R. Pecova

Acidification of the oesophagus acutely increases the cough sensitivity in patients with gastro-oesophageal reflux and chronic cough.

Abstract  Gastro‐oesophageal reflux disease (GORD) is one of the most common causes of chronic cough; however, the mechanisms by which GOR initiates coughing are incompletely understood. We address the hypothesis that acidification of oesophagus acutely increases the cough reflex sensitivity in patients with GORD and chronic cough. Nine patients with GORD with chronic cough and 16 patients with GORD without cough were recruited. In a randomized double blind study, saline and acid (HCl, 0.1 mol L−1) were separately infused into oesophagus via naso‐oesophageal catheter. Cough reflex sensitivity to inhaled capsaicin was determined immediately after completion of each infusion. Infusion of acid into oesophagus increased capsaicin cough reflex sensitivity in patients with GORD and chronic cough. In contrast, acid had no effect on the cough sensitivity in patients with GORD without cough. In a separate study, acid infusion into oesophagus did not affect the cough sensitivity in 18 healthy subjects. We conclude that acid in the oesophagus acutely increases the cough reflex sensitivity to capsaicin in patients with GORD and chronic cough. This phenomenon may contribute to the pathogenesis of cough due to GORD.

Mechanisms of the cough associated with rhinosinusitis

The diseases of the nose and paranasal sinuses (rhinosinusitis) often in combination with asthma and gastroesophageal reflux are common causes of chronic cough in patients with normal chest radiograph. The relationships between rhinosinusitis and cough are incompletely understood. We investigated modulation of the cough reflex by the inputs from the nose. We demonstrate that the cough reflex is sensitized by the intranasal administration of sensory nerve activators in animal models and in humans. Cough reflex is also sensitized in the guinea pig model of allergic nasal inflammation and in patients with allergic rhinitis. In patients with allergic rhinitis the cough sensitization is augmented during the allergen season. We conclude that the cough reflex can be sensitized from the nose. Our data indicate that this sensitization is mediated by nasal sensory nerves. We speculate that by inducing the cough reflex sensitization rhinosinusitis contributes to chronic cough. If combined with environmental or endogenous cough triggers, the cough reflex sensitization is predicted to cause excessive coughing. The potential endogenous cough triggers may be associated with rhinosinusitis (postnasal drip, aspiration of nasal secrets) or secondary to a coexistent disease such as asthma or gastroesophageal reflux.

Cough sensitivity in atopic dermatitis

The aim of study was to investigate the cough sensitivity (C2) to capsaicin (CAPS) in patients with atopic dermatitis without clinical respiratory symptoms. Cough sensitivity (C2) is defined as the lowest CAPS concentration, which evokes two or more coughs. Forty eight dermatological patients (21 M, 27 F; mean age 44 yr) and 24 healthy volunteers (14 M, 10 F; mean age 37 yr) inhaled deep breath (2 l) of CAPS aerosol in doubled concentrations (from 0.02 to 200 micromol/l) (Pari Provokationstest I, PARI WERK; mass median diameter 1.2 microm). Cough sensitivity (C2) expressed as geometric mean (95% CI) of CAPS concentration was 0.13 micromol/l (0.06-0.31) in 26 patients with atopic dermatitis (10 M, 16 F; mean age 41 yr), 5.51 micromol/l (1.33-22.90) in 22 patients with psoriasis (11 M, 11 F; mean age 46 yr) and 4.29 micromol/l (2.54-7.26) in 24 controls. There is significant difference of cough sensitivity (C2) between patients with atopic dermatitis and healthy volunteers (p<0.001) and also between patients with atopic dermatitis and psoriasis (p<0.001). Cough sensitivity (C2) in atopic dermatitis patients without clinical respiratory symptoms is significantly increased. In patients with psoriasis cough sensitivity (C2) is not significantly changed.

Deep Nasal Inspirations Increase the Cough Threshold in Children with Mild Asthma

Asthma is a chronic inflammatory disease characterized by bronchospasms accompanied with frequent coughing, the pathogenesis of which is not clear. In healthy adults deep inspirations (DIs) provide a protective effect against bronchoconstriction triggered by methacholine inhalation, which correlates with the number of accompanying cough efforts. The aim was to study the effect of deep nasal inspirations representing the voluntary equivalent of the sniff-like aspiration reflex on the capsaicin-induced cough in children with mild asthma. The cough reflex sensitivity to capsaicin was determined using a compressed air-driven nebulizer in 21 children (8 girls and 13 boys of median age 13.3 year) suffering from mild asthma (FEV(1)∼80%). The effect of five previous DIs through the nose was examined on the elicitability of two and five or more cough efforts (C2, C5). Under control conditions, the concentration of 20.86 (14.58-29.8) μmol/l of capsaicin provoked two cough efforts (C2). After five DIs similar reaction required significantly higher concentrations of capsaicin: 29.02 (18.88-44.6) μmol/l; P=0.016. Five or more cough efforts (C5) were not significantly changed after previous DIs 161.49 (77.31-337.33) μmol/l and without DIs 141.52 (68.77-291); P=0.54. A series of five deep inspirations decreases the cough reflex sensitivity to evoke two efforts (C2) in children with mild asthma. The inhibitory effect of similar DIs disappeared after repeated applications of increasing doses of capsaicin, aiming to evoke five or more cough efforts, suggesting a reflex character of protective effect of DIs.

Cough reflex sensitivity does not correlate with the esophageal sensitivity to acid in patients with gastroesophageal reflux disease

The sensitization of cough reflex observed in patients with gastroesophageal reflux disease (GERD) is attributed to activation of vagal C-fibers innervating the esophagus by acid, while the heartburn in GERD is mediated by esophageal acid sensitive C-fibers derived from (dorsal root ganglia) DRG. Here we explored the relationship between cough reflex sensitivity (CRS) and esophageal sensitivity to acid. We evaluated CRS to capsaicin inhalation and esophageal sensitivity to acid (intensity of heartburn evoked by esophageal infusions of acid pH = 3, 2 and 1) in patients with GERD and chronic heartburn before and 3 months after proton pump inhibitor (PPI) treatment. There was no correlation between CRS and esophageal sensitivity to acid at any pH tested. PPI treatment substantially reduced esophageal sensitivity to acid but did not affect CRS. We conclude that a simple direct relationship between CRS and esophageal sensitivity to acid is unlikely. The results indicate that spinal and vagal afferent pathways from the esophagus are probably influenced separately in subjects with GERD.

Cough in Allergic Rhinitis

The diseases of the nose and paranasal sinuses are among the most commonly identified causes of chronic cough (Pratter, 2006). Depending on the population studied and the variations in diagnostic algorithm, the diseases of nose and sinuses are reported to contribute to coughing in 20–40% of patients with chronic cough who have normal chest radiograph (Chung & Pavord, 2008). The mechanisms of chronic cough in rhinosinusitis are incompletely understood. Several mechanisms have been proposed, single or in combination: upper airway cough syndrome previously postnasal drip (PND), direct irritation, inflammation in the lower airways and the cough reflex sensitization (Pratter, 2006).

One Session Bilateral Carotid Stenting – Experience from Slovakian Center

Abstract Objectives: Bilateral carotid artery stenting (BCAS) in one session is relatively rare procedure. However, clear recommendations still do not exist. The aim of our study was to analyze efficacy and safety of the BCAS performed by single operator in our center. Material and Methods: A retrospective analysis of 95 carotid angioplasty with stent implantation (CAS) patients performed in our center, totally 9 patients (8 males and 1 female, age 59-83, average 69) was identified where simultaneous BCAS was performed. All patients had bilateral hemodynamic significant stenosis (≥ 70 %), and all patients had symptomatic stenosis. Results: Only 1 patient was without any complication. The most frequent complications were arterial hypotension. However, duration of stay on the Intensive Care Unit, or hospitalisation was not prolonged. From serious complications we noticed one case of periprocedural filter occlusion and one patient died 30 days after procedure. No other serious complications were in the BCAS group noticed. Conclusion: Because of limited data it is not possible to make any clear conclusions or recommendations from the results of our study. Our data show that probably BCAS appears to be safe and effective way in the treatment of bilateral carotid artery stenosis in high-risk population.

COUGH REFLEX SENSITIVITY TESTING IN ASTHMATIC PATIENTS AND HEALTHY VOLUNTEERS

Abstract Asthma and allergic diseases are complex conditions caused by a combination of genetic and environmental factors. Cough is a major symptom in some people with asthma. Cough reflex sensitivity (CRS) test with capsaicin is one of the most important method for cough studying. Cough reflex sensitivity was defined as the lowest concentration of capsaicin that elicited 2 or more (C2) and 5 or more coughs (C5). The aim of this study was to find out a cough reflex sensitivity in patients with asthma bronchiale and in healthy volunteers. In the present study we conclude that cough reflex sensitivity was significantly increased in asthmatic adult patients compared with healthy adult volunteers.