Abstract Cough is a common symptom of almost all childhood respiratory diseases. In a typical consultation session, physicians may seek for qualitative information (e.g., wetness) and quantitative information (e.g., Cough frequency) either by listening to voluntary Coughs or by interviewing the patients/carers. This information is useful in the differential diagnosis and in assessing the treatment outcome of the disease. The manual Cough assessment is tedious, subjective, and not suitable for long-term recording. Researchers have attempted to develop automated systems for Cough assessment but none of the existing systems have specifically targeted the pediatric population. In this paper we address these issues and develop a method to automatically identify Cough segments from the pediatric sound recordings. Our method is based on extracting mathematical features such as non-Gaussianity, Shannon entropy, and cepstral coefficients to describe Cough characteristics. These features were then used to train an artificial neural network to detect Coughs segment in the sound recordings. Working on a prospective data set of 14 subjects (sound recording length 840 min), proposed method achieved sensitivity, specificity, and Cohen's Kappa of 93%, 98%, and 0.65, respectively. These results indicate that the proposed method has the potential to be developed as an automated pediatric Cough counting device as well as the front-end of a Cough analysis system.
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Automatic Identification of Wet and Dry Cough in Pediatric Patients with Respiratory Diseases
Annals of Biomedical Engineering, 2013Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. Chang, Amalia Setyati, Rina TriasihAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis especially in children. Wet Coughs are more likely to be associated with lower respiratory track bacterial infections. At present during a typical consultation session, the wet/dry decision is based on the subjective judgment of a physician. It is not available for the non-trained person, long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop an automated technology to classify Cough into ‘wet’ and ‘dry’ categories. We propose novel features and a Logistic regression model (LRM) for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric Coughs (C = 536) recorded using a bed-side non-contact microphone from N = 78 patients. Results of the automatic classification were compared against two expert human scorers. The sensitivity and specificity of the LRM in picking wet Coughs were between 87 and 88% with 95% confidence interval on training/validation dataset (310 Cough events from 60 patients) and 84 and 76% respectively on prospective dataset (117 Cough events from 18 patients). The kappa agreement with two expert human scorers on prospective dataset was 0.51. These results indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
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automated algorithm for wet dry Cough sounds classification
International Conference of the IEEE Engineering in Medicine and Biology Society, 2012Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. ChangAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis. Wet Coughs are more likely to be associated with bacterial infections. At present, the wet/dry decision is based on the subjective judgment of a physician, during a typical consultation session. It is not available for long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop fully automated technology to classify Cough into ‘Wet’ and ‘Dry’ categories. We propose novel features and a Logistic regression-based model for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric and adult Coughs recorded using a bed-side non-contact microphone. The sensitivity and specificity of the classification were obtained as 79±9% and 72.7±8.7% respectively. These indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
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EMBC - Automated algorithm for Wet/Dry Cough sounds classification
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and, 2012Co-Authors: V Swarnkar, Yusuf A Amrulloh, Udantha R. Abeyratne, Anne B. ChangAbstract:Cough is the most common symptom of several respiratory diseases. It is a defense mechanism of the body to clear the respiratory tract from foreign materials inhaled accidentally or produced internally by infections. The identification of wet and dry Cough is an important clinical finding, aiding in the differential diagnosis. Wet Coughs are more likely to be associated with bacterial infections. At present, the wet/dry decision is based on the subjective judgment of a physician, during a typical consultation session. It is not available for long term monitoring or in the assessment of treatment efficacy. In this paper we address these issues and develop fully automated technology to classify Cough into ‘Wet’ and ‘Dry’ categories. We propose novel features and a Logistic regression-based model for the classification of Coughs into wet/dry classes. The performance of the method was evaluated on a clinical database of pediatric and adult Coughs recorded using a bed-side non-contact microphone. The sensitivity and specificity of the classification were obtained as 79±9% and 72.7±8.7% respectively. These indicate the potential of the method as a useful clinical tool for Cough monitoring, especially at home settings.
