Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 43-year-old female with old myocardial infarction and stenosed bypass grafts developed sustained Torsades de Pointes/ventricular flutter (rate = 300-400 beats per minute) during coronary arteriography after contrast injection to the diagonal graft. Cough-CPR (rate = 37/min) was started within 5 s of dysrhythmia initiation and continued through two defibrillation attempts (200 and 360 joules), and IV lidocaine was administered until return of spontaneous circulation 62 s later. The patient never lost consciousness during this very rapid dysrhythmia. Certain cardiac arrest resuscitation measures (namely, initial defibrillation attemps, IV lidocaine administration) can thus be initiated in a patient while performing cough-CPR and maintaining adequate cerebral perfusion. During the dysrhythmia with Cough-CPR: (a) aortic systolic pressures averaged 100 mmHg--this has commonly been observed in other reports, and (b) aortic diastolic pressures were always > or = 50 mmHg and averaged 63 mmHg, which has seldom been this high during cough-CPR. Dysrhythmia reversion occurred 4 s after the second defibrillation attempt and 80 msec after the peak of the highest cough-generated aortic pressure pulse (128 mmHg). Cough-induced ventricular tachycardia reversion has previously been reported; this may have acted in concert with electrical defibrillation to facilitate dysrhythmia reversion. The patient recovered without incident.
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PMID:Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter. 798 90

Thirty-five patients (10 men and 25 women) with a preoperative diagnosis of cardiac myxoma have undergone cardiac surgery since 1964 at the University of Louvain. The mean age of the patients was 49 (range 20-75) years. The most commonly encountered symptoms were: dyspnoea 49%; thoracic pain 26%; cough and peripheral embolism 17% each; stroke and preoperative atrial fibrillation 14% each; flutter 11%; expectoration, acute pulmonary oedema, syncope and transient ischaemic attack 6% each; and pulmonary embolism 3%. The different locations were: left atrium 66%; right atrium 26%; both atria 3%; right ventricle 3%: and retrohepatic vena cavae 3%. Septal implantation was found in 66%. Histological examination confirmed 28 myxomas but three 'tumours' were thrombi, two haemangiomas, one rhabdomyosarcoma and one liposarcoma. The follow-up has now reached 2829 months with an average of 81 months per patient (range 0-342 months). Three patients died early (9%) and there were four late deaths (11%). No cases were familial. Surgical resection is the correct treatment for cardiac myxomas and gives good long-term results.
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PMID:Cardiac myxoma. 807 15

The Flutter is a handheld device designed to facilitate clearance of mucus in hypersecretory lung disorders. Exhalation through the Flutter results in oscillations of expiratory pressure and airflow, which vibrate the airway walls (loosening mucus), decrease the collapsibility of the airways, and accelerate airflow, facilitating movement of mucus up the airways. We studied 18 patients with cystic fibrosis and mild to moderate lung disease to determine the efficacy of the Flutter in clearing mucus from the airways. The amount of sputum expectorated (measured by weight) when the Flutter was used was compared with the amount expectorated with vigorous voluntary coughing and with postural drainage (chest percussion and vibration). The amount of sputum expectorated by subjects using the Flutter was more than three times the amount expectorated with either voluntary cough or postural drainage (p < 0.001). There were no adverse effects. The Flutter is simple to use, inexpensive, and fully portable, and once the patient and family are instructed in its use, it does not require the assistance of a caregiver. For hospitalized patients, elimination of the need for a therapist could reduce health care costs. Long-term studies of the use of the Flutter seem justified to determine its effects on pulmonary function and outcome.
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PMID:Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. 855 15

The acute effects of use of the Flutter on expectoration of sputum were studied in patients with chronic respiratory diseases who had problems expectorating sputum. The Flutter is a handy, simple, physiotherapy device that is easy to use. Seventeen patients were enrolled in the study. For three consecutive days, the patients were asked to use the Flutter for 15 min when they had the hardest time expectorating sputum. They were also asked to measure the volume of the expectorant obtained during those 15 min and the following 30 min. Expectoration, coughing, and breathlessness were graded with visual analogue scales designed by us. Peak expiratory flow rate was also measured. For the control condition, the patients were asked to remove the stainless steel ball from the device and then to use the device as stated above on the three consecutive days immediately before or after the experimental days. Scores of "difficulty in expectoration" and "chest discomfort" were lower on the second and third experimental days than on the control days (mean+/-SE of difficulty in expectoration on the second day: 3.8+/-0.6 vs 4.4+/-0.6, p<0.05: on the third day: 3.0+/-0.5 vs 4.2+/- 0.6, p<0.02; chest discomfort on the second day: 2.9+/-0.6 vs 3.5/+-0.7, p<0.04; on the third day: 2.3+/-0.6 vs 2.9+/-0.6, p<0.01). No significant differences were noted in cough intensity, cough frequency, breathlessness, or peak expiratory flow. Sputum volume was larger on the second and third experimental days than on the control days (second day: 13.9+/-3.6 vs 11.3+/-3.1 ml, p<0.04; third day: 13.2+/-2.8 vs 9.9+/-2.1 ml, p<0.01). We conclude that use of the Flutter can increase the expectoration of sputum and can relieve related symptoms.
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PMID:[Acute effect of use of the Flutter on expectoration of sputum in patients with chronic respiratory diseases]. 862 74

Chronic obstructive pulmonary disease (COPD) is characterized by sputum production and cough. It has been shown that mucus hypersecretion predisposes to recurrent bronchial infection and that reduction in airway secretions is associated with clinical improvement. Recently a new pipe-shaped device for chest physiotherapy, the flutter VRP1 ("VarioRaw:" Aubonne, Switzerland), was introduced in order to help clear bronchial hypersecretion. We determined the long-term efficacy of daily chest physiotherapy with the VRP1 in COPD and bronchial hypersecretion. 13 men and 7 women with COPD and sputum hypersecretion were studied; 10 were assigned to the physiotherapy group, and 10 to the control group getting sham therapy. After 3 months of physiotherapy, FVC, FEV1 and distance walked in 12 minutes increased in the treated group, but were almost unchanged in the sham-treated group. Arterial blood gases, the maximum voluntary ventilation, and respiratory rate at rest were unchanged in both groups. There was also an overall significant improvement in COPD symptoms in the physiotherapy group compared to baseline (p < 0.05). We conclude that long-term home physiotherapy with the flutter VRP1 is effective in COPD in improving airflow, functional ability and symptoms.
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PMID:[Physiotherapy in chronic obstructive pulmonary disease: oscillatory breathing with flutter VRP1]. 885 70

Mucolytic treatment with rhDNase is part of the current therapy for cystic fibrosis (CF) lung disease. The Flutter valve, a device for enhancing airway mucus clearance, has recently been approved for use in CF patients. Exhalation through the Flutter valve leads to oscillations of expiratory airflow, improving mucus viscoelasticity and stimulating clearance. The goal of our in vitro study was to evaluate the individual and combined effects of Flutter valve oscillations and rhDNase treatment on the viscoelastic (rheological) properties of CF sputum. Sputum specimens were collected from 19 CF patients and subjected to the following protocols: 1) baseline sample with no treatment applied; 2) application of oscillations generated by airflow through the Flutter valve; 3) incubation at 37 degrees C for 30 min with 10% vol/wt rhDNase (Pulmozyme) to achieve a final concentration of 2.5 microg/mL (approximately 100 nM); 4) combination of Flutter valve oscillations and 10% vol/wt normal saline (0.9% NaCl); 5) combination of Flutter valve oscillations and 10% vol/wt rhDNase at 2.5 microg/mL final concentration. For each protocol, the mucus rigidity index (log G* at 1 rad/s) was measured at baseline and at 30 min. Values are presented as mean+/-SEM. The cough clearability index (CCI) was computed from measurements of mucus viscoelasticity, based on relationships established in model studies. Flutter valve treatment alone did not result in a significant reduction in the rigidity of CF sputum (2.24+/-0.13 vs. 2.11+/-0.13, P=0.19), nor did rhDNase (2.5 microg/mL) alone, although we have previously shown (Pediatr. Pulmonol. 1995; 20:78) that both of these treatments reduce sputum spinnability, which is more sensitive to molecular weight reduction. In comparison to individual treatments, combined treatment with Flutter valve oscillations and rhDNase significantly reduced the mucus rigidity to 1.85+/-0.19 from 2.24+/-0.13 (P< 0.001), consequently increasing the predicted clearability of the sputum (from 1.09+/-0.26 to 1.83+/-0.48, P=0.012). These in vitro results suggest that a combination of biochemical treatment (e.g., DNase) and mechanical oscillation may have a better therapeutic potential for mucus clearance in CF lung disease.
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PMID:Effects of sputum oscillations and rhDNase in vitro: a combined approach to treat cystic fibrosis lung disease. 981 Oct 74

Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults. Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet, Flutter, positive expiratory pressure mask, high-frequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders. The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.
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PMID:Physiotherapy for airway clearance in adults. 1062 75

National and international societies have issued guidelines on the management of heart failure: The European Society of Cardiology, WHO, ACC/AHA Task Force Report, US Department of Health and Human Services, German Society of Cardiology. The therapeutic approaches to heart failure have undergone considerable changes during the last few years. The guidelines have to be updated almost yearly due to new results from prospective randomized studies. Although an agreement could be reached with respect to general measures and drug treatment, no agreement on mechanical devices, pacemakers and surgical interventions has been reached. The basis for medical treatment of chronic heart failure depends on diuretics, digitalis, ACE inhibitors, and beta-blockers. Calcium antagonists and other positive inotropic drugs, other than digitalis, should be avoided as far as possible. Thiazides, loop diuretics and aldosterone antagonists are needed for acute and chronic treatment of heart failure, alone or in combination (diuretic resistant heart failure!). Digitalis glycosides are needed in patients with atrial fibrillation with a fast ventricular rate or atrial flutter and in patients with systolic dysfunction, large hearts and symptomatic failure class NYHA III and IV. However, digitalis does not convert atrial fibrillation to sinus rhythm. Today there is no question that ACE inhibitors improve the prognosis of all patients with heart failure in all stages, if ejection fraction is reduced. Therefore, most patients after myocardial infarction or after having experienced pump failure due to myocarditis or cardiomyopathy are treated with ACE inhibitors and diuretics. The beneficial effects of ACE inhibitors seem to be most pronounced the worse the situation is. Relative risk reductions (mortality!) between 10% and 40% have been published depending on the severity of symptomatic left ventricular dysfunction. Those patients with high absolute risk have more to gain than those with low risk for any given "risk reduction", of course. Recent studies also indicate that most high risk cardiac patients profit from ACE inhibitors even if pump function is normal (i.e., patients with coronary heart disease, diabetes mellitus, cerebral vascular disease, hypertension) (15). AT1 antagonists can substitute for ACE inhibitors, if the latter are not tolerated due to cough. Up to now, beta-blocking agents apart from diuretics seem to be the best investigated drugs in heart failure. Large controlled studies with bisoprolol, carvedilol and metoprolol in addition to diuretics, digitalis and ACE inhibitors convincingly yielded positive results in chronic left ventricular failure patients. Reduction of mortality by 35% and even of sudden cardiac deaths by 40% have been proven beyond doubt. Thus, heart failure patients today should also receive beta-blocking agents in all stages of the disease. In the era of controlled prospective studies (evidence-based medicine), physicians are well advised to use only drugs that have been proven beneficial in large controlled studies.
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PMID:The management of heart failure--an overview. 1119 49

Assisted coughing and mechanical cough aids compensate for the weak cough flow in patients with neuromuscular diseases (NMD). In cases with preserved respiratory muscles also breathing techniques and special devices, e. g., flutter or acapella can be used for secretion mobilisation during infections of the airways. These means are summarised as oscillating physiotherapy. Their mechanisms are believed to depend on separation of the mucus from the bronchial wall by vibration, thus facilitating mucus transport from the peripheral to the central airways. In mucoviscidosis and chronic obstructive pulmonary disease their application is established, but there is a paucity of data regarding the commitment in patients with neuromuscular diseases. The effective adoption of simple oscillation physiotherapeutic interventions demands usually a sufficient force of the respiratory muscles--exceptions are the application of the percussionaire (intrapulmonary percussive ventilator, IPV) or high frequency chest wall oscillation (HFCWO). In daily practice there is evidence that patients with weak respiratory muscles are overstrained with the use of these physiotherapeutic means, or get exhausted. A general recommendation for the adoption of simple oscillating physiotherapeutic interventions cannot be made in patients with NMDs. Perhaps in the future devices such as IPV or HFCWO will prove to be more effective in NMD patients.
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PMID:[Oscillating physiotherapy for secretolysis]. 1831 81

The most important process in the treatment for lung cancer patients with poor lung function especially due to chronic obstructive pulmonary disease (COPD) is an adequate preoperative physiologic assessment to identify patients who are at increased risk for perioperative death and severe complications. Once the patient is assessed to not have increased risk for death after curative-intent surgery, he or she should be aggressively treated to achieve best possible baseline level of function. Preoperative treatments are the same as those for patients with COPD not preparing for surgery, which consist of smoking cessation, medication including bronchodilators, and pulmonary rehabilitation. The main part of recent pulmonary rehabilitation program for patients with COPD is exercise training. A few recent manuscripts demonstrated that short-term preoperative pulmonary rehabilitation including exercise training could improve exercise capacity of lung cancer patients with COPD and might have important implications for surgical outcome. Postoperative strategies to reduce pulmonary complications include adequate pain control with epidural analgesia, oral care, and airway clearance techniques (postural drainage, coughing, huffing, flutter breathing, percussion, vibration, and squeezing). To provide optimal surgical outcome for lung cancer patients with poor lung function, there is nothing but the accumulation of the fundamental treatments.
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PMID:[Perioperative strategies for lung cancer patients with poor lung function]. 2071 8


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