Sensory hyperreactivity – a possible mechanism underlying cough and asthma‐like symptoms

Millqvist, Eva; Bende, Mats; Löwhagen, O.

doi:10.1111/j.1398-9995.1998.tb03843.x

Cited by 122 publications

(145 citation statements)

References 11 publications

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“…The tidal breathing method of capsaicin challenge, used in the present study, was developed for SHR and has been modified with time and has shown good reproducibility [5,9,24,40]. The testing of cough sensitivity with capsaicin inhalation is otherwise often performed with a "single-breath" technique using increasing concentrations of capsaicin until the individual coughs, for example, two or five times (C2 or C5), which has shown a good reproducibility [41,42].…”

Section: Discussionmentioning

confidence: 99%

“…The single-breath technique was more dependent on a standardized inhalation technique compared to the fixed time and concentration technique [44]. One potential problem with using the "single-breath" technique is that patients with SHR have an easily evoked cough reflex, and even inhalation of saline can induce coughing [9,40]. The occurrence of a tachyphylaxis problem after performing the test with the single-breath technique speaks in favour of the tidal breathing technique used in this study, which has also been discussed by other authors [45].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with SHR react more strongly than healthy individuals to provocation with inhaled capsaicin, and the cutoff values for a positive reaction have been determined [4]. The capsaicin inhalation test in the diagnosis of SHR has good short-term and long-term reproducibility [5,9]. Capsaicin, the main, pungent ingredient in chili, stimulates the unmyelinated C-fibers of the sensory nervous system, giving a burning sensation by activating the ion channel of transient receptor potential vanilloid subunit 1 (TRPV1) [10].…”

Section: Introductionmentioning

confidence: 99%

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Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Millqvist

Ternesten-Hasséus

Bende

2008

Pulmonary Pharmacology & Therapeutics

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To cite this version:Eva Millqvist, Ewa Ternesten-Hasséus, Mats Bende. Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity. Pulmonary Pharmacology & Therapeutics, 2008, 21 (5) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A c c e p t e d m a n u s c r i p t 4

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Millqvist

Ternesten-Hasséus

Bende

2008

Pulmonary Pharmacology & Therapeutics

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“…Millqvist et al first proposed the term airway sensory hyperreactivity (SHR) to define a syndrome of self reported odour intolerance combined with heightened sensitivity to inhaled capsaicin [16]. An accurate estimate of the prevalence of SHR in the general population is…”

Section: How Common Is Airway Sensory Hyperreactivity (Shr)?mentioning

confidence: 99%

Are there clinical features of a sensitized cough reflex?

McGarvey

McKeagney²,

Polley

et al. 2009

Pulmonary Pharmacology & Therapeutics

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Key words: sensory hyperresponsiveness, hyperreactivity, cough reflex, receptor AbstractCough reflex hypersensitization is a key feature in patients with troublesome cough. The clinical consequence of this hypersensitive state is typified by bouts of coughing often triggered by low threshold stimuli encountered by the patient during normal daily activities including exposure to aerosols, scents and odours, a change in air temperature and when talking or laughing. These features are often perceived by cough patients to be the most disruptive aspect of their condition and undoubtedly contribute to impaired quality of life.Patients with troublesome cough may describe a range of additional symptoms and sensations including an 'urge to cough' or the feeling of an 'itch' at the back of the throat, or a choking sensation and occasionally chest pain or breathlessness. It is uncertain if these features arise due to the processes responsible for cough reflex sensitisation or as a direct consequence of the underlying cough aetiology. In an attempt to understand the clinical features of a sensitized cough reflex, the spectrum of symptoms typically described by cough patients will be reviewed and possible underlying mechanisms considered. Since an intact cough reflex is crucial to airway protection, anti-tussive treatment that attenuates the hypersensitive cough state rather than abolishing the cough reflex completely would be preferable. Identifying such agents remains a clinical, scientific and pharmacological challenge.

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“…The sense of air hunger appears to arise from an increased brain stem 'drive' to breathe (35,36,52,53). Even patients with normal lung function and without signs of hypercapnia and hypoxia may suffer from air hunger (51,(54)(55)(56)(57). Thus, activation of airway sensory nerves may lead to dyspnea, which need not necessarily be dependent on bronchial constriction (51).…”

Section: Dyspneamentioning

confidence: 99%

Diagnosis of asthma – a new approach

Löwhagen

2012

Allergy

Self Cite

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Current definition of asthma involves four cornerstones: inflammation, hyperresponsiveness, bronchoconstriction, and symptoms. In research, the symptoms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness, wheeze, cough, tightness of the chest, and shortness of breath. As there are several symptoms, a primary question is how they are related to bronchoconstriction, the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment. However, there is no or poor correlation between these two variables, which means that they represent different mechanisms. Reduced lung function, such as a low FEV 1 , represents bronchial constriction, what do the symptoms represent? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks, but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality of life. Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misinterpretation when assessing health status and effect of treatment. Although a 'soft' variable, the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process, regardless of inflammation, allergy, psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum of symptoms and mechanisms integrated in a single asthma syndrome.

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Sensory hyperreactivity – a possible mechanism underlying cough and asthma‐like symptoms

Cited by 122 publications

References 11 publications

Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Inhaled ethanol potentiates the cough response to capsaicin in patients with airway sensory hyperreactivity

Are there clinical features of a sensitized cough reflex?

Diagnosis of asthma – a new approach

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