chronic cough are presented in algorithmic form (Fig 1-3). Guidelines with algorithms for evaluating chronic cough in pediatric patients < 15 years of age are presented in the section entitled "Guidelines for Evaluating Chronic Cough in Pediatrics" 2,4 [Fig 4, 5]. For a full discussion on how to use the algorithms, please refer to these sections. Summary and Recommendations Recommendations for each section of these guidelines are listed under their respective section titles. For an in-depth discussion or clarification of each recommendation, readers are encouraged to read the specific section in question in its entirety. Methodology and Grading of the Evidence for the Diagnosis and Management of Cough 5 • The recommendations were graded, by consensus by the panel, using the American College of Chest Physicians Health and Science Policy Grading System, which is based on the following two components: quality of evidence; and the net benefit of the diagnostic and therapeutic procedure. • The quality of evidence is rated according to the study design and strength of other methodologies used in the included studies.

Nasal obstruction can be monitored objectively by measurement of nasal airflow, as evaluated by nasal peak flow, or as airways resistance/conductance as evaluated by rhinomanometry. Peak flow can be measured during inspiration or expiration. Of these measurements, nasal inspiratory peak flow is the best validated technique for home monitoring in clinical trials. The equipment is portable, relatively inexpensive, and simple to use. One disadvantage, however, is that nasal inspiratory peak flow is influenced by lower airway as well as upper airway function. Rhinomanometry is a more sensitive technique that is specific for nasal measurements. The equipment, however, requires an operator, is more expensive, and is not portable. Thus, it is applicable only for clinic visit measures in clinical trials. Measurements require patient cooperation and coordination, and not all can achieve repeatable results. Thus, this objective measure is best suited to laboratory challenge studies involving smaller numbers of selected volunteers. A nonphysiological measure of nasal patency is acoustic rhinometry. This sonic echo technique measures internal nasal luminal volume and the minimum cross-sectional area. The derivation of these measures from the reflected sound waves requires complex mathematical transformation and makes several theoretical assumptions. Despite this, however, such measures correlate well with the nasal physiological measures, and the nasal volume measures have been shown to relate well to results obtained by imaging techniques such as computed tomography scanning or magnetic resonance imaging. Like rhinomanometry, acoustic rhinometry is not suitable for home monitoring and can be applied only to clinic visit measures or for laboratory nasal challenge monitoring. It has advantages in being easy to use, in requiring little patient cooperation, and in providing repeatable results. In addition to nasal obstruction, allergic rhinitis is recognized to be associated with impaired mucociliary clearance and altered nasal responsiveness. Measures exist for the monitoring of these aspects of nasal dysfunction. Although measures of mucociliary clearance are simple to perform, they have a poor record of reproducibility. Their incorporation into clinical trials is thus questionable, although positive outcomes from therapeutic intervention have been reported. Measures of nasal responsiveness are at present largely confined to research studies investigating disease mechanisms in allergic and nonallergic rhinitis. The techniques are insufficiently standardized to be applied to multicenter clinical trials but could be used in limited-center studies to gain insight into the regulatory effects of different therapeutic modalities.

BackgroundThe common cold, the most prevalent contagious viral disease in humans still lacks a safe and effective antiviral treatment. Iota-Carrageenan is broadly active against respiratory viruses in-vitro and has an excellent safety profile. This study investigated the efficacy and safety of an Iota-Carrageenan nasal spray in patients with common cold symptoms.MethodsIn a randomized, double-blind, placebo-controlled exploratory trial, 35 human subjects suffering from early symptoms of common cold received Iota-Carrageenan (0.12%) in a saline solution three times daily for 4 days, compared to placebo.ResultsAdministration of Iota-Carrageenan nasal spray reduced the symptoms of common cold (p = 0.046) and the viral load in nasal lavages (p = 0.009) in patients with early symptoms of common cold. Pro-inflammatory mediators FGF-2, Fractalkine, GRO, G-CSF, IL-8, IL-1α, IP-10, IL-10, and IFN-α2 were reduced in the Iota-Carrageenan group.ConclusionsIota-Carrageenan nasal spray appears to be a promising treatment for safe and effective treatment of early symptoms of common cold. Larger trials are indicated to confirm the results.

Studies based on the nasal cycle are difficult because multiple measurements of nasal patency need to be made over many hours. There is a great need for a simple portable instrument that can be used away from the clinical laboratory for studies on the nasal cycle. Our aim was to investigate the usefulness of a small portable spirometer in studying the nasal cycle. The Mir Spirobank spirometer was fitted with a nasal adapter to measure the volume of air expired from each nasal passage during a slow vital capacity (VC). The spirometer was used to measure the fractions of the slow VC volume of air expired through the right and left nasal passage in turn. Hourly measurements were made over a 5-hour period in six healthy volunteers. The spirometry measurements of the volume of air expired from each nasal passage were compared with nasal conductance of each nasal passage (airflow at 75 Pa) obtained by posterior rhinomanometry. The spirometer was found easy to use by both the investigator and the patients. Simple regression analysis of the spirometer and rhinomanometer measures of airflow partitioning found a correlation coefficient of r = 0.827 (p < 0.0001: n = 36). These results indicate that the partitioning of nasal expired volume measured by spirometry is directly comparable with partitioning of nasal airflow obtained with rhinomanometry. Spirometry has considerable advantages over rhinomanometry for studies on the nasal cycle because of portability and ease of use.

This up-to-date overview will look at the rationale for the recommendation of combination products for multi-symptom relief of common cold and flu. Common cold and flu are defined by their multi-symptom nature with data showing a variety of symptoms reported simultaneously each day over the first six days of illness. Multi-ingredient combination products for multi-symptom relief are formulated to safely, simply, and simultaneously treat multiple symptoms when used as directed. The rationale for the formulation combination products for common cold and flu is therefore practical, logical and reasonable. No evidence has been found that multi-symptom relief medicines are inherently less safe than single-active ingredient medicines. Multi-symptom relief combination products containing several active ingredients provide a safe, effective, cost-effective, and convenient way of treating the multiple symptoms of common cold and flu, when used as directed. This therapy requires some special information for the patient to be provided by the physician and the pharmacist.