Methods for assessing cough sensitivity

Mai, Yuanbang; Fang, Liman; Zhong, Shuxin; Silva, S Dushinka Shaniya Helen de; Chen, Ruchong; Lai, Kefang

doi:10.21037/jtd-2020-icc-005

Cited by 13 publications

(24 citation statements)

References 117 publications

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“…18,19 Cough inhalation challenges have been previously performed using acidic agents (e.g., citric acid, acetic acid and tartaric acid) and other stimulants such as capsaicin. 20,21 However, widespread clinical use of these agents has been limited by the need for specialized equipment, general tolerability and uncertainty surrounding significance of results. 22 Mannitol is readily available in most lung function laboratories and reasonably well tolerated.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge

et al. 2021

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Background and objective: Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. Methods: We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio-recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k-means cluster analysis. Results: Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r = À0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female-predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender-balanced cluster with lower cough frequency and normal laryngeal sensitivity. Conclusion: Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.

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Section: Discussionmentioning

confidence: 99%

Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge

et al. 2021

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“…In preclinical animal studies, the invasive intratracheal mechanical stimulation was found to induce the cough reflex in anaesthetised rabbits/cats/dogs (16)(17)(18)(19)(20). For humans in clinical practice, the common area where the mechanical stimulation has been applied are the large airways level and the chest (8,9). In 2004, Lee and Eccles reported the first study to elicit cough in humans by the vibration of the airway at the trachea level with a modified men's shaver.…”

Section: Mechanical Challenge Testsmentioning

confidence: 99%

“…Twenty-four-hour cough counting is a semi-objective assessment and has been suggested as the best method to quantify cough ( 6 ), but due to its labour-intensive and time-consuming nature, it has been largely confined to the research setting. Finally assessing cough reflex sensitivity, usually by inhalational challenge, can be used to dissect the pathophysiologic mechanisms of cough and evaluate the effect of drug intervention in clinical trials ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Chronic cough—the limitation and advances in assessment techniques

Zhang¹,

Sykes²,

Brindle³

et al. 2022

J Thorac Dis

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Accurate and consistent assessments of cough are essential to advance the understanding of the mechanisms of cough and individualised the management of patients. Considerable progress has been made in this work. Here we reviewed the currently available tools for subjectively and objectively measuring both cough sensitivity and severity. We also provided some opinions on the new techniques and future directions.The simple and practical Visual Analogue Scale (VAS), the Leicester Cough Questionnaire (LCQ), and the Cough Specific Quality of Life Questionnaire (CQLQ) are the most widely used self-reported questionnaires for evaluating and quantifying cough severity. The Hull Airway Reflux Questionnaire (HARQ) is a tool to elucidate the constellation of symptoms underlying the diagnosis of chronic cough. Chemical excitation tests are widely used to explore the pathophysiological mechanisms of the cough reflex, such as capsaicin, citric acid and adenosine triphosphate (ATP) challenge test. Cough frequency is an ideal primary endpoint for clinical research, but the application of cough counters has been limited in clinical practice by the high cost and reliance on aural validation. The ongoing development of cough detection technology for smartphone apps and wearable devices will hopefully simplify cough counting, thus transitioning it from niche research to a widely available clinical application.

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“…Several PROMs can be used for assessment of LSD (see methods). These questionnaires provide easily obtainable subjective baseline data which can then be used to monitor patient progress and treatment outcomes [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough

Novakovic

Sheth

Stewart

et al. 2021

JCM

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Laryngeal sensory dysfunction (LSD) encompasses disorders of the vagal sensory pathways. Common manifestations include chronic refractory cough (CRC) and abnormal throat sensation (ATS). This study examined clinical characteristics and treatment outcomes of LSD using a novel approach of laryngeal supraglottic Onabotulinum toxin Type A injection (BTX). This was a retrospective review of clinical data and treatment outcomes of supraglottic BTX in patients with LSD. Between November 2019 and May 2021, 14 patients underwent 25 injection cycles of supraglottic BTX for treatment of symptoms related to LSD, including ATS and CRC. Primary outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Cough Severity Index (CSI), Reflux Symptom Index (RSI), and Voice Handicap Index-10 (VHI-10) at baseline and within three months of treatment. Pre- and post-treatment data were compared using a linear mixed model. After supraglottic BTX, LHQ scores improved by 2.6. RSI and CSI improved by 8.0 and 5.0, respectively. VHI-10 did not change as a result of treatment. Short-term response to SLN block was significantly associated with longer term response to BTX treatment. These findings suggest that LSD presents clinically as ATS and CRC along with other upper airway symptoms. Supraglottic BTX injection is a safe and effective technique in the treatment of symptoms of LSD.

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Methods for assessing cough sensitivity

Cited by 13 publications

References 117 publications

Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge

Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge

Chronic cough—the limitation and advances in assessment techniques

Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough

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