Interpretation of Cough Provoked by Airway Challenges

Koskela, Heikki; Kontra, Kirsi M.; Purokivi, Minna; Randell, Jukka

doi:10.1378/chest.128.5.3329

Cited by 34 publications

(48 citation statements)

References 29 publications

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“…The exclusion criteria for all the subjects were febrile respiratory tract infection within six weeks, and post-salbutamol FEV 1 less than 60% [18]. In addition, subjects with excessive spontaneous cough (>10 coughs in response to 0.9% saline inhalation) and subjects with fall of FEV 1 more than 10% during neither of inhalation challenge used, were excluded from the study [19,20]. Thirty-six asthmatic and fourteen healthy subjects completed the study.…”

Section: Methodsmentioning

confidence: 99%

Cough response to isocapnic hyperpnoea of dry air and hypertonic saline are interrelated

Purokivi

Koskela

Brannan

et al. 2011

Cough

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BackgroundMechanisms behind asthmatic cough are largely unknown. It is known that hyperosmolar challenges provoke cough in asthmatic but not in the healthy subjects. It has been postulated that isocapnic hyperpnea of dry air (IHDA) and hypertonic aerosols act via similar mechanisms in asthma to cause bronchoconstriction. We investigated whether there is an association between cough response induced by IHDA and hypertonic saline (HS) challenges.MethodsThirty-six asthmatic and 14 healthy subjects inhaled HS solutions with increasing osmolalities administered via ultrasonic nebuliser until 15 cumulative coughs were recorded. The IHDA consisted of three three-minute ventilation steps: 30%, 60% and 100% of maximal voluntary ventilation with an end-point of 30 cumulative coughs. The challenges were performed on separate days at least 48 hours between them and within one week. Inhaled salbutamol (400 mcg) was administered before the challenges to prevent bronchoconstriction. The cough response was expressed as the cough-to-dose ratio (CDR) which is the total number of coughs divided by the maximal osmolality inhaled or the maximal ventilation achieved.ResultsCough response to IHDA correlated with the HS challenge (Rs = 0.59, p < 0.001). Cough response to IHDA was at its strongest during the first minute after the challenge. IHDA induced more cough among asthmatic than healthy subjects CDR being (mean ± SD) 0.464 ± 0.514 and 0.011 ± 0.024 coughs/MVV%, p < 0.001, respectively. Salbutamol effectively prevented bronchoconstriction to both challenges.ConclusionsAsthmatic patients are hypersensitive to the cough-provoking effect of hyperpnoea, as they are to hypertonicity. Cough response induced by IHDA and HS correlated well suggesting similar mechanisms behind the responses.

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Section: Methodsmentioning

confidence: 99%

Cough response to isocapnic hyperpnoea of dry air and hypertonic saline are interrelated

Purokivi

Koskela

Brannan

et al. 2011

Cough

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“…There is increasing evidence that aerosol hyperosmolar solutions has the potential to provoke cough through activation of peripheral afferent nerve fibers not only in asthmatic but also in healthy humans and naïve animals (Pedersen et al, 1998; Koskela et al, 2004, 2005, 2008; Singapuri et al, 2008; Purokivi et al, 2011). The challenge of guinea pig airway with hyperosmolar solutions of NaCl (4%) or Mannitol (0.9 M) in vitro leads to activation of jugular ganglion neurons—projecting to trachea and main stem bronchi—that may trigger cough (Pedersen et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

Down-Regulation of Cough during Exercise Is Less Frequent in Healthy Children than Adults. Role of the Development and/or Atopy?

et al. 2017

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Cough is typically associated with physical activity in children with asthma, but the characteristics of the relationship between cough and exercise has not been established under physiological conditions. The aim of the study was to describe the effect of exercise on the reflex cough response elicited by a single breath of capsaicin in non-asthmatic children. A group of non-asthmatic adults was studied as reference. Thirty children and 29 adults were recruited. The cough reflex sensitivity to capsaicin was first determined to establish the dose that provokes 5 cough efforts (C5). The number of coughs elicited by C5 (NC5) was then compared at baseline and during a standardized submaximal treadmill exercise. Data are expressed as median (interquartile range). Children and adults showed a significant decrease in NC5 (respectively from 5.0 (4.0–6.0) to 2.5 (2.0–4.0), p < 0.0005 and from 6.0 (5.0–7.0) to 2.0 (0.0–3.0, p < 0.0005). During exercise, NC5 was observed to decrease in all adult subjects, but in only 24/30 children (80%, p = 0.02). A trend for a higher incidence of personal and familial atopy was observed in children that lacked cough down-regulation during exercise compared with other children. It is concluded that the cough reflex response to capsaicin is down regulated by exercise in both children and adults. The effect however is less consistently observed in the former. The difference may reflect maturation of descending inhibitory pathways of the cough reflex, but may also be associated to atopy. The data stress the importance of assessing the time relationship of cough and exercise in questionnaire studies of asthma.

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“…In adults, several studies have examined cough in relation to several tests of airway hyper-responsiveness and have suggested that cough can be used as a marker of asthma. However, others have shown that medications used to abolish the broncho-constriction effect did not influence the cough response (17)(18)(19). In pediatric clinical practice, arguably delineating cough in relation to exercise is more applicable than that to other airway challenges.…”

Section: Discussionmentioning

confidence: 99%

Cough and exhaled nitric oxide levels: what happens with exercise?

Petsky¹,

Kynaston²,

McElrea³

et al. 2013

Paediatric Respiratory Reviews

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Cough associated with exertion is often used as a surrogate marker of asthma. However, to date there are no studies that have objectively measured cough in association with exercise in children. Our primary aim was to examine whether children with a pre-existing cough have an increase in cough frequency during and post-exercise. We hypothesized that children with any coughing illness will have an increase in cough frequency postexercise regardless of the presence of exercise-induced broncho-constriction (EIB) or atopy. In addition, we hypothesized that Fractional exhaled nitric oxide (FeNO) levels decreases post-exercise regardless of the presence of EIB or atopy. Children with chronic cough and a control group without cough undertook an exercise challenge, FeNO measurements and a skin prick test, and wore a 24-h voice recorder to objectively measure cough frequency. The association between recorded cough frequency, exercise, atopy, and presence of EIB was tested. We also determined if the change in FeNO post exercise related to atopy or EIB. Of the 50 children recruited (35 with cough, 15 control), 7 had EIB. Children with cough had a significant increase in cough counts (median 7.0, inter-quartile ranges, 0.5, 24.5) compared to controls (2.0, IQR 0, 5.0, p = 0.028) post-exercise. Presence of atopy or EIB did not influence cough frequency. FeNO level was significantly lower post-exercise in both groups but the change was not influenced by atopy or EIB. Cough post-exertion is likely a generic response in children with a current cough. FeNO level decreases post-exercise irrespective of the presence of atopy or EIB. A larger study is necessary confirm or refute our findings.

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Interpretation of Cough Provoked by Airway Challenges

Cited by 34 publications

References 29 publications

Cough response to isocapnic hyperpnoea of dry air and hypertonic saline are interrelated

Cough response to isocapnic hyperpnoea of dry air and hypertonic saline are interrelated

Down-Regulation of Cough during Exercise Is Less Frequent in Healthy Children than Adults. Role of the Development and/or Atopy?

Cough and exhaled nitric oxide levels: what happens with exercise?

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