Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Millqvist, Eva; Ternesten-Hasséus, Ewa; Bende, Mats

doi:10.1016/j.pupt.2008.06.002

Cited by 22 publications

(13 citation statements)

References 45 publications

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“…FEV 1 was measured before and after each provocation. In accordance with dose-response relationships seen in several earlier studies using the same capsaicin provocation model (18,19,31,32), the missing data for those patients whose provocations were halted due to excess coughing were filled in by doubling the number of coughs evoked by 2.0 µmol/L capsaicin to represent the cough response to 10.0 µmol/L capsaicin.…”

Section: Capsaicin Provocationsupporting

confidence: 68%

“…This prospective study included 18 consecutively chosen patients, 9 women and 9 men, aged between 18 and 60 years, with a median age of 35 years (95% confidence interval [CI]: [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

Section: Study Participantsmentioning

confidence: 99%

“…The control group consisted of 21 subjectively healthy non-smoking subjects (12 women and 9 men) aged between 25 and 54 years, with a median age of 41 years (95% CI: [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. They were screened using questions on airway symptoms and symptoms in response to chemicals and scents.…”

Section: Study Participantsmentioning

confidence: 99%

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Sensitivity to Environmental Irritants and Capsaicin Cough Reaction in Patients with a Positive Methacholine Provocation Test before and after Treatment with Inhaled Corticosteroids

Ekstrand¹,

Ternesten-Hasséus²,

Arvidsson³

et al. 2011

Journal of Asthma

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Section: Capsaicin Provocationsupporting

confidence: 68%

Section: Study Participantsmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

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Sensitivity to Environmental Irritants and Capsaicin Cough Reaction in Patients with a Positive Methacholine Provocation Test before and after Treatment with Inhaled Corticosteroids

Ekstrand¹,

Ternesten-Hasséus²,

Arvidsson³

et al. 2011

Journal of Asthma

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“…In a previous study, the same group showed similar differences for SAR subjects when challenged with chlorine (Shusterman et al 2003). Patients with sensory hyperreactivity (Millqvist et al 2008) showed not only a higher number of coughs when provoked with 0.4 or 2 µM of capsaicin aerosols, their response was dose-dependent and increased by pre-inhalation of ethanol (5 and 25 %). Control subjects showed no response to ethanol inhalation.…”

Section: Discussionmentioning

confidence: 99%

Sensory irritation as a basis for setting occupational exposure limits

Bartsch²,

et al. 2014

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There is a need of guidance on how local irritancy data should be incorporated into risk assessment procedures, particularly with respect to the derivation of occupational exposure limits (OELs). Therefore, a board of experts from German committees in charge of the derivation of OELs discussed the major challenges of this particular end point for regulatory toxicology. As a result, this overview deals with the question of integrating results of local toxicity at the eyes and the upper respiratory tract (URT). Part 1 describes the morphology and physiology of the relevant target sites, i.e., the outer eye, nasal cavity, and larynx/pharynx in humans. Special emphasis is placed on sensory innervation, species differences between humans and rodents, and possible effects of obnoxious odor in humans. Based on this physiological basis, Part 2 describes a conceptual model for the causation of adverse health effects at these targets that is composed of two pathways. The first, “sensory irritation” pathway is initiated by the interaction of local irritants with receptors of the nervous system (e.g., trigeminal nerve endings) and a downstream cascade of reflexes and defense mechanisms (e.g., eyeblinks, coughing). While the first stages of this pathway are thought to be completely reversible, high or prolonged exposure can lead to neurogenic inflammation and subsequently tissue damage. The second, “tissue irritation” pathway starts with the interaction of the local irritant with the epithelial cell layers of the eyes and the URT. Adaptive changes are the first response on that pathway followed by inflammation and irreversible damages. Regardless of these initial steps, at high concentrations and prolonged exposures, the two pathways converge to the adverse effect of morphologically and biochemically ascertainable changes. Experimental exposure studies with human volunteers provide the empirical basis for effects along the sensory irritation pathway and thus, “sensory NOAEChuman” can be derived. In contrast, inhalation studies with rodents investigate the second pathway that yields an “irritative NOAECanimal.” Usually the data for both pathways is not available and extrapolation across species is necessary. Part 3 comprises an empirical approach for the derivation of a default factor for interspecies differences. Therefore, from those substances under discussion in German scientific and regulatory bodies, 19 substances were identified known to be human irritants with available human and animal data. The evaluation started with three substances: ethyl acrylate, formaldehyde, and methyl methacrylate. For these substances, appropriate chronic animal and a controlled human exposure studies were available. The comparison of the sensory NOAEChuman with the irritative NOAECanimal (chronic) resulted in an interspecies extrapolation factor (iEF) of 3 for extrapolating animal data concerning local sensory irritating effects. The adequacy of this iEF was confirmed by its application to additional substances with lower data density (acet...

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“…Women with chronic cough show a heightened reflex compared to men, probably due to overexpression of TRPs (59). The exposition both to irritants and common intense odors seem to increase the cough reflex through the afferent pathway activated by TRPs (60,61). As discussed above, cough hypersensitivity is associated to the most common causes of chronic cough and it helps to understand the pathogenesis of the symptom.…”

Section: Shortness Of Breath 2014; 3 (4): 159-164mentioning

confidence: 96%

Chronic and unexplained cough

Zanasi¹

2014

SOB

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SummaryCough is a frequent symptom reported in general practice consults. Even though most of the cases concern acute and self limiting episodes, if cough persists a comprehensive diagnostic evaluation should be started. Patients that scarcely respond to empiric therapy or whose symptoms are not clearly referable to one of the most common causes of cough may receive the diagnosis of unexplained cough. These patients frequently develop depression or social retirement. Recent studies have suggested that hypersensitivity of the cough reflex could be the pathogenic mechanism underlying unexplained cough. However hypersensitivity syndrome should not be used as an easy way out for patients with a complicated history of cough. Through our paper we will briefly review the most common causes of cough and how they could be involved in the development of hypersensitivity cough syndrome.KEY WORDS: chronic cough; hypersensitivity syndrome; idiopathic cough; unexplained cough. IntroductionOn one hand cough represents a primary defensive mechanism of the airways. It prevents inhalation and aspiration of harmful gasses and particles from the environment and helps the mucous clearance from the lowAlthough the management of acute cough can require more than one visit, the impact on patient's quality of life is limited if compared to chronic cough.

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Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Cited by 22 publications

References 45 publications

Sensitivity to Environmental Irritants and Capsaicin Cough Reaction in Patients with a Positive Methacholine Provocation Test before and after Treatment with Inhaled Corticosteroids

Sensitivity to Environmental Irritants and Capsaicin Cough Reaction in Patients with a Positive Methacholine Provocation Test before and after Treatment with Inhaled Corticosteroids

Sensory irritation as a basis for setting occupational exposure limits

Chronic and unexplained cough

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