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At least 19 recordsLinked to original sources
PubMed1979

Evidence of whooping-cough-vaccine efficacy from the 1978 whooping-cough epidemic in Hertfordshire.

The question of the efficacy of whooping-cough immunisation was central to the controversy that started in 1974. Definitive answers were not possible at the time because of the very low levels of whooping-cough in the preceding years and the absence of up-to-date information. The widespread abandonment of whooping-cough immunisation and the subsequent epidemic of whooping-cough have provided a natural epidemiological experiment. Figures from Hertfordshire in 1978 show that for children aged 4 years and under whooping-cough immunisation conferred 92% protection.

Child Health Services↗
PubMed2026

The Genetic Architecture of Chronic Cough: From Sensory Hypersensitivity to Treatable Trait.

Chronic cough is a prevalent global clinical disorder with substantial quality-of-life impairment, and refractory cases remain a major unmet medical need. Cough hypersensitivity syndrome is the core pathological mechanism of chronic cough, and growing genetic evidence has confirmed that inherited susceptibility shapes cough hypersensitivity, clinical heterogeneity and therapeutic responsiveness, redefining chronic cough as a biologically mediated sensory-neural disorder rather than a non-specific secondary symptom of airway diseases. This review summarises genetic evidence for chronic cough from family-based studies, pharmacogenomics and genome-wide association studies (GWAS), revealing distinct genetic architectures of chronic dry cough and sputum production, with enrichment of sensory-neural pathway variants and key genetic loci such as replication factor C subunit 1 (RFC1) functional genomic analyses link genetic variation to vagal afferent excitability, and rare genetic neurological disorders further illuminate the neurogenic basis of cough hypersensitivity. Moreover, genetic insights identify tractable treatable traits and rationalise antitussive drug development, supporting genotype-guided patient stratification. We conclude that integrating genetic architecture into clinical phenotyping and translational research provides a critical framework for precision management of chronic cough, and future progress relies on harmonised deep phenotyping and multi-ancestry genetic studies.

RFC1 gene↗
PubMed1977

Cough. A comprehensive review.

An understanding of the anatomic, physiologic, and pathophysiologic aspects of cough is necessary to appropriately diagnose and treat patients with cough. In the majority of persons, cough that is acute and self-limiting is usually secondary to a viral upper respiratory tract infection; cough that is chronic and persistent is usually due to chronic bronchitis or postnasal drip. In the remaining persons, to determine the cause of cough, it is necessary to systematically consider anatomic locations were receptors and afferent nervous pathways are located. Definitive treatment of cough depends on determining its precise cause and then initiating specific therapy for the underlying disorder. Only when the cause of cough remains unknown or when cough performs no useful function and its complications represent a potential hazard to the patient, should symptomatic treatment be considered. Combination cough preparations should not be prescribed.

Antitussive Agents↗
PubMed1978

Influence of tracheal muscular tone on the initiation of cough reflex.

We devised a canine blood-perfusion preparation which made feasible administration of drugs directly at the local tracheal site. The hypothesis of Salem and Aviado on cough mechanism that a local airway constriction induced by stimuli may be a trigger in stimulating cough receptors was investigated using this preparation. Close intraarterial injections of acetylcholine (ACh) and histamine did not elicit a cough although intense tracheal constrictions were evident. The cough reflex elicited by electrical stimulation of the mucosa of isolated upper trachea in situ was accompanied by a slight systemic hypotension, tracheal vasodilatation and tracheal muscular constriction. The latter two changes occurred after a time lag following coughs. Close intraarterial infusions of isoproterenol and papaverine caused a prominent tracheal dilatation, but did not suppress the coughs. Pretreatment with atropine sufficiently inhibited cholinergic tracheoconstriction but had no effect on the electrically induced coughs. Furthermore, an augmentation of the tracheal muscular tone produced by an infusion of ACh did not enhance the cough reflex. In light of our observations, the aforementioned hypothesis should be reconsidered.

Acetylcholine↗
PubMed1979

Cough reflex changes in local tracheitis.

The authors describe changes in the cough reflex in unanaesthetized cats with experimental local tracheitis. Inflammation was produced by a silk suture fixed in the trachea and cough was elicited by mechanical stimulation of different parts of the respiratory tract mucosa. The resultant cough values (the number of efforts, the intensity of the maximum effort and the intensity of the attack) were compared with the corresponding values in healthy cats. In animals with a tracheal suture, inflammation was confined to the trachea. The intensity of cough elicited by stimulation of this region increased significantly compared with normal (on the 15th to 17th day of inflammation), whereas cough elicited from the laryngopharyngeal and tracheobronchial region did not. On about the 20th day of inflammation the authors found a decrease in the intensity of the maximum effort of cough elicited from the inflamed part of the trachea and a decrease in the intensity of the maximum effort and the intensity of the coughing attack elicited from the laryngopharyngeal and tracheobronchial region. They assume that the decrease could have been due to the development of protective inhibition in central structures participating in integration of the cough reflex.

Animals↗
PubMed1979

Elimination of test particles from the human tracheobronchial tract by voluntary coughing.

The effect of coughing on the elimination of inhaled 6 micrometer radioactively tagged teflon particles in humans was studied by external measurements of the radioactivity retained in the lungs before and after 1--2 min of voluntary coughing. In six healthy subjects coughing produced no substantial elimination of the particles. Six out of eight patients with lung disease produced expectorate and also eliminated particles from the lungs by coughing. The other two patients had no phlegm, did not produce any expectorate and did not eliminate particles by coughing. An increased amount of tracheobronchial secretion thus seems to be necessary for coughing to be effective. In the patients, the elimination of particles by coughing was fairly reproducible, suggesting that the test model may be useful for investigation of the influence of physiological and pharmacological factors on the elimination process.

Adult↗
PubMed1979

Effect of experimental hydrothorax on the cough reflex in conscious cats.

The authors induced experimental hydrothorax in cats by injecting dextran into the pleural cavity under brief N2O anaesthesia. They examined the parameters of cough -- elicited by mechanical stimulation of the airway mucosa -- and blood gas and pH values under normal conditions and after the injection of 50, 100, 200 and 250 ml dextran. The tests were always performed 30 min after terminating anaesthesia, i.e. in conscious animals. The free fluid in the thorax was found, in conscious cats, to reduce the inspiratory values of cough, but to have no effect on cough expiration. This is in agreement with previous findings showing that the intensity of a cough expiration does not always depend on the intensity of the preceding cough inspiration. According to this finding, the decrease in the expiratory values of cough observed during experimental pleurisy cannot be due to the actual exudate. In cats, experimental hydrothorax in doses of 200 and 250 ml leads to respiratory insufficiency. The authors further found that, for the study of interoception in the airways of conscious cats, which requires experimental induction of pathological conditions under brief anaesthesia, nitrous oxide is a convenient anesthetic.

Animals↗
PubMed1979

Prevalence and etiology of chronic cough without sputum production in coal miners.

Chronic cough in the sense of the international definition was found in 50.5% of a group of 970 coal-miners at work without pneumoconiosis. In 14.7% of these subjects the cough was without phlegm production. Non productive cough is therefore not a rare event and this symptom may not be neglected in the natural history of chronic bronchitis in coal-miners. The changes in lung function are similar whether the cough is productive or not. In both cases endoscopic and histological features are suggestive of an established chronic inflammatory process. Allergy is not more frequent in subjects with dry cough than in those with productive cough.

Bronchi↗
PubMed1977

Cough syncope: the possible relation to hydrocephalus ex vacuo.

Pneumoencephalographic data in five male patients with cough syncope were compared to those from age-matched patients with syncope from other causes. The 3rd ventricle width was significantly larger in patients with cough syncope than in the control group (p less than 0.01). Theoretically, the most plausible role of hydrocephalus ex vacuo in cough syncope may be: either it causes increased sensitivity to changes normally encountered during coughing, or--which seems less likely--it may abolish mechanisms normally restraining cough.

Asthma↗
PubMedDate not supplied

Carotid blood velocity during cough studies in man.

Utilizing a Doppler ultrasonic flowmeter catheter, right carotid artery blood velocity was measured during 91 coughing episodes in 16 patients. Such coughing reduced carotid blood velocity by 40 +/- 22% (control = 34 +/- 8 cm per second, cough = 20 +/- 9 cm per second, p less than 0.001). There was an insignificant low degree of corrleation between the level of simultaneously recorded mean right pressure and the percent decline of peak carotid blood velocity, suggesting that impaired venous return was not the only factor responsible for the observed changes. It is concluded that (1)coughing diminishes phasic carotid blood velocity and (2)reduced cerebral perfusion may play a role in the pathogenesis of cough syncope.

Adult↗
PubMed1979

Effects of postural drainage, exercise, and cough on mucus clearance in chronic bronchitis.

The effects of postural drainage, exercise, and cough on mucus clearance were compared in 8 patients with chronic bronchitis. A bolus of 99mTc albumin aerosol was inhaled at a high inspiratory flow rate to enhance proximal deposition. Retention of deposited aerosol in the lung, as a function of time, was quantified using a gamma camera and subsequent computer analysis. Coughing greatly accelerated total lung (P less than 0.005) and peripheral (P less than 0.005) mucus clearance. Exercise resulted in much smaller changes than did cough, but significantly increased total lung clearance (P less than 0.005). Postural drainage in which coughing was prohibited did not alter clearance. These results have therapeutic implications and stress the importance of controlling cough when evaluating therapeutic interventions by these techniques.

Aged↗
PubMed1977

[Intensity of the epidemic process of whooping cough under conditions of mass immunization over a period of many years].

On the basis of analysis of whooping cough incidence in 1959 to 1975 in Moscow the authors present characteristics of the epidemic process under conditions of planned many-year immunization of children against this infection. Whooping cough morbidity proved to undergo significant changes-from sharp falls the first 8 years of immunization to a relative stabilization with a gradual reduction the last 5 years. Marked seasonal and periodic elevations persist against the background of reduction of morbidity. Preschool- and schoolchildren are equally involved in the epidemic process; the most frequently involved are nonvaccinated children aged 1 year and 4 to 10 years, which lost postvaccinal immunity. Further reduction of the severity of whooping cough and increase in the number of unimanifested forms of the infection was noted. This was apparently connected not only with immunization, but also with the reduction of the virulence of H. pertusis detected in studying the cultures isolated in Moscow from 1967 to 1974. The intensity indices of the epidemic process in whooping cough pointed to the necessity of using a more effective vaccine for the protection of children from whooping cough, despite the noted reduction of morbidity, and diminished severity of the course of the disease, and of the causative agent virulence.

Adolescent↗
PubMed1976

Self-administered cardiopulmonary resuscitation by cough-induced cardiac compression.

Repeated rhythmic (every 1-3 sec.) coughs were documented to maintain consciousness up to 39 seconds in 3 patients developing ventricular fibrillation during coronary arteriography. The arterial pressure wave resulting from a cough exceeded that induced by external chest compression in 2 individuals in whom both techniques were employed and in 5 others treated by external compression alone. Cough-induced cardiac compression is self-performed, and compared to external chest compression is less likely to traumatize the chest wall or heart and can be performed in any position on any surface. It is recommended that patients undergoing coronary arteriography be previously trained to cough abruptly and repeatedly every 1-3 seconds. The potential for utilizing this technique in other areas (i.e., CCU, home) is less favorable than in catheterization-induced ventricular fibrillation, but it might be employed successfully in patients with premonitory symptoms of ventricular arrhythmias or Stokes-Adams seizures. The prior training of high risk individuals (and their spouses) to induce effective coughing in the victim might be lifesaving.

Aged↗
PubMed1978

Differential attention in the treatment of operant cough.

This case study reports the successful use of differential attention in the treatment of chronic operant coughing of 6 months' duration in a 13-year-old boy. The boy was hospitalized, where the symptom was ignored and his adaptive age-appropriate behaviors were reinforced with points and praise. Fines were levied for self-derogatory statements. Obtrusive and unobtrusive observations revealed the cough rate higher when the patient was aware of being observed than when he was unaware of being observed. After 4 days the cough rate dropped to zero, where it remained except for a slight recurrence on the day of discharge. His parents were trained in maintaining the differential attention contingencies in effect in the hospital and were able to transfer these conditions to the home. Thus, when the cough again returned once the patient was home, they were able to immediately terminate it. Follow-up of over 36 months revealed the boy to be symptom free.

Adolescent↗
PubMed1979

Chronic cough as the sole presenting manifestation of bronchial asthma.

Six patients with chronic cough, without history of dyspnea or wheezing, had normal base-line spirometry but hyper-reactive airways, as demonstrated with methacholine. Maintenance therapy with bronchodilators promptly eliminated the cough in all patients. Three to 12 months later therapy was discontinued for three days, cough returned, and detailed pulmonary-function studies were carried out. Again, base-line values were normal, but after methacholine one-second forced expiratory volume decreased an average of 40 per cent in the patients as compared to 30 per cent in normal controls (P less than 0.001). The point of identical flow was increased by methacholine to 43.5 per cent of vital capacity in the patients, as compared to 6 per cent in normal controls (P less than 0.001), and the alveolar plateau was 4.8 deltaN2 per liter, as compared to 1.4 in normal controls (P less than 0.01). Specific airway conductance was lowered in patients and controls, but the post-methacholine value was significantly lower in the patients. On the basis of their persistently hyper-reactive airways, inducible diffuse airway bronchoconstriction and excellent response to bronchodilator therapy, these patients appear to have a variant form of asthma in which the only presenting symptom is cough.

Adolescent↗
PubMedDate not supplied

[Prevalence of chronic productive cough and obstructive ventilatory dysfunction in a rural community with minimal air pollution].

Results obtained during an epidemiological investigation on chronic cough and obstructive ventilatory dysfunction in subjects without bronchopulmonary affections of known etiopathogeny, carried out in a rural environment with minimal air pollution on 282 men aged between 40 and 69 years, indicate the following: --there was a lower prevalence of chronic cough in the rural environment as compared with the urban one (12.8:21.0). The percentage of heavy smokers being approximately similar in both environments, the difference could be explained by the variable intensity of air pollution, the impact of which was exerted on the large airways (hypertrophy of the serous-mucous glands resulting in hypercrinia with dyscrinia); --similar prevalence in the two environments of the obstructive ventilatory dysfunction (11,0:8,7) suggests that this abnormality, an expression of the narrowing of the small airways, could be due to other pathogenic factors. Functional pulmonary tests with sensitivity higher than the ratio between FEV 1.0 and VC (as, for instance VEmx 50% VC) could provide higher percentages of obstructive disturbances both among chronic coughing and non-coughing subjects, revealing the latent form of the obstruction, as opposed to the manifest one as evidenced by a decrease of the FEV 1.0/VC ratio.

Adult↗
PubMedDate not supplied

[The controversy concerning whooping cough vaccination (author's transl)].

The importance of the neurological complications of whooping cough vaccination has been greatly exaggerated. Their frequency may vary tenfold, depending on the authors. Most of the latter are mainly linked to age and are thus coincidences. Other etiologies may be responsible, as also may a receptive constitutional background, the vaccine then simply reveals a preexisting condition. Present whooping cough vaccines are efficacious as shown by the fall in morbidity curves and the large number of cases in unvaccinated subjects during epidemics. Whooping cough in infants remains a problem which can only be solved by vaccination. Primary vaccination should be carried out as early as possible, while strictly observing the contraindications. The poor absorption of whooping cough vaccines is in favour of their injection by the intramuscular route which is better tolerated. Other vaccines with less reaction and more immunogenic are being sought.

Age Factors↗