Sensitivity of the cough reflex in young and elderly subjects

Newnham, D M; Hamilton, Steven

doi:10.1093/ageing/26.3.185

Cited by 64 publications

(41 citation statements)

References 24 publications

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“…Central nervous system disorders, dementia and poor PS were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Previous studies (6,(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) as well as in the current study suggested that a high frequency of aspiration pneumonia is possibility related to older age, poor PS, dementia and previous brain infarction in Japan. Anaerobes, Streptococcus anginosus group, S. pneumonia, H. influenzae and S. aureus, are thought to be important pathogens in aspiration pneumonia (12).…”

Section: Discussionsupporting

confidence: 74%

Clinical Features and the Role of Atypical Pathogens in Nursing and Healthcare-associated Pneumonia (NHCAP): Differences between a Teaching University Hospital and a Community Hospital

et al. 2012

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Objective The Japan Respiratory Society documented a new category of guidelines for nursing and healthcare-associated pneumonia (NHCAP), which is distinct from community acquired pneumonia (CAP). The objective of this study was to determine the epidemiological differences between NHCAP patients in a teaching university hospital and a community hospital. In addition, to clarify the strategy for treatment of NHCAP, we investigated the role of atypical pathogens. Methods We analyzed 250 NHCAP and 421 CAP cases in a university hospital and 349 NHCAP and 374 CAP cases in a community hospital. Results Patient age and the incidences of poor general condition were significantly higher in the community hospital compared with those in the university hospital. The distribution and frequency of pathogens, especially multidrug-resistant (MDR) pathogens, were significantly different between the two hospitals. Central nervous system disorders, dementia and poor performance status, which was possibility related to aspiration pneumonia, were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Atypical pathogens were detected in a few cases in patients with NHCAP. Conclusion There were many differences in the clinical characteristics between NHCAP patients in a university hospital and a community hospital even for hospitals located in the same area. Aspiration pneumonia was thought to be the main characteristic of NHCAP in both hospitals. Thus, all NHCAP patients did not need the same empiric therapy with a multidrug regimen directed against MDR pathogens. In addition, physicians rarely need to consider atypical pathogens in NHCAP treatment.

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Section: Discussionsupporting

confidence: 74%

Clinical Features and the Role of Atypical Pathogens in Nursing and Healthcare-associated Pneumonia (NHCAP): Differences between a Teaching University Hospital and a Community Hospital

et al. 2012

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“…Thus, the absence of any serious cardiac event in our population could likely be explained by the absence of sedation, by accurate and quick oxygen supplementation during FOB, by the professional skill and experience of the bronchoscopist and by the amount of lidocaine administered to the patients. Although the cough reflex is reduced in the elderly [38], we did not change their premedication.…”

Section: Discussionmentioning

confidence: 99%

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

D’Ippolito

Foresi²,

Castagnetti

et al. 2016

Monaldi Arch Chest Dis

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Aim. To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. Methods. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older (“very elderly”; =>75 yrs), were reviewed. Results. Patients aged 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged <75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively.Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Conclusions. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

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“…It is known that reduced bradykinin and substance P levels repress cough reflex and therefore increase the risk to develop pneumonia [12]. As previously reported, a suppressed cough reflex in elderly individuals increases the risk of aspiration and respiratory infection [3]. Use of ACE inhibitors was also found to improve swallowing reflex in 22 elderly individuals with aspiration pneumonia but did not increase the normal reflex in healthy subjects [36].…”

Section: Discussionmentioning

confidence: 78%

“…Available data implicate that pathogenesis of pneumonia correlates with attenuation of cough reflex [2,3], an important defensive respiratory reflex that protects the lungs from inhalation or aspiration of potentially injurious substances and clears excess secretions [4,5]. Basic investigation has shown that bradykinin and substance P sensitize the sensory nerves of the airways and enhance the cough reflex, which may have a protective role on the tracheobronchial tree [6].…”

Section: Introductionmentioning

confidence: 99%

Increased risk of pneumonia associated with angiotensin-converting enzyme (CD143) rs4340 polymorphism

Zhang

Liu

2015

Clin Exp Med

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The study aims to investigate the genetic association between rs4340 polymorphism at intron 16 of the angiotensin-converting enzyme (CD143) gene and pneumonia predisposition. Electronic database of PubMed, Embase, and CNKI (China National Knowledge Infrastructure) was searched for the studies addressing the association between CD143 rs4340 genotypes and pneumonia risk. The odds ratio (OR) with its 95 % confidence interval (CI) was employed to estimate the association. In total, ten case-control studies, including 1239 pneumonia cases and 2400 healthy controls, met the inclusion criteria. Our results showed a significant association between rs4340 SNP and pneumonia risk using the recessive model (OR 1.43, 95 % CI 1.20-1.70). A significantly increased risk was also indicated under the recessive model in Asian populations (OR 1.63, 95 % CI 1.16-2.30), Caucasian populations (OR 1.34, 95 % CI 1.09-1.65), community-acquired pneumonia (OR 1.42, 95 % CI 1.16-1.75) rather than nosocomial pneumonia (OR 1.47, 95 % CI 0.97-2.23). However, further studies with gene-gene and gene-environmental interactions should be considered to confirm this association.

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Sensitivity of the cough reflex in young and elderly subjects

Abstract: The sensitivity of the cough reflex appears to be significantly reduced in elderly subjects. This may increase the risk of aspiration and bronchopulmonary infection in old age, even in the absence of respiratory disease.

Cited by 64 publications

References 24 publications

Clinical Features and the Role of Atypical Pathogens in Nursing and Healthcare-associated Pneumonia (NHCAP): Differences between a Teaching University Hospital and a Community Hospital

Clinical Features and the Role of Atypical Pathogens in Nursing and Healthcare-associated Pneumonia (NHCAP): Differences between a Teaching University Hospital and a Community Hospital

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

Increased risk of pneumonia associated with angiotensin-converting enzyme (CD143) rs4340 polymorphism

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