Fifteen Years' Experience with Carbon Dioxide in the Management of Cough

Banyai, Andrew L.

doi:10.1378/chest.13.1.1

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…17 It is inferred that they must exist in other sites since mechanical stimulation of the external auditory canals and eardrums, paranasal sinuses, pharynx, diaphragm, pleura, pericardium, and stomach have all been reported to cause cough. [18][19][20][21][22][23][24][25][26] Whereas laryngeal and tracheobronchial receptors appear to be irritated by both chemical and mechanical stimuli, 27 receptors in other sites most probably respond only to mechanical triggers. 18,27 Mechanical receptors are sensitive to touch and displacement.…”

Section: Anatomy Of the Cough Reflexmentioning

confidence: 99%

Managing Cough as a Defense Mechanism and as a Symptom

Irwin

Boulet

Cloutier

et al. 1998

Chest

559

158

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Section: Anatomy Of the Cough Reflexmentioning

confidence: 99%

Managing Cough as a Defense Mechanism and as a Symptom

Irwin

Boulet

Cloutier

et al. 1998

Chest

559

158

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“…Surfactants have been used clinically to suppress irritant cough in patients with tuberculosis (Lovacheva et al, 2006). Extrinsic CO 2 has been shown to suppress irritant cough in patients with pulmonary tuberculosis (Banyai et al, 1944; Banyai, 1947). In addition, most subjects reported increased ease of breathing during and post treatment, increased sputum volume and reduced nasal congestion during and after treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Extrinsic CO 2 has been shown to relax airway smooth muscle (Duane et al ., 1979; Twort and Cameron, 1986; El Mays et al ., 2011) via non-adrenergic non-cholinergic pathways (Choudhury et al ., 2012, Fisher and Hansen, 1976) and to reduce airway resistance in asthmatics (Van den Elshout et al 1991, Fisher and Hansen, 1976) Inhaled CO 2 also improves ventilation – perfusion matching in the lungs (Brogan et al ., 2004, Ingram 1975, Dorrington et al ., 2010) thus enhancing arterial oxygen saturation. Inhaled CO 2 has also been shown to attenuate acute lung injury (Tang et al, 2019), and has anti-inflammatory (Tang et al, 2019), antiviral, anti-bacterial properties (reviewed in El-Betany et al , 2020,) and antitussive effects (Banyai et al ., 1944; Banyai, 1947).…”

Section: Introductionmentioning

confidence: 99%

A Phase IIa Open Label Study to Evaluate the Safety, Tolerability and Efficacy of S-1226 Administered by Nebulization in Subjects with Cystic Fibrosis Lung Disease

Shrestha

Githumbi

Oslanski³

et al. 2021

Preprint

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RationaleThere are approximately 35,000 people with Cystic Fibrosis (CF) in North America. This condition is characterized by impaired airway clearance resulting in chronic infection and bronchiectasis. Current airway clearance treatments include nebulized hypertonic saline and Recombinant Human DNase, which may be limited by bronchospasm and cost, respectively. S-1226, a novel biophysical therapeutic agent combines carbon dioxide (CO2) enriched air (a bronchodilator) with nebulized perflubron (PFOB), (a synthetic surfactant). They act synergistically to open airways, enhance mucus clearance, and increase blood oxygenation. We report preliminary results from a Phase II clinical trial.MethodsAn open label, single-center, Phase IIa study of subjects (≥14 years) with mild-moderate (FEV1 40-80%) CF lung disease treated with multiple ascending doses of S-1226 (week one), followed by the highest tolerated dose for 5 consecutive days (week two). Each dose of S-1226 comprised three successive treatments of 3mL of perflubron nebulized (Circulaire®II) for two-minutes with CO2 concentrations ranging from 4 to 12%. The oxygen concentration was maintained at ambient levels. Treatments were administered twice daily. Efficacy measurements included spirometry, lung clearance index (LCI), lung volumes, blood oxygenation (SPO2), sputum weight and the respiratory domain of quality of life (QOL) questionnaire (CFQ-R). Safety included adverse event (AE) and tolerance monitoring, vital signs, and assessment of end-tidal CO2.ResultsWe report preliminary data on safety and efficacy for six CF subjects. All subjects tolerated all doses of S-1226. There were 5 reported AEs in 3 subjects. All were mild and resolved spontaneously. End-tidal CO2 immediately after treatment was comparable to baseline. SpO2 (baseline 91-95%) rapidly improved in all subjects with treatment. Five of six subjects had improvements in their LCI. Three subjects that were compliant in collecting mucus showed increases of 14%, 29% and 64% over baseline. Percent predicted FEV1 response was variable, decreasing initially with return to pre-treatment values at two weeks. Four of the six subjects reported improvements in CFQ-R scores, three of which showed a clinically important difference (> 4 points). An important observation was that S-1226 controlled irritant (but not productive) cough in all five subjects and at all concentrations of S-1226.ConclusionsAll doses of S-1226 were safe and well tolerated. Treatments with up to 12% extrinsic CO2 over short periods of time did not result in an elevation of end-tidal CO2. The preliminary efficacy results, including overall improved oxygen saturation, CFQ-R scores, increased expectorated mucus and LCI values provide evidence for potential beneficial effects of S-1226 for CF lung disease but require larger trials and longer-term treatments to fully assess efficacy in CF.

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“…For example the following differences between harmful and helpful coughing must be well understood: (1) Harmful coughing is produced by: [1][2][3] (A) Stimulation of the cough reflex by extra-pulmonary irritation due to: (a) Drainage from the paranasal sinuses (b) An elongated uvula (c) Pressure on the trachea or bronchi by mediastinal Inrlammatton, tumors, or dilated blood vessels (B) Non-inflammatory lesions of the bronchial tree such as benign or malignant tumors *Read at the American Medical Association's Third Annual Clinical Session, Washington, D. C., December 8, 1949. For example the following differences between harmful and helpful coughing must be well understood: (1) Harmful coughing is produced by: [1][2][3] (A) Stimulation of the cough reflex by extra-pulmonary irritation due to: (a) Drainage from the paranasal sinuses (b) An elongated uvula (c) Pressure on the trachea or bronchi by mediastinal Inrlammatton, tumors, or dilated blood vessels (B) Non-inflammatory lesions of the bronchial tree such as benign or malignant tumors *Read at the American Medical Association's Third Annual Clinical Session, Washington, D. C., December 8, 1949.…”

mentioning

confidence: 99%

Cough: Its Pathology, Therapy and Management* *Read at the American Medical Association's Third Annual Clinical Session, Washington, D. C., December 8, 1949.

Hobby¹

1952

Diseases of the Chest

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Fifteen Years' Experience with Carbon Dioxide in the Management of Cough

Cited by 8 publications

References 19 publications

Managing Cough as a Defense Mechanism and as a Symptom

Managing Cough as a Defense Mechanism and as a Symptom

A Phase IIa Open Label Study to Evaluate the Safety, Tolerability and Efficacy of S-1226 Administered by Nebulization in Subjects with Cystic Fibrosis Lung Disease

Cough: Its Pathology, Therapy and Management* *Read at the American Medical Association's Third Annual Clinical Session, Washington, D. C., December 8, 1949.

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