Cough and the Common Cold

Abstract

To determine whether the cough of the common cold arises from upper respiratory stimuli and whether antihistamine-decongestant therapy is an effective treatment for this cough, we prospectively evaluated volunteers with uncomplicated common colds in a randomized, double-blind, placebo-controlled study. After completing a standardized questionnaire and undergoing a physical examination, throat-culturing, and pulmonary function testing, subjects took the active drug or identical-appearing placebo for 7 days while they kept a diary in which they ranked the severity of 17 symptoms for 14 days. Pulmonary function testing was repeated, on average, on Days 4, 8, and 14. Forty-six percent of the variation in cough severity could be explained by throat-clearing and 47% of the variation in throat-clearing severity by postnasal drip. FIF50%, the only physiologic parameter that significantly correlated with cough, rose as cough severity fell. Antihistamine-decongestant therapy reduced postnasal drip and significantly decreased the severity of cough, nasal obstruction, nasal discharge, and throat-clearing during the first few days of the common cold. In addition, cough was 20 to 30% less prevalent in the active drug group within 3 days of starting therapy. We conclude that the cough of the common cold arose from upper respiratory tract stimuli and that cough and other cardinal symptoms of the common cold were reduced with antihistamine-decongestant therapy when these symptoms were at their worst.

Are there clinical features of a sensitized cough reflex?

“…The most obvious example is the change in cough reflex sensitivity following an upper respiratory tract infection. After a viral infection, the cough reflex becomes hyperreactive and remains in this activated state for a variable period of time (typically no more than 2-3 weeks while the patient is symptomatic [53]) following which the hyperreactivity diminishes and the cough reflex responsiveness returns to its baseline state [46]. However, in some circumstances this hypersensitized state persists long after the initial triggering event leading to a chronic cough state ( …”

Psychosocial risk factors for upper respiratory infection: Depression as a mediator of associations between neuroticism and upper respiratory illness.

“…One basis for this claim is prior evidence that symptom reports are highly related to clinical judgements of health status based on observations of gross physical pathology (Roden, 1958;Totman, et al, 1980) and to physiological markers for pathological processes associated with infections (Naclerio, et al, 1988;Totman, Reed & Craig, 1977) and to pre-existing antibodies prior to viral exposure (Broadbent, et al, 1984;Totman, et al, 1977). Symptom report measures also clearly distinguish inoculated and placebo groups in controlled studies of viral inoculations (e.g., Jackson, Dowling, Spiesman & Boand, 1958) and are sensitive to pharmacological interventions intended to modify the physiological bases of symptoms (Curley, et al, 1988;Howard, et al, 1979). Symptom report measures also are related to biochemical markers which may be related to general susceptibility to respiratory infections (Jemmott, 1987;Lytle & McNamara, 1967;Lytle, Rytel & Edwards, 1966;Rossen, et al, 1970;Yodfat & Silvian, 1977).…”

Cough: Differential diagnosis and rational pharmacotherapy

“…В случае кашля длительностью от 3 до 8 нед принято говорить о подостром (затяжном), или «постинфекци-онном», кашле. Данная клиническая классификация позволяет актуализировать перечень причин кашля и определить направле-ния диагностического поиска и лечения [2,[10][11][12][13][14][15].…”