Predictors of Objective Cough Frequency in Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med. 2013 Mar 7;

Authors: Sumner H, Woodcock A, Kolsum U, Dockry R, Lazaar AL, Singh D, Vestbo J, Smith JA

Abstract
RATIONALE: Cough is one of the principle symptoms of COPD but the potential drivers of cough are likely to be multi-factorial and poorly understood. OBJECTIVES: To quantify cough frequency in an unselected group of COPD subjects and investigate the relationships between cough, reported sputum production, smoking, pulmonary function and cellular airway inflammation. Method: We studied 68 subjects with COPD (mean age 65.6yrs(±6.7), 67.6% male, 23 smokers, 45 ex-smokers) and 24 healthy volunteers (mean age 57.5yrs(±8.9), 37.5% male, 12 smokers, 12 non-smokers). Subjects reported cough severity, cough specific quality of life and sputum expectoration and performed spirometry, sputum induction, cough reflex sensitivity to capsaicin and 24hr ambulatory cough monitoring. MEASUREMENTS AND MAIN RESULTS: COPD current smokers had the highest cough rates [median 9.0c/h (IQR 4.3-15.6), almost double that of COPD ex-smokers [4.9c/h (2.3-8.7) (p=0.018)] and healthy smokers [5.3c/h (1.2-8.3), (p=0.03)], whereas healthy volunteers coughed the least [0.7c/h (0.2-1.4)]. Cough frequency was not influenced by age or gender and only weakly correlated with cough reflex sensitivity to capsaicin (logC5 r=-0.36, p=0.004). Reported sputum production, smoking history and current cigarette consumption strongly predicted cough frequency, explaining 45.1% variance in a general linear model (p<0.001). In subjects producing a sputum sample, cough frequency was related to current cigarette consumption and percentage of sputum neutrophils (p=0.002). CONCLUSION: Ambulatory objective monitoring provides novel insights into the determinants of cough in COPD, suggesting sputum production, smoking and airway inflammation may be more important than sensitivity of the cough reflex.

PMID: 23471467 [PubMed - as supplied by publisher]

Related Articles

Megatrials for Bronchodilators in Chronic Obstructive Pulmonary Disease (COPD) Treatment: Time to Reflect.

J Am Board Fam Med. 2013 Mar;26(2):221-4

Authors: van Dijk WD, van den Bemt L, van Weel C

Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Although (long-acting) bronchodilators are used to relieve symptoms, the impact of bronchodilators on COPD mortality remains an unresolved issue. Our aim was to explore the results and the interpretations of the results of studies of bronchodilator treatment from high-impact COPD trials. METHODS: We searched PubMed and Embase for primary publications of randomized controlled trials with more than 1000 participants with COPD and that studied the effectiveness of long-acting bronchodilator treatment. We assessed population characteristics, primary outcomes, focus of outcomes, and possible bias from concomitant pulmonary medication. RESULTS: We retrieved 5 primary publications of large trials. Participants tended to be patients with rather severe COPD who were cared for at a hospital. Only half of the primary outcomes were statistically significant. Reports tended to focus on statically significant outcomes and not necessarily on primary outcomes or outcomes of the whole study population. The relevance of study outcomes was rarely discussed. Discussion: The rather small effects of bronchodilators in a COPD population that is not representative for daily care, together with the tendency of relying on statistical rather than clinical significance, hampers translation to the large number of patients with COPD in the community.

PMID: 23471939 [PubMed - in process]

Related Articles

Thymic epithelial tumours: from basic principles to individualised treatment strategies.

Eur Respir Rev. 2013 Mar 1;22(127):75-87

Authors: Girard N

Abstract
Thymic epithelial tumours represent a wide range of anatomical, clinical, histological and molecular malignant entities that may be aggressive and difficult to treat. The histopathological classification distinguishes thymomas from thymic carcinomas. Thymomas may be associated with autoimmune disorders. The management of thymic epithelial tumours is a paradigm of co-operation between clinicians, surgeons and pathologists, from establishing the diagnosis to organising the multimodal therapeutic strategy. Surgery is the mainstay of the curative-intent treatment, as complete resection represents the most significantly favourable prognostic factor on overall survival. In case of invasion of intra-thoracic structures and/or dissemination to the pleura and the pericardium, precluding complete resection to be achieved, primary chemotherapy has been used to reduce the tumour burden, possibly allowing subsequent surgery and/or radiotherapy. Novel strategies are needed, especially for refractory, recurrent tumours and thymic carcinomas, which carry a poor prognosis. Personalised approaches are currently being developed, as potentially "druggable" molecular targets are emerging from recent integrated genomic analyses. Along with the large variety of questions relative to the treatment strategy, thymic epithelial tumours represent a model of therapeutic implementation and achievement in orphan thoracic oncology, showing how the advent of new results induces new questions, as well as diversifies further clinical research directions and international collaborative initiatives.

PMID: 23457169 [PubMed - in process]

Related Articles

Nanoparticle-based therapy for respiratory diseases.

An Acad Bras Cienc. 2013 Mar 5;

Authors: Silva AL, Santos RS, Xisto DG, Alonso SD, Morales MM, Rocco PR

Abstract
<p id="para1">Nanotechnology is an emerging science with the potential to create new materials and strategies involving manipulation of matter at the nanometer scale (<100 nm). With size-dependent properties, nanoparticles have introduced a new paradigm in pharmacotherapy - the possibility of cell-targeted drug delivery with minimal systemic side effects and toxicity. The present review provides a summary of published findings, especially regarding to nanoparticle formulations for lung diseases. The available data have shown some benefits with nanoparticle-based therapy in the development of the disease and lung remodeling in respiratory diseases. However, there is a wide gap between the concepts of nanomedicine and the published experimental data and clinical reality. In addition, studies are still required to determine the potential of nanotherapy and the systemic toxicity of nanomaterials for future human use.

PMID: 23460424 [PubMed - as supplied by publisher]