Water Aerosols and Cough

doi:10.1006/pupt.2002.0359

Pulmonary Pharmacology & Therapeutics

Volume 15, Issue 3, May 2002, Pages 205-211

https://doi.org/10.1006/pupt.2002.0359 Get rights and content

Abstract

Inhalation of ultrasonically nebulised distilled water (fog) induces cough; however, the receptor type(s) mediating this reflex are poorly defined. In humans, cough threshold can be determined by inhalation of progressively increasing fog concentrations; the intensity of the associated motor response can be indexed in terms of flow-related variables as well as of the peak and slope of the integrated electromyographic activity of the abdominal muscles. We have evaluated coughing in patients with Parkinson's disease who show a high incidence of serious chest infections. These patients turned out to have a normal cough threshold but reduced expiratory muscle force during reflex coughing; this suggests an impairment in the central mechanisms subserving muscle activation possibly leading to inefficient airway clearing. Recurrent chest infections also affect laryngectomised patients. These patients have a normal cough threshold but reduced muscle force during coughing in response to threshold stimuli. Voluntary coughing is preserved in these patients, and this should be used to facilitate mucus removal. In normal subjects, fog inhalation causes cough and increases in respiratory drive and minute ventilation, mainly accounted for by increases in tidal volume, possibly due to activation of airway rapidly adapting receptors. Nedocromil sodium administration increases cough threshold and attenuates the ventilatory responses. The assessment of sensory and motor components of coughing may represent a useful tool for those investigating cough in humans.

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Cough latencies in individual challenges are summarized in Table 2. Nebulized distilled water is used as an tussive stimulus in animal models and clinical studies; it is known to induce a weaker cough response than citric acid (Fontana et al., 2002; Hegland et al., 2016). Inhalation of nebulised distilled water does induce cough, but the type of receptor(s) responsible for such a cough are poorly defined.
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Cough response to all tested aerosols was significantly higher than to saline. Pre-treatment with GSK300 did not influence response to osmotic stimuli − only reduced cough to citric acid. GSK900 reduced cough response to hypotonic stimuli and citric acid.
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Individuals are generally content to self-medicate for acute cough. It is only when the cough becomes persistent that they seek medical assistance. It is not known why patients cough in association with an acute upper respiratory tract infection (URTI), although interest has focused on how viruses may influence airway sensory nerve function and contribute to heightened cough reflex sensitivity. Why some patients develop a persistent cough following a viral URTI is also unclear. Much more is known about the causes and aggravants of chronic cough although there is no broad agreement as to the best way to manage such patients. Asthma, upper gastrointestinal dysfunction and rhinitis are frequently associated with chronic cough, although the impact of cough in suppurative lung disease and interstitial lung fibrosis is rarely considered. The development of effective treatments for cough remains a challenge and will require co-operation between clinicians, scientists and the pharmaceutical industry.
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^f1: Author for correspondence: Giovanni A. Fontana, M. D., Dipartimento di Area Critica Medico Chirurgica, Unità Funzionale di Medicina Respiratoria, Viale G. B. Morgagni, 85, 50134 Firenze, Italia. Tel: +30-055-413183; Fax: +39-055-4223202; E-mail: [email protected]

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Review ArticleWater Aerosols and Cough

Abstract

Pulm Pharmacol

J Allergy Clin Immunol

Adaptation of cough reflex with different types of stimulation

Eur Respir J

An electromyographic method of objectively assessing cough intensity and use of the method to assess effects of codeine on the dose-response curve to citric acid

Br J Clin Pharmac

Lack of importance of the superior laryngeal nerves in citric acid cough in humans

J Appl Physiol

Effects of bronchodilators on the cough response to inhaled citric acid in normal and asthmatic subjects

Thorax

Sensitivity of the human cough reflex: effect of inflammatory mediators prostaglandin E2, bradykinin, and histamine

Am Rev Respir Dis

Repeatability of cough-related variables during fog challenges at threshold and suprathreshold stimulus intensity in humans

Eur Respir J

A noninvasive electromyographic study on threshold and cough intensity in humans

Eur Respir J

Contribution of airway collapse to supramaximal expiratory flows

J Appl Physiol

Cough intensity in the laryngectomee

Clin Otolaryngol

The physical parameters of cough: the larynx in a normal single cough

Acta Otolaryngol

The relation between force, velocity and integrated electrical activity in human muscles

J Physiol

Ballistic contractions in man: characteristic recruitment pattern of single motor units in the tibialis anterior muscle

J Physiol

Defective motor control of coughing in Parkinson's disease

Am J Respir Crit Care Med

Effects of treatment on airway dynamics and respiratory muscle strength in Parkinson's disease

Am Rev Respir Dis

Physiology of basal ganglia disorders: an overview

Can J Neurol Sci

A physiological mechanism of bradykinesia

Brain

Human ballistic arm abduction movements: effects of L -Dopa treatment in Parkinson's disease

Neurology

Review Article
Water Aerosols and Cough

Sensitivity of the human cough reflex: effect of inflammatory mediators prostaglandin E₂, bradykinin, and histamine