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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intermittent vagus nerve stimulation can reduce the frequency of seizures in patients with refractory epilepsy. Stimulation of vagus nerve afferent fibers can also cause vocal cord dysfunction, laryngeal spasm, cough, dyspnea, nausea, and vomiting. Vagus nerve stimulation causes an increase in respiratory rate, decrease in respiratory amplitude, decrease in tidal volume, and decrease in oxygen saturation during periods of device activation. It usually does not cause an arousal, or a change in heart rate or blood pressure. Most patients have an increase in their apnea-hypopnea index (AHI). Patients with VNS can have central apneas, obstructive hypopneas, and obstructive apneas. These respiratory events can be reduced with changes in the vagus nerve stimulator operational parameters or with the use of CPAP. In summary, there are complex relationships between epilepsy and obstructive sleep apneas. In particular, patients with refractory epilepsy need assessment for undiagnosed and untreated obstructive sleep apnea before implantation of vagus nerve stimulator devices. Patients with vagus nerve stimulators often have an increase in apneic events after implantation, and these patients need screening for sleep apnea both before and after implantation.
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PMID:Obstructive sleep apnea and respiratory complications associated with vagus nerve stimulators. 2189 79

Chronic cough is defined as cough lasting more than 2 months. Common causes for chronic cough in nonsmokers with normal chest radiographs and pulmonary functions include gastroesophageal reflux disease (GERD), cough-variant asthma (CVA), and upper airway cough syndrome (UACS). Current guidelines recommend diagnosing the etiology of chronic cough based upon the results of therapy for suspected GERD, CVA, and UACS. Despite following current recommendations for diagnosis and treatment, the cause for a significant proportion of chronic cough remains unexplained.Recent reports indicate the resolution of chronic cough following treatment of concomitantly diagnosed obstructive sleep apnea (OSA). Whether this represents a co-occurrence of two commonly prevalent disorders or a pathophysiologic relationship between OSA and cough remains unknown. This review offers insights into a pathophysiologic link between OSA and the commonly purported etiologies for cough, namely, GERD, UACS, and CVA. In addition, evidence for a relationship between airway inflammation that can trigger or perpetuate cough and OSA is discussed. This review explores mechanisms by which nocturnal continuous positive airway therapy resolves cough by improving underlying airway inflammation secondary to OSA and impacts upon GERD, CVA, and UACS.
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PMID:Chronic cough and OSA: a new association? 2217 Dec 9

Chronic rhinosinusitis (CRS) is a rather common disease in children, but its symptoms are often subtle and non-specific and this may result in overlooking a correct diagnosis. In turn, a missed diagnosis of CRS prevents a correct management to be performed and is associated with uneffective investigations and improper treatments. Actually, when CRS symptoms, which are mainly nasal congestion and obstruction, nasal discharge, facial pain, cough, and halitosis, are correctly assessed, the clinical diagnosis of CRS may be achieved, and confirmation may be obtained by imaging criteria or nasal fibroendoscopy. In imaging, computed tomography (CT) is the first choice technique for the evaluation of CRS and is able to provide an anatomic road map when surgery is required. Magnetic resonance imaging (MRI) of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. Also for middle ear disorders, CT is the first choice because it detects opacification of the middle ear cavity and mastoid cells, presence of fluids or debris, and allows the ossicular chain and the cortical bone of the mastoid to be evaluated. Another important diagnostic issue is the need to look for disorders that are frequently associated with CRS, such as obstructive sleep apnea syndrome (OSAS), that has some recognized risk factors in adenotonsillar hypertrophy, craniofacial anomalies, obesity, and neuromuscular disorders. Other associated disorders requiring investigation are recurrent or persistent otitis media and difficult asthma.
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PMID:Diagnosis of chronic rhinosinusitis. 2276 50

Uncertain etiology of cervical osteophytes, in particular emerging in geriatric population, is a rare skeletal system disease. Often, the cases are asymptomatic and may lead to symptoms such as dysphagia, cough, dyspnea, and dysphonia. We present a patient who had anterior osteophytes causing symptoms of severe obstructive sleep apnea (OSA), and literature on etiology of OSA has been reviewed. A 57-year-old male patient with complaints of snoring and cessation of breathing during sleep was referred to the ear nose throat clinic. Cervical radiograph and computed tomography showed the osteophytes in the anterior of the vertebral corpus at the level C1-2. In addition, bridging osteophyte was observed between C6 and C7 vertebrae. The patient's neck circumference was 41 cm, body mass index was 29 kg/m2, Epworth Sleepiness Scale score was 11, and apnea hypopnea index was 62. Surgery was recommended, but the patient refused. Continuous positive airway pressure titration was applied with 12.6 cm H2O pressure; apnea control was attained with an AHI of 2.7. One of the rare causes of OSA, a case of cervical vertebral osteophyte, was presented, and we would like to draw attention to the importance of ear nose throat examination in the diagnosis of OSA.
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PMID:Cervical osteophytes: a rare cause of obstructive sleep apnea. 2297 99

Obesity is a critical factor in the development of sleep-disordered breathing (SDB). Snoring is the most frequent nocturnal symptom suggesting a diagnosis of SDB. Other common nighttime symptoms include snorting, gasping, choking, coughing, and witnessed apneas. The most frequent diurnal symptom in SDB is excessive daytime sleepiness. Patients suspected of having SDB should undergo a full night of in-laboratory polysomnography or in-home oligosomnography. SDB includes a spectrum of disorders; the most common are obstructive sleep apnea and central sleep apnea.
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PMID:Sleep-disordered breathing. 2309 31

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease of unknown cause characterized by relentlessly progressive restrictive-ventilatory limitation, hypoxia, dyspnea, and cough. Both the incidence and prevalence of IPF appears to be increasing, with little impact on its dismal 3-year median survival, despite two decades of clinical trials. Increasingly recognized are the serious associated comorbid illnesses, including pulmonary hypertension, chronic obstructive pulmonary disease, gastroesophageal reflux disease, obstructive sleep apnea, obesity, lung cancer, and depression that further contribute to the substantial rise in the use of IPF-related healthcare resources. At present, lung transplantation remains the sole viable treatment for the few who qualify. Pharmacologic interventions targeting lung function and survival have remained largely disappointing, and very few investigations have specifically targeted comorbid conditions, symptoms, quality-of-life, and healthcare resource utilization. In reviewing the burden of illness associated with IPF, including the epidemiology, comorbidities, quality-of-life and the physical, psychosocial, and economic costs of this devastating disease, we hope to highlight some of the unmet medical needs associated with IPF, and encourage both public support and further investigations into these and other patient-centered outcomes and not just that of survival and lung function.
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PMID:The burden of idiopathic pulmonary fibrosis: an unmet public health need. 2478 Jul 18

We experienced two patients with chronic coughs whose symptoms persisted after initial treatment under a diagnosis of suspected upper airway cough syndrome or cough variant asthma. Neither patient exhibited daytime somnolence, although both were subsequently found to have severe obstructive sleep apnea. Following the administration of nocturnal continuous positive airway pressure therapy, the cough symptoms rapidly improved in both cases. These cases represent the first reports of obstructive sleep apnea-induced chronic cough in Japan.
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PMID:Utility of continuous positive airway pressure therapy for treating chronic coughs in patients with obstructive sleep apnea. 2482 89

We report three pediatric heart transplant (HTx) patients whose respiratory symptoms were successfully controlled with long-term, low-dose macrolide administration (clarithromycin: CAM; approximately 2.5 mg/kg bid). The first case was an 18-year-old boy who underwent HTx at the age of three for dilated cardiomyopathy (DCM). Beginning at age 5, he had repeated fevers and respiratory symptoms. He was diagnosed with chronic sinusitis at age 11 and sinobronchial syndrome with mild bronchiectasis at age 14. Administration of long-term, low-dose CAM and otolaryngeal topical therapy led to significant improvement of his symptoms. The second case was a 7-year-old boy who underwent HTx for DCM at age one. Starting at age 4, he had repeated fevers and cough due to atelectasis and pneumonia. As antibiotics and respiratory physical therapy proved ineffective, he received long-term, low-dose CAM, resulting in successful control of his atelectasis and recurrent pneumonia. The third case was a 13-year-old boy who underwent HTx at age 6 for DCM. He had chronic sinusitis starting at age 7, and was diagnosed with obstructive sleep apnea syndrome at age 10. Adenotonsillectomy and continuous positive airway pressure support therapy were indicated. At age 13, long-term, lowdose CAM administration was started following mycoplasma infection. In all three cases, the levels of calcineurin inhibitors (cyclosporine and tacrolimus) and everolimus were kept in the optimal range with careful drug monitoring. Longterm, low-dose macrolide administration effectively prevents and treats respiratory complications in pediatric HTx patients as long as attention is paid to potential drug interactions.
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PMID:The successful management of respiratory complications with long-term, low-dose macrolide administration in pediatric heart transplant recipients. 2529 1

The clinical manifestation included snoring and mouth breathing for 2 years, repeated coughing and shortness of breath in action for more than 1 year. Physical examination of oral cavity showed tonsils were in grade III. The endoscopy showed 2/3 of postnaris were blocked by the adenoids. The preoperative ultrasonic cardiogram revealed the right atrial and right ventricular dilatation, pulmonary artery widened. The preoperative polysomnography (PSG) showed apnea-hypopnea index (AHI) was 28.5 events an hour, and the lowest oxygen saturation (LSaO2) was 39%. The patient was diagnosed as severe obstructive sleep apnea hypopnea syndrome with pulmonary hypertension. The postoperative PSG showed the AHI was 11.7 events an hour, and the LSaO2 was 86%. The ultrasonic cardiogram at 5 months after surgery didn't show any abnormalities.
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PMID:[One case of pediatric obstructive sleep apnea hypopnea syndrome with pulmonary hypertension]. 2620 Dec 1

Cough is one of the most common symptom of many respiratory diseases. The Korean Academy of Tuberculosis and Respiratory Diseases organized cough guideline committee and cough guideline was developed by this committee. The purpose of this guideline is to help clinicians to diagnose correctly and treat efficiently patients with cough. In this article, we have stated recommendation and summary of Korean cough guideline. We also provided algorithm for acute, subacute, and chronic cough. For chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered. If UACS is suspicious, first generation anti-histamine and nasal decongestant can be used empirically. In CVA, inhaled corticosteroid is recommended in order to improve cough. In GERD, proton pump inhibitor is recommended in order to improve cough. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, angiotensin converting enzyme inhibitor, habit, psychogenic cough, interstitial lung disease, environmental and occupational factor, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and idiopathic cough can be also considered as cause of chronic cough. Level of evidence for treatment is mostly low. Thus, in this guideline, many recommendations are based on expert opinion. Further study regarding treatment for cough is mandatory.
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PMID:The Korean Cough Guideline: Recommendation and Summary Statement. 2677 Feb 30


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