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

As a symptom of an underlying condition, cough is one of the most common reasons patients see physicians. To the majority, a cough means that 'something is wrong' and it causes exhaustion and/or self-consciousness. Patients find these reasons as well as effects on lifestyle, fear of cancer and/or AIDS or tuberculosis to be the most troublesome concerns for which they seek medical attention. The treatment of cough can be divided into two main categories: (a) therapy that controls, prevents or eliminates cough (i.e. antitussive); and (b) therapy that makes cough more effective (i.e. protussive). Antitussive therapy can be either specific or nonspecific. Definitive or specific antitussive therapy depends on determining the aetiology or operant pathophysiological mechanism, and then initiating specific treatment. Since the cause of chronic cough can almost always be determined, it is possible to prescribe specific therapy that can be almost uniformly successful. Non-specific antitussive therapy is directed at the symptom; it is indicated when definitive therapy cannot be given. Practically speaking, the efficacy of nonspecific therapy must be evaluated in double-blind, placebo-controlled, randomised studies of pathological cough in humans. Such studies have demonstrated the efficacy of dextromethorphan, codeine and ipratropium bromide aerosol in patients with chronic bronchitis. While the preferred treatment for patients with cough due to angiotensin converting enzyme (ACE) inhibitor therapy is withdrawal of the offending drugs, it may be possible to ameliorate the cough by adding nifedipine, sulindac or indomethacin to the treatment regimen. The efficacy of protussive therapy has not been well documented. Although hypertonic saline aerosol and erdosteine in patients with bronchitis, and amiloride aerosol in patients with cystic fibrosis have been shown to improve mucus clearance, their clinical utility has not been adequately studied.
 ...
PMID:Appropriate use of antitussives and protussives. A practical review. 769 10

Inhalation of nicotine (0-64 mg/ml) and capsaicin (2 x 10(-6)-2.5 x 10(-4) M) in 24 healthy nonsmoking subjects produced a concentration-dependent cough response. Two subjects coughed to capsaicin but not to nicotine. The mean (95% confidence interval) nicotine concentrations causing two and five coughs were 5.5 (3.5-8.7) and 15.8 (10.0-25.1) mg/ml, respectively, and were reproducible over 3 different days. Capsaicin inhalation did not alter the response to nicotine and vice versa. Both agents increased respiratory resistance, but the response was more rapid to capsaicin. Inhalation of nicotine (0-8 mg/ml) over 5 min caused increases in heart rate and blood pressure and a decrease in skin temperature. Inhaled ipratropium bromide (0.50 mg) had an antitussive effect and also inhibited the nicotine-induced bronchoconstriction, indicating a vagally mediated effect. Sodium cromoglycate (0.20 mg) did not affect cough or airway resistance changes caused by nicotine. This study shows that inhaled nicotine produces a concentration-dependent cough and airway obstruction in healthy subjects, probably because of stimulation of afferent nerve endings in the bronchial mucosa and mediated through parasympathetic cholinergic pathways. Respiratory reflexes evoked by nicotine are similar to those produced by capsaicin, but it is unclear whether these reflexes are mediated by the same type of sensory nerves.
 ...
PMID:Inhaled nicotine in humans: effect on the respiratory and cardiovascular systems. 792 66

The examination were carried out in a group of 14 patients with mild bronchial asthma. The effect of Berodual (1 dose = 0.02 mg ipratropium bromide + 0.05 mg fenoterol), ipratropium bromide (Atrovent, 1 dose = 0.02 mg) and fenoterol (Berotec, 1 dose = 0.2 mg) were assessed. All the drugs were administered 3 x 2 doses/daily, except Berotec--3 x 1 dose/daily--during 14 days. Dyspnoea, cough, sputum scores were calculated and values of FEV1, FVC, FEF25-75 and PC20 (mg/ml metacholine) were measured. All this drugs after 2 weeks therapy statistically significantly reduced dyspnoea, cough and sputum. The best bronchodilating and protective effect were observed after Berodual compare with Atrovent or Berotec.
 ...
PMID:[Effect of fenoterol, ipratropium bromide and combination drug-berodual-on selected clinical parameters and lung function in patients with asthma]. 795 Oct 83

Ipratropium bromide is an atropine-like bronchodilator with a mechanism of action via the anticholinergic pathway, and which may decrease cyclic guanosine monophosphate. Twenty ventilated patients (14-85 years old) with acute airflow obstruction and wheezing or coughing participated in a double-blind trial of nebulized bronchodilator treatment. Maintenance theophylline with or without a steroid preparation was continued and comparison was made between ipratropium bromide and a placebo. The study was randomized and conducted on two separate days commencing at the same time each morning. It was found that both the inspiratory resistance and the respiratory symptom scores decreased after ipratropium inhalation. The arterial O2 and CO2 tension did not change. Cardiovascular side effects appeared to be minimal. Since lung compliance was not affected by aerosol administration of ipratropium, it is possible that this drug acts only on the large airways. No significant alteration in the mean airway pressure was observed. We conclude that ventilated patients with bronchospasms can benefit from nebulized ipratropium alone. Their responses, assessed in terms of inspiratory resistance and symptom relief, may be explained by the bronchodilatation and better airflow resulting from the inhaled ipratropium.
 ...
PMID:[Effects of ipratropium bromide as a nebulized solution on respiratory function in mechanically ventilated patients]. 810 82

Whether nebulized ipratropium bromide is of benefit to mechanically ventilated patients with chronic bronchitis is not well defined. The objective of the study was to determine the effect of ipratropium bromide as a nebulized solution on ventilatory function in patients with severe airflow limitation and under ventilator treatment because of respiratory failure. The design was a randomized, double-blind, controlled trial. Forty-two ventilated patients (43 to 83 years old) with acute airflow obstruction and wheezing or coughing were chosen. The patients were randomly allocated to treatment every 6 h with either 500 micrograms of nebulized ipratropium bromide or 0.9 percent saline solution. Comparison was made between ipratropium bromide and placebo. Their responses were assessed in terms of arterial blood gas analysis, pulmonary mechanics, and respiratory symptoms. No significant differences in oxygenation, arterial CO2 tension, or static lung compliance attributable to ipratropium were found. However, a significant tendency to decreased mean airway resistance, peak inspiratory pressure, mean airway pressure, and improved symptom status 24 h after giving ipratropium was observed. We conclude that ventilated patients with obstructive lung disease could obtain incremental benefit from adding nebulized ipratropium to aminophylline. Their responses may be explained by the bronchodilating effect of ipratropium that resulted in a reduced airway resistance and a lower mean airway pressure.
 ...
PMID:Nebulized ipratropium bromide in ventilator-assisted patients with chronic bronchitis. 818 45

1. Oxitropium bromide (Oxivent), an anticholinergic bronchodilator, inhibits coughing induced by hypotonic aerosols in both asthmatic and non-asthmatic individuals. We have now extended this work to investigate whether this antitussive activity is reproducible in cough associated with viral infection. 2. The effect of oxitropium bromide (200 micrograms three times daily) on cough and pulmonary function has been studied in 56 non-asthmatic volunteers with upper respiratory tract infections (URTI) in a double-blind, randomised, parallel group, placebo controlled study over 10 days. 3. Lung function, symptom questionnaire and cough response to ultrasonically nebulised distilled water (UNDW) inhalation were initially recorded within 72 h of development of cough and again after the 10 day treatment period. By use of a diary card at home, frequency and severity of cough, nocturnal symptoms and general malaise were assessed daily throughout the treatment period using 5 cm visual analogue scales (VAS). Peak expiratory flow rate (PEFR) was recorded thrice daily before treatment over this 10 day period. 4. VAS scores of symptoms and UNDW-induced cough frequency all decreased over the 10 days of observation whether oxitropium bromide or placebo was administered. The mean PEFR showed a statistically significant fall in morning values during the early stages of infection which lessened with recovery but no effect of treatment with oxitropium bromide was observed (P > 0.05). 5. Oxitropium bromide, which inhibits the cough response to UNDW, does not offer an effective therapy for cough associated with an upper respiratory tract viral infection.
 ...
PMID:The effect of anticholinergic bronchodilator therapy on cough during upper respiratory tract infections. 818 64

To investigate the additive effect of oral theophylline on combined inhaled anticholinergic agent and beta 2-agonist therapy, 12 patients with stable COPD (64.6 +/- 5.9 years) completed a randomized, double-blind placebo-controlled crossover trial of oral theophylline for a 4-week period (400 mg for 2 weeks, followed by 600 mg for 2 weeks). All of the patients continued to inhale both salbutamol, 200 micrograms, and ipratropium bromide, 40 micrograms, using a metered-dose inhaler four times a day. Spirometry was assessed before, and 15 and 60 min after the inhalation of bronchodilators at 2-week intervals. Even after the inhalation of salbutamol and ipratropium, theophylline significantly improved FEV1 and daily peak expiratory flow rate compared with the placebo. No significant improvement in the daily symptom scores for cough, sputum, wheezing, or shortness of breath was observed throughout the different phases of treatment. This study shows that the additive bronchodilating effect of theophylline, when used in combination with salbutamol, 200 micrograms, and ipratropium, 40 micrograms, is significant but small in stable COPD. The addition of theophylline did not significantly improve the patient's symptoms. Oral theophylline, when used in combination with an inhaled anticholinergic agent and an inhaled beta 2-agonist, may be of limited value in the treatment of stable COPD.
 ...
PMID:Is oral theophylline effective in combination with both inhaled anticholinergic agent and inhaled beta 2-agonist in the treatment of stable COPD? 832 65

The Chronic Obstructive Pulmonary Disease Early Intervention Trial, or Lung Health Study, is a multicenter randomized clinical trial sponsored by the Division of Lung Diseases of the National Heart, Lung, and Blood Institute. The hypothesis being tested is that over a 5-year period, a comprehensive intervention program can reduce both the rate of decline in pulmonary function and the rates of respiratory morbidity and mortality in middle-aged smokers with mild to moderate airflow obstruction. The primary outcome variable of the trial is the annual rate of decline of maximum postbronchodilator FEV1. Secondary outcomes are the development of respiratory and nonrespiratory morbidity and mortality. After screening 73,694 cigarette smokers, aged 35 to 60 years, 5,887 participants were randomized into three equal groups: usual care, smoking intervention with daily use of a metered-dose inhaler with ipratropium bromide, and smoking intervention with inhalation of placebo. Eligible participants had a ratio of FEV1 to forced vital capacity (FVC) of 70 percent or less, were free of known life-limiting conditions, expressed willingness to enter the intervention program if so randomized, and gave written informed consent prior to entry into the trial. Spirometry, methacholine challenge, and questionnaires were strictly standardized within and across centers. The purpose of this report is to describe the characteristics of randomized participants at the time of entry into the study. For both sexes, three measures of lung function--average cross-sectional FEV1/FVC ratio, FEV1, and FEV1 percentage of predicted normal--showed slight downward trends for each successively older 5-year age cohort. The increase in FEV1 after isoproterenol was 15 percent or more in only 2.4 percent of men and 2.8 percent of women. A positive response to methacholine (defined as a fall in FEV1 of > 20 percent from baseline at concentrations up to 25 mg/ml) occurred in 63 percent of men and 87 percent of women. The cross-sectional prevalences of cough, phlegm, wheeze on most days or nights, and shortness of breath were 49 percent, 43 percent, 32 percent, and 43 percent, respectively. Respiratory symptoms were reported by a higher proportion of participants in the younger age groups than in the older age groups. Participants who reported cough, phlegm, and/or wheeze averaged lower FEV1 percent predicted and higher probability of positive response to methacholine than participants who did not. Shortness of breath appeared to be significantly associated with lower lung function and higher reactivity in men but not in women.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Chronic Obstructive Pulmonary Disease Early Intervention Trial (Lung Health Study). Baseline characteristics of randomized participants. 840 77

Using radiolabeled, monodispersed aerosols (99mTc-iron oxide) and gamma camera analysis, we measured the efficacy of cough for clearing mucus from the airways of the lung following inhalation of the bronchodilator ipratropium bromide (IB) (Atrovent, Boehringer Ingelheim, Inc), a drug that has been shown to have no effect on mucociliary clearance in COPD. Clearance of radiolabeled aerosol was studied over a 2.5-h period on three separate days, a control day with no coughing, and two study days during which the patient performed controlled cough maneuvers over the course of clearance measurements following IB or placebo therapy (double blind, crossover). Fifteen patients, age > 45 years, with stable moderate-to-severe airway obstruction (mean FEV1/FVC = 0.45) were studied. IB diminished the effectiveness of cough for clearing the radiolabeled particles from the airways. This effect of IB on cough clearance may be due to (1) changes in the airflow dynamics induced by bronchodilation or (2) altered rheology or depth of airway secretions.
 ...
PMID:The acute effect of ipratropium bromide bronchodilator therapy on cough clearance in COPD. 843 42

The purpose of this study was to evaluate the usefulness of ultrasonically nebulized distilled water (UNDW) inhalation for assessing cough receptor sensitivity and also the effects of inhaled anticholinergic agents and beta 2-agonists on the number of coughs induced by the UNDW inhalation in patients with chronic cough. All patients were non-smokers and had neither bronchial hyperreactivity nor atopic status. We studied the effects of inhaled oxitropium bromide (300 micrograms) and fenoterol hydrobromide (600 micrograms) on the number of coughs induced by UNDW inhalation for 3 minutes in 9 patients with chronic cough and the effects of inhaled fenoterol hydrobromide (400 micrograms) on the number of coughs induced by UNDW inhalation for 1 minute in 8 patients with chronic cough using a randomized, double-blind, cross-over method. There was no significant difference in pulmonary function test results before and after UNDW inhalation. In both the 3-minute and 1-minute UNDW inhalation studies, the number of coughs was greater in the patients than in normal subjects. Patients with chronic cough may have a high level of cough sensitivity, inhaled fenoterol significantly reduced the number of coughs in the patients in both the 3-minute and 1-minute UNDW inhalation studies (p < 0.05). However, compared with control, inhaled oxitropium did not reduce the number of coughs caused by the 3-minute UNDW inhalation in the patients. Tachyphylaxis was observed in normal subjects in the 3-minute UNDW inhalation study when repeated at a 30-minute interval. We conclude that 1-minute UNDW inhalation method may be safe and useful for measuring cough receptor sensitivity of patients with chronic cough and that inhaled beta 2-agonists may have an inhibitory effect on cough induced by irritation of cough receptors through unknown mechanisms other than the bronchodilator effect.
 ...
PMID:[Effects of inhaled anticholinergic agents and beta 2-agonists on distilled water induced cough in patients with chronic cough]. 885 12


<< Previous 1 2 3 4 5 6 7 8 Next >>